Medicines can help manage arthritis pain and support daily activity. The right choice depends on your joint, other conditions, medicines, and treatment goals. Pain relief does not rebuild cartilage.
U.S. AVAILABILITY
Over-the-counter (OTC)
Available without a prescription in the United States. OTC does not mean risk-free: follow the specific package label and review regular use with your clinician or pharmacist.
OTC diclofenac sodium 1% gel · Voltaren Arthritis Pain and equivalents
Diclofenac arthritis gel
A rub-on option for knee arthritis pain.
Guidelines support topical NSAIDs for knee OA. They generally expose the rest of the body to less medicine than oral NSAIDs; they are not risk-free. A deep hip joint is less suited to topical treatment.
Side effects you may notice
Redness, itching, dryness, or irritation where the gel is applied can occur.
Serious risks & warning signs
Even a rub-on NSAID can cause stomach bleeding, kidney injury, cardiovascular problems, or a severe allergic reaction. Stop and get emergency help for vomiting blood, black stools, chest pain, stroke symptoms, or trouble breathing. Stop and seek medical advice for a rash.
Before you use it
Check skin reactions, NSAID allergies, other medicines, and the exact product instructions. Ask before combining a topical NSAID with an oral NSAID.
FDA status & sources
Voltaren Arthritis Pain has an FDA-approved OTC label for arthritis pain in specified joints. Its label does not establish effectiveness for the hip, shoulder, or spine. Other gels and creams need their own label check.
Pain relief with a medical-history and interaction check.
Oral NSAIDs can reduce knee and hip OA pain. The 2019 ACR/Arthritis Foundation guideline strongly recommends them when appropriate. NICE advises considering an oral NSAID if topical treatment is ineffective or unsuitable. These medicines also come in prescription formulations or strengths; do not increase an OTC dose to imitate a prescription.
Side effects you may notice
Indigestion, stomach pain, nausea, diarrhea or constipation, and dizziness can occur. Effects and their frequency differ by drug.
Serious risks & warning signs
Ulcers and stomach or intestinal bleeding can occur without warning. NSAIDs can also cause kidney injury, fluid retention, high blood pressure, heart attack or stroke. Stop and get emergency help for chest pain, stroke symptoms, vomiting blood, black stools, or trouble breathing. Contact a clinician promptly for new swelling or reduced urination.
Before you use it
Stomach ulcers or bleeding, kidney problems, and cardiovascular risks matter. Ask about blood thinners, blood pressure, heart or kidney disease, and stomach protection. Do not combine multiple NSAIDs unless your clinician specifically directs it. FDA advises avoiding NSAIDs at 20 weeks of pregnancy or later unless a health professional advises otherwise.
FDA status & sources
Status and indications are product-specific: prescription NSAIDs have approved labels, while OTC products may follow an approved application or OTC monograph. A brand name is not a blanket approval for every formulation or use.
Tylenol and generic acetaminophen; called paracetamol in some countries
Acetaminophen
A different pain reliever, with limited average OA benefit.
Acetaminophen is not an NSAID. ACR conditionally recommends it, particularly for short-term or occasional use when NSAIDs are unsuitable. NICE does not recommend routine use because evidence of benefit is weak.
Side effects you may notice
Usually well tolerated when used as directed; many people have no noticeable side effects. A rash should not be treated as a routine, harmless effect.
Serious risks & warning signs
Too much can cause liver failure, even before symptoms appear. For a possible overdose, contact Poison Control immediately at 1-800-222-1222 in the U.S.; do not wait to feel ill. Stop and seek medical attention for a new rash or blistering. Trouble breathing or facial swelling requires emergency help.
Before you use it
Too much can cause serious liver injury. Check cold, flu, sleep, and combination pain products for duplicate acetaminophen. Ask about liver disease and alcohol use; follow the exact label or prescriber instructions.
FDA status & sources
Many OTC acetaminophen products are marketed under the OTC monograph framework rather than individual product approval. Their pain-relief labeling does not establish cartilage repair.
Require a prescription and an individualized review. Prescription strength is not automatically a better choice; the aim is useful relief with acceptable risks.
Celecoxib · meloxicam · prescription ibuprofen or naproxen
Prescription anti-inflammatory medicines
Pain relief with a medical-history and interaction check.
These oral NSAIDs can reduce OA pain and inflammation. Celecoxib and meloxicam require a prescription in the U.S.; ibuprofen and naproxen also have OTC versions. Choice depends on your health history, interactions, and response—not simply a higher strength.
Side effects you may notice
Indigestion, stomach pain, nausea, diarrhea or constipation, and dizziness can occur. Effects and their frequency differ by drug.
Serious risks & warning signs
Ulcers and stomach or intestinal bleeding can occur without warning. NSAIDs can also cause kidney injury, fluid retention, high blood pressure, heart attack or stroke. Stop and get emergency help for chest pain, stroke symptoms, vomiting blood, black stools, or trouble breathing. Contact a clinician promptly for new swelling or reduced urination.
Before you use it
Stomach ulcers or bleeding, kidney problems, and cardiovascular risks matter. Ask about blood thinners, blood pressure, heart or kidney disease, and stomach protection. Do not combine multiple NSAIDs unless your clinician specifically directs it. FDA advises avoiding NSAIDs at 20 weeks of pregnancy or later unless a health professional advises otherwise.
FDA status & sources
These prescription NSAIDs have FDA-approved, product-specific labels. Celecoxib and meloxicam labels include relief of OA signs and symptoms. They do not repair cartilage. Prescription topical diclofenac formulations also exist; their labeling differs from OTC 1% arthritis gel.
A prescription option for selected people with persistent pain.
Duloxetine acts on pain-processing pathways and is not an NSAID or an opioid. ACR conditionally recommends it for knee, hip, and hand OA, with most direct evidence from knee studies. It may be considered even when depression is not the reason for treatment.
Side effects you may notice
Nausea, dry mouth, constipation, sleepiness, reduced appetite, sweating, and dizziness can occur.
Serious risks & warning signs
Important risks include liver injury, blood-pressure changes, falls, low sodium, and serotonin syndrome. Fever with agitation, confusion, tremor or muscle stiffness needs urgent care. New suicidal thoughts require immediate help, especially in young people or after treatment changes. Yellow skin or eyes requires prompt medical review.
Before you use it
Discuss nausea, dizziness, blood-pressure changes, liver and kidney disease, and interactions. Important label warnings include suicidal thoughts and behaviors in children, adolescents and young adults, and serotonin syndrome. Do not start, combine, or abruptly stop it without prescriber guidance.
FDA status & sources
Cymbalta is FDA-approved for chronic musculoskeletal pain in adults; its label includes OA trial evidence. This is pain treatment, not an approval for joint regeneration. Check the exact product label.
ACR conditionally recommends tramadol in selected circumstances and conditionally recommends against non-tramadol opioids. NICE advises against strong opioids for OA and restricts weak opioids to exceptional short-term circumstances.
Side effects you may notice
Constipation, nausea, vomiting, sleepiness, dizziness, and itching can occur; effects vary by opioid.
Serious risks & warning signs
Opioids can cause addiction and fatal overdose. Slow breathing or being difficult to wake is an emergency: call 911 and give naloxone if available. Alcohol, benzodiazepines, and other sedating drugs increase danger. Tramadol can also cause seizures and serotonin syndrome, especially with interacting medicines such as duloxetine.
Before you use it
Dependence, overdose, sedation, falls, and interactions can outweigh benefits. Tramadol is an opioid, not a risk-free alternative. If you already take an opioid, arrange an individualized review; do not abruptly stop it.
FDA status & sources
Opioid drugs have product-specific approved pain indications and major warnings. FDA approval does not make them a preferred long-term OA treatment or establish joint repair.
Sources checked September 20, 2026. The ACR recommendations cited are from the 2019 guideline, published in 2020; NICE recommendations are from NG226. Examples are not endorsements or a complete list. The exact current product label and clinician advice govern use. FDA regulation of OTC medicines: read the FDA explanation ↗.