Ease arthritis pain safely

Published: August 2013

If you have arthritis pain and have suffered a heart attack, heart failure, kidney failure, stroke, or ulcer, or are at risk for them, you should choose your pain reliever carefully, according to our new Best Buy Drugs report. Common medicines such as ibuprofen (Advil and generic) and naproxen (Aleve and generic) can help relieve aches and minor injuries, but they can also cause or worsen cardiovascular and gut problems.

Our review of the pain relievers known as nonsteroidal anti-inflammatory drugs, or NSAIDs, found that all of them are equally effective but that some may be safer than others. For example, naproxen doesn't appear to pose the same heart attack and stroke risk as the other NSAIDs do (except for heart-protecting aspirin), and celecoxib (Celebrex) is easier on the stomach.

Options in treating arthritis pain

If you have:	Consider these, in this order:
No or low gastrointestinal risk and no heart or stroke risk	• Generic ibuprofen, naproxen, or other NSAID • Acetaminophen (4,000 milligrams daily maximum)
Gastrointestinal risk but no or low heart or stroke risk¹	• Acetaminophen (4,000 mg daily maximum) • Lowest effective dose of ibuprofen or naproxen (or other NSAID), plus a stomach-acid reducer² • Celecoxib with or without stomach-acid reducer • Topical NSAID
Heart or stroke risk but no or low gastrointestinal risk¹	• Acetaminophen (4,000 mg daily maximum) • Naproxen • Aspirin plus a stomach-acid reducer² • Topical NSAID
Heart or stroke risk and gastrointestinal risk¹	• Acetaminophen plus aspirin for heart protection, with a stomach-acid reducer² • Naproxen with a stomach-acid reducer² • Topical NSAID • Stay alert for signs of an ulcer: burning stomach pain, blood in stool, or black, tarry stools • Use lowest effective dose of each drug
Kidney disease or failure	• Avoid NSAIDs

^{1. People with an elevated risk of bleeding or cardiovascular problems should talk with their doctor before taking an NSAID.}

^{2. Such as lansoprazole (Prevacid 24HR and generic) or omeprazole (Prilosec OTC and generic).}

People at high risk of a heart attack, stroke, or bleeding should first try acetaminophen (Tylenol and generic), which is a different type of pain reliever and doesn't cause those conditions. If that doesn't ease your pain enough, naproxen might make sense. It's one of our two Best Buy Drugs picks. (The other is ibuprofen.) If you have an increased risk of intestinal bleeding, you might consider celecoxib after acetaminophen. It has a lower risk of serious ulcer complications compared with other NSAIDs.

NSAIDs applied to the skin—diclofenac gel (Voltaren), drops (Pennsaid), and patches (Flector)—may be worth a try if you have heart or intestinal problems. Studies suggest that they cause less internal bleeding. And because there are lower levels of the drug in the body, they might pose a lower risk of heart attack and stroke. But more studies are needed to confirm this.

Editor's Note:

These materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multi-state settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).