Treating the pain and inflammation of attacks

Once an attack of gout has started, it usually gets better with time – even without treatment – over a few days or weeks. Doctors think that this happens because the cells of the immune system stop reacting to the uric acid crystals, which means that the inflammation gets better*.

Most people need treatment to reduce the pain and inflammation caused by attacks. People who only have occasional attacks, for example every few years, may only need treatment to deal with these attacks. People who have more frequent attacks may need daily medication to reduce the amount of uric acid (urate) in their blood and prevent further attacks or joint damage (see ‘Long-term treatment to lower uric acid and prevent attacks and long-term problems‘).

A consultant rheumatologist explains how gout should be treated.

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Most people find that the earlier they recognise the onset of an attack and take their medication, the better it works for them. People we talked to found it useful to keep a supply of medication, prescribed by their GP, at home so that they could take it as soon as they noticed the first signs of an attack.

Alan found it hard to visit his GP during an attack because of the severe pain. He has now been prescribed tablets to keep at home in case he needs them.

Age at interview 73

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People we talked to had different preferences for the tablets they took to treat the pain and inflammation of attacks. Some found that one drug worked better for them than another. Others could not take certain medication because of the side effects or because they had other health issues such as kidney or heart problems (see ‘Side effects of gout medication‘ and ‘Living with gout and other conditions‘).

Eddie has tried various treatments for his attacks. He prefers to take paracetamol with codeine and ibuprofen because he did not like the side effects of other medication.

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Two of the most common treatments for attacks are non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine. Steroids (tablets or injections) can also be prescribed. Some people chose to take other painkillers, such as paracetamol or co-codamol (paracetamol and codeine), but others found these were ineffective. People we talked to also found ice packs useful for pain relief.

Non-steroidal anti-inflammatories (NSAIDs)

Non-steroidal anti-inflammatory drugs (NSAIDs) are used to relieve pain and inflammation. Examples of these drugs include ibuprofen, naproxen, diclofenac, indometacin (indomethacin) and etoricoxib (Arcoxia).

Ibuprofen can be bought over the counter in a pharmacy, but a doctor can prescribe other drugs and stronger doses.

Aspirin is not recommended for treating gout, but people who are taking low daily doses (75mg) to prevent heart attacks should continue taking it as usual.

NSAIDs can cause problems such as stomach upsets, indigestion or damage to the lining of the stomach. Drugs that help to protect the stomach can be prescribed to prevent these problems (e.g. omeprazole and lansoprazole). Arthrotec tablets contain an NSAID diclofenac and misoprostol, which prevents the side effects of diclofenac.

Vic tried colchicine and various NSAIDs but they gave him digestive problems. He was then prescribed Arthrotec.

Age at interview 75

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Most people were cautious about the way they took NSAIDs because they were aware of the possible side effects. Peter always takes them after food to avoid stomach problems. Other people made sure that they only took a short course of tablets.

NSAIDs slightly increase the risk of heart attacks and strokes. This means that these drugs should be used with caution in people who might be at higher risk, for example because of high blood pressure, high cholesterol, diabetes or smoking. NSAIDs are not advised for people with heart or kidney failure.


Colchicine helps reduce the inflammation caused by uric acid crystals in and around joints. In the UK it cannot be bought over the counter but only with a prescription.

Common side effects of colchicine are nausea and/or vomiting and diarrhoea. Most people who took high doses had these side effects. Lower doses are effective and less likely to cause side effects (for more see ‘Side effects of gout medication‘).

For Alastair, the thought of an attack without medication is horrendous. Colchicine has usually improved his symptoms within six hours.

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Steroids are usually only prescribed if NSAIDs and colchicine are not effective in treating an attack, or if these drugs are unsuitable for a particular person. Steroids can be prescribed as an injection into the joint or muscle, or as a course of tablets (usually prednisolone).

Paula was prescribed steroids. She did not know what to expect but was impressed with how quickly they reduced the inflammation and pain.

Age at interview 46

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Ice packs

An ice pack on the affected joint can reduce swelling, heat and pain. Ice packs can be used in addition to any of the medications for gout. It is best to protect the skin from direct contact with the ice (e.g. by wrapping an ice pack in a towel). Many people we spoke to found ice packs helpful in relieving symptoms during an attack.

Ian learnt to recognise the first signs of an attack. He used ice to cool his joint and found that moving around was helpful.

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(For more see ‘Decisions and feelings about treatments‘).

*Mechanisms of inflammation in gout. Dalbeth N, Haskard DO. Rheumatology (Oxford). 2005 Sep;44(9):1090-6.

Feelings about the diagnosis of gout

People we spoke to recalled having lots of questions when they were first diagnosed. Finding out how to ease the pain took priority for most,...