Choosing an OTC pain reliever for osteoarthritis

Choosing an OTC pain reliever for osteoarthritis

The Medicine Cabinet: Ask the Harvard Experts

Q: I have osteoarthritis in both knees. What’s the best over-the-counter pain reliever?

A: Osteoarthritis is a leading cause of disability and reduced quality of life around the globe. Osteoarthritis can occur in any joint. But it strikes the knees, hips, spine and hands most often. The chance of developing osteoarthritis increases with advancing age and body weight.

The main problem is loss of the cartilage that covers and protects the ends of the bones where they meet at a joint. Without this protective coating, bone rubs against bone. This causes the joint to get irritated and inflamed.

Other than surgery, there is no cure for knee osteoarthritis. So, treatments focus on relieving pain and decreasing stiffness. Getting symptom relief not only provides comfort, it allows people with osteoarthritis to stay physically active. That’s necessary to maintain muscle strength, a key to avoiding disability.

Some studies looking at the best over-the-counter pain relievers have shown acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) offer similar results. However, more recent studies suggest that drugs such as naproxen and ibuprofen might be slightly better.

I still recommend that people try acetaminophen first. If taken in appropriate doses, it’s safer than an NSAID. I recommend no more than a total of 3,250 milligrams per 24 hours.

Be careful — many products contain acetaminophen. So if you are taking other medicines, be sure that acetaminophen is not one of the ingredients. The main danger of acetaminophen is taking an accidental overdose, which can cause liver failure.

If you are not getting satisfactory relief with acetaminophen, it is reasonable to try over-the-counter naproxen or ibuprofen. However, if you have a history of internal bleeding, peptic ulcer disease or kidney problems, be sure to check with your doctor first before taking an NSAID.

Stick to the recommend doses on the label. By the way, save yourself some money. Generic versions work as well as brand names.

Neither acetaminophen nor an NSAID is a substitute for regular exercise that includes both aerobics and strength training. You may actually find you need less pain relievers as your fitness and strength improve.

(Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit