Osteoarthritis pain: how to organise your painkillers safely

With osteoarthritis it is easy to end up taking more painkillers than intended; organising doses and active ingredients helps you control pain safely.

To avoid overdoing painkillers with osteoarthritis, the most useful thing is to know which active ingredient each medicine contains, keep fixed doses separate from ‘as needed’ doses and note each one down. That way you avoid accidentally combining two products with the same active ingredient or going over the maximum dose in the leaflet.

We explain which painkillers are used, their main risks and how to organise them in your daily life. Remember that the choice and the dose are decided by your doctor for your individual case.

Which painkillers are used for osteoarthritis?

There is no single painkiller for everyone: your doctor chooses based on the joint affected, how intense the pain is and your other conditions. The Spanish Society of Rheumatology, in its tips for people with osteoarthritis, stresses not self-medicating and letting your doctor decide what suits you at each stage.

The NHS summarises the usual options like this:

• Paracetamol: for short-term pain, although many people find it helps little.
• NSAID creams or gels: particularly useful for osteoarthritis of the knees and hands.
• NSAIDs by mouth: if creams are not enough, usually together with a stomach protector, and they are not suitable for everyone.
• Opioids: for severe pain, generally for short periods because of effects such as drowsiness or constipation.
• Other options: capsaicin cream or steroid injections, when other measures have not worked.

How can you avoid taking too much without realising?

The most common risk is taking the same active ingredient from two different products. The leaflet for a 1 g paracetamol warns that it should not be used together with other medicines containing paracetamol, because high doses can damage the liver. Many cold and flu remedies and some painkiller combinations contain it.

For example, one 1 g paracetamol leaflet sets a maximum of 4 g in 24 hours for adults, with at least 4 hours between doses, and 2 g in people with liver disease or chronic alcohol use; other leaflets set 3 g. That is why your reference is always the leaflet for your medicine and what your doctor tells you.

Why do anti-inflammatories need special care?

Because, taken by mouth over time, they can affect the stomach, kidneys, blood pressure and heart. The AEMPS, the Spanish medicines agency, recommends always using the lowest possible dose for the shortest possible time, and avoiding high doses of ibuprofen (2,400 mg a day or more) in people with serious cardiovascular disease.

The AEMPS also notes that ibuprofen reduces the antiplatelet effect of low-dose aspirin, and that regular use may reduce its heart-protective effect. If you take blood pressure medication, read whether you can take ibuprofen with blood pressure tablets, and to learn more about this group, what NSAIDs are and how they work.

How should you organise fixed doses and ‘as needed’ doses?

Clearly separate what you take at fixed times from what you take only when you are in pain, and keep a simple record of rescue doses. That record protects you from repeating doses and gives your doctor real information to adjust your treatment.

1. Ask your doctor to write down which painkiller is fixed, which is for rescue and how many rescue doses you can take a day.
2. Note on your phone or in a notebook the time and the medicine of each rescue dose.
3. Keep your painkillers in one place, so you do not have boxes scattered around the house.
4. Before buying anything without a prescription for a cold or pain, ask the pharmacist whether it contains an active ingredient you already take.
5. If you need rescue doses almost every day, say so: your treatment may need reviewing.

And do not forget the measures without tablets: according to the Spanish Society of Rheumatology, exercise protects the joint and strengthens the muscles, and excess weight makes osteoarthritis progress faster.

A practical example: Pilar and the winter cold remedy

Take the case of Pilar, 67, retired and very active, with osteoarthritis of the knees and hands and high blood pressure. Her doctor has prescribed paracetamol at fixed times and an anti-inflammatory gel for her hands. At home she also keeps ibuprofen from a time she had toothache.

One winter day, with a cold, she buys a cold and flu remedy. When paying she mentions at the pharmacy that she already takes paracetamol, and the pharmacist warns her that the cold remedy also contains it. He recommends another option and suggests she talks to her doctor about the ibuprofen, because of her blood pressure. Since then, Pilar notes down her rescue doses and asks before buying any medicine.

How can IMA Health help you?

With IMA Health, a specialised pharmacy prepares your scheduled medication by day and time, so fixed painkiller doses are organised together with the rest of your treatment. Medicines you only take when you are in pain usually stay in their own packaging; your pharmacist will tell you how best to handle them.

We also take care of coordination with the pharmacy, home delivery and follow-up. Find out more in the IMA Health service.

Sources

• AEMPS: Cardiovascular risk of high-dose ibuprofen or dexibuprofen (2015, in Spanish)
• AEMPS: Metamizole and risk of agranulocytosis (2018, in Spanish)
• CIMA (AEMPS): Paracetamol Cinfa 1 g tablets package leaflet (in Spanish)
• Inforeuma (Spanish Society of Rheumatology): Ten tips for people with osteoarthritis (in Spanish)
• NHS: Osteoarthritis, treatment

This article is for information only and does not replace advice from your doctor or pharmacist.