Pain medication

There are a number of measures that can be implemented to improve the symptoms of arthritis in the knee before surgery is indicated. Pain relief medication can be effective in reducing symptoms and should be used if tolerated. There should be a step wise approach starting with paracetamol and anti-inflammatories and then adding in stronger pain killers as required. Details on the various different types of pain killers are provided below.

Non-steroidal anti-inflammatory drugs 
(NSAIDS)

 

This type of pain relief is the first line treatment for all patients with symptomatic arthritis. As with all medications there are side-effects and they're not suitable for everyone. It's a good idea to ask a pharmacist or doctor for advice before taking an NSAID if you:

  • have asthma

  • have had an allergic reaction to NSAIDs in the past

  • have had stomach ulcers in the past

  • have any problems with your heart, liver, kidneys, blood pressure, circulation or bowels

NSAIDs might not necessarily need to be avoided in these cases, but they should only be used on the advice of a healthcare professional as there may be a higher risk of side effects. Common examples of NSAIDS include; ibuprofen, naproxen and diclofenac.

Paracetamol

Paracetamol is a common painkiller used to treat aches and pain and is effective in the management of arthritic pain. 

Check with your doctor or pharmacist if you:

  • have had an allergic reaction to paracetamol or any other medicines in the past

  • have liver or kidney problems

  • regularly drink more than the maximum recommended amount of alcohol (14 units a week)

  • take medicine for epilepsy

  • take medicine for tuberculosis (TB)

  • take the blood-thinner warfarin and you may need to take paracetamol on a regular basis

Opioids

 

Opioid analgesics can be divided into those used for mild-to-moderate pain (such as codeine phosphate) and those used for moderate-to-severe pain (such as morphine or oxycodone hydrochloride).

Opioids should only be considered in certain patients for the short to medium term treatment of chronic arthritic pain, when other treatments have been insufficient; the benefits should outweigh the risks of serious harms (such as addiction, overdose and death). With continuous longer-term use of opioids, tolerance and dependence compromise both safety and efficacy.

When starting treatment with an opioid there should be an agreement between the prescriber and patient about the expected outcomes—with advanced agreement on the reduction and cessation of the opioid if these are not met. Consideration should be given to a gradual reduction of the opioid to the lowest effective dose or complete cessation. If an individual is having to take doses >90 mg/day morphine equivalent, a referral to a specialist pain clinic will be sought.