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Joint Pain Medication: Common Side Effects

If you suffer from occasional joint pain, you are among one-third of adults in the nation that report having had joint pain within the last 30 days. Joints provide connections between the bones, which are extremely important for normal movement. Joint pain can be mild or severe depending on what is causing the pain. Acute joint pain usually lasts a few weeks and persistent joint pain that lasts for weeks to months or even longer is considered to be chronic. According to the Centers for Disease Control and Prevention (CDC), joint pain is classified as severe when a person rates their pain level as 7 out of 10 on a scale of 0 (no pain) to 10 (most severe pain). Persistent or chronic joint pain is when a person has joint pain almost every day within the span of three months. 

Causes for joint pain can vary and are usually due to damage to the joint like after an injury, or a disease like arthritis. The CDC reports that one in four adults with arthritis, or about 15 million people, experience arthritis-related severe joint pain. Additionally, half of all adults with arthritis experience persistent pain. Osteoarthritis is the most common type of arthritis, but other rheumatic conditions like rheumatoid arthritis, gout, lupus, or fibromyalgia can also cause significant joint pain. 

Treatment of joint pain is usually focused on preserving the joint by reducing inflammation that causes the pain. Treatment methods include oral medications that are either prescription or over the counter (OTC), topical medications or injections. Here is a list of the most common medications used to treat joint pain and what you can expect as side effects. Being aware of the potential side effects associated with a medication or muscle relaxer can help you decide which drug is right for you. 

Over the counter medications

Non-steroid anti-inflammatory drugs (NSAIDs) 

If your joint pain is moderate to severe, taking an OTC drug that belongs to the class of NSAIDs can relieve your pain by reducing inflammation. Common NSAIDs are Ibuprofen (Advil or Motrin) or Naproxen (Motrin). The NSAIDs work by reducing the amount of a substance called prostaglandin that makes us feel pain. The drugs do this by binding to an enzyme called COX that is responsible for the production of prostaglandin. They are very effective in reducing pain from arthritis, so they are often the first medications prescribed to treat the condition. 

NSAIDs are meant for short-term use. There are some side effects associated with taking them and the longer you take them, the more side effects you are likely to experience. Mainly, NSAIDs are known for being rough on the stomach. Ibuprofen and naproxen can increase the risk of stomach bleeding and stomach ulcers. If you have a previous history of peptic ulcer disease or inflammatory bowel disease, then taking NSAIDs can make these conditions worse. In extreme cases, these drugs can severely irritate the stomach lining and can cause internal bleeding. 

The most common side effects of taking NSAIDs are: 

  • Stomach upset
  • Diarrhea
  • Gas
  • Heartburn
  • Nausea 
  • Vomiting

Taking the drugs with milk, food, or an antacid can help lessen stomach issues. 

Additionally, NSAIDs can increase the risk of:

  • Heart attack
  • Stroke
  • Heart failure
  • Blood clots

If you have cardiovascular disease, taking NSAIDs can also increase the risk of heart problems. 

Aspirin

Aspirin was one of the first anti-inflammatory NSAID drugs discovered. For a long time, aspirin was used to relieve fever and headache. It is effective in reducing joint pain that results from inflammation, as seen in arthritic conditions. 

Aspirin is the only NSAID that does not pose cardiovascular risks and in fact, it is used at low doses to protect against cardiovascular disease like heart attack and stroke. It is also used at a low dose to prevent the formation of blood clots. 

Since aspirin belongs to the NSAIDs, side effects also mainly affect the stomach lining. Aspirin can cause irritation of the stomach, nausea and indigestion. Less common, but more serious side effects include:

  • Stomach bleeding
  • Vomiting
  • Bruising
  • Worsening of asthma
  • Inflammation of the stomach 

If you have a history of peptic ulcers, taking aspirin can make these symptoms much worse and is usually not recommended. 

Children under the age of 16 should not take aspirin without consulting a doctor, because it can potentially cause Reye’s Syndrome after exposure to a virus such as chicken pox. 

Acetaminophen

Acetaminophen, known as the brand name Tylenol, is not an NSAID. Unlike the NSAIDs, acetaminophen does not actually reduce inflammation, but it alters chemicals in the brain that make us feel pain. Since inflammation is not reduced by acetaminophen, it is more useful in treating mild to moderate pain.

Acetaminophen does not cause the same side effects in the stomach as NSAIDs. So, it is often recommended to relieve pain when you cannot take NSAIDs due to stomach issues. Additionally, acetaminophen is less likely to increase blood pressure, so people with a history of cardiovascular problems that cannot take NSAIDs can also use acetaminophen to reduce joint pain. 

The major consequence of taking acetaminophen is that it can cause severe liver damage or liver failure at high doses. If you drink more than three alcoholic beverages a day while taking acetaminophen, this greatly increases your risk of liver damage. Symptoms of liver damage include nausea or vomiting, yellow skin or whites of eyes, loss of appetite, pain in the upper right abdomen, profuse sweating and dark or tarry stools. 

Prescription Medications

Prescription NSAIDs 

Diclofenac (Voltaren) and Celecoxib (Celebrex) are two prescription medications that are used to treat joint pain that belong to the class of NSAIDs. Diclofenac is a popular choice to manage chronic inflammatory joint pain that results from osteoarthritis or rheumatoid arthritis. As an NSAID, diclofenac can cause stomach problems. These include:

  • Stomach burning, cramping and bloating 
  • Stomach ulcers
  • Diarrhea
  • Constipation
  • Headache
  • Dizziness
  • Ringing in the ears 

People with a history of gastric ulcers should not use diclofenac. The medication can also increase the risk of cardiovascular disease, so you should consult a doctor before taking this medication if you are at a higher risk for this. 

Celecoxib is also an NSAID that is commonly used to treat osteoarthritis, rheumatoid arthritis and ankylosing spondylitis. The NSAIDs block the action of the COX proteins to reduce prostaglandin levels. While all other NSAIDs block both COX-1 and COX-2, currently celecoxib is the only FDA-approved NSAID that is a COX-2 inhibitor. 

The FDA has issued a few black box warnings for celecoxib. These include:

  • Stomach problems warning: Taking celecoxib can increase the risk of stomach bleeding, stomach ulcers, or holes in the stomach or intestine, which can be fatal. People with a history of stomach bleeding or ulcers should not take celecoxib.  
  • Heart risk warnings: Celecoxib can cause an increased risk of heart attack, heart failure or stroke.
  • Coronary artery bypass graft warning: Taking celecoxib before or after this type of surgery can increase the risk of heart attack or stroke.

Opioids

The opioid medications, codeine and hydrocodone (Vicodin), are among the most effective medications to reduce pain. Codeine is best when used for mild to moderate pain, whereas hydrocodone is stronger and is effective for severe pain. Opioid drugs work by altering the perception of pain. The drugs bind to certain receptors on cells that prevent the messages of pain from being transmitted to the brain so we don’t feel pain. 

Common side effects of opioids include:

  • Feeling dizzy
  • Drowsiness
  • Constipation
  • Vomiting
  • Nausea

Codeine can also make you feel light headed, as well as experience excessive sweating and shortness of breath. Hydrocodone can cause itching as a common side effect. 

Misuse of codeine and hydrocodone is a major problem. Excessive use of the opioid drugs at high doses can be dangerous and cause serious health consequences like higher rate of infections and liver damage. Long-term use of either drug can also cause dependence, which can lead to serious withdrawal symptoms when you stop taking the drug. 

Due to the high rate of misuse, the FDA has put restrictions on how you can purchase opioid drugs. A valid written prescription from your doctor must be provided to your pharmacy before you can pick up the medication. 

Oral steroids

Oral steroids are drugs that mimic the hormone, cortisol, in our body. Prednisone and cortisone are two widely used prescription oral steroids that are taken to treat joint pain in arthritis.  They can reduce inflammation in the body and decrease activity of the immune system by reducing the amount of inflammatory molecules made by the body that damage tissues and joints. 

Common side effects of oral steroids include:

  • Acne
  • Blurred vision
  • Trouble sleeping
  • Bruising easily
  • High blood pressure
  • Weight gain
  • Increased growth of body hair
  • Muscle weakness
  • Less resistance to infection
  • Stomach irritation or bleeding
  • Swollen or puffy face
  • Mood swings
  • Water retention
  • Worsening of diabetes
  • Cataracts or glaucoma

As an alternative to oral tablets, steroid injections are often used for the treatment of arthritis. Injections can deliver the drug directly into the painful joint to reduce inflammation and provide more efficient pain relief. Steroid injections used to treat arthritis do not usually cause the same side effects as taking oral steroids but in rare occurrences, complications such as bleeding into the joint, skin discoloration, infection, weakening of bones or ligaments and allergic reactions at the injection site can occur. 

Managing joint pain 

Medication overuse can actually increase the pain that you experience, so it is important to consult a doctor about finding ways to make your pain more tolerable. 

Topical medications that include menthol, lidocaine, capsaicin or salicylate are available over the counter, and these are a good option for joint pain that occurs in a specific area. Prescription topical analgesics that contain diclofenac can also provide significant pain relief. 

Additionally, if the cause of your joint pain is due to rheumatoid arthritis, your doctor may also prescribe specialized prescription drugs to treat the condition. Discuss possible side effects of these drugs with your doctor to be aware of what to expect. 

Physical therapy is also a great way to reduce pain, improve your range of motion, and build up muscle strength around the joint through exercises. Your doctor may recommend a combination treatment plan that includes medication and physical therapy. 

Overall, identifying the cause of joint pain by visiting your doctor’s office can help you find the right treatment plan and muscle relaxants to safely decrease your pain. 

Published September 2nd, 2020 by Chris Riley
Fact Checked by Chris Riley

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