Medicines doctors use to treat osteoarthritis include:

• Acetaminophen, which may help relieve pain.
• Nonsteroidal anti-inflammatory drugs (NSAIDs), which reduce inflammation and relieve fever.
• Corticosteroid injections in the joint (intra-articular), which reduce inflammation.
• Hyaluronan injections, which may relieve pain.
• Opioids, which may relieve moderate to severe pain.

Some studies have shown that acetaminophen and nonsteroidal anti-inflammatory drugs are equally effective for mild to moderate joint pain. Other studies suggest that NSAIDs are more effective than acetaminophen and that side effects are similar.

Topical (applied to the skin) agents may provide short-term pain relief. These include topical NSAIDs, capsaicin, and pain-relieving creams.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). These are among the most common treatments for osteoarthritis pain.� Purchased over-the-counter or by prescription, NSAIDs ¡ª such as aspirin, ibuprofen (Advil or Motrin) and diclofenac (Cataflam, Voltaren) ¡ª act quickly to relieve pain. There are more than 30 drugs classified as NSAIDs and each has a slightly different chemical structure, is metabolized differently and seems to work differently among patients. (Other drugs, such as methotrexate, chloroquine, pencillamine and gold salts, work through the immune system and have some anti-inflammatory effects.) For severe osteoarthritis pain, the NSAID ketorolac (Toradol) can be given as an injection for speedy, although brief, pain relief.

Comments:

• Aspirin is probably the least expensive NSAID available. Its active ingredient is synthesized from salicin, a natural substance found in willow bark and other plants. Americans take more than 30 billion aspirin tablets a year at a cost of $1 billion. However, aspirin has multiple side effects ¨C so many, in fact, that the drug probably would not receive modern-day U.S. Food and Drug Administration approval.� While low doses of aspirin appear to help prevent heart attacks and may help prevent colon cancer and Alzheimer's Disease, aspirin can cause gastrointestinal problems and trigger life-threatening allergic reactions in some people. (See Arthritis Books and Videos for more information about aspirin.)

• Long-term use of NSAIDs can cause complications in arthritis patients. These can range from minor bleeding in the gastrointestinal tract, to liver or kidney toxicity (poisoning).� In fact, stomach irritation is so common with frequent NSAID use that some doctors also prescribe misoprostol (Cytotec), a drug that protects the stomach lining.� (Misoprostol has its own potential side effects, including nausea, gas, headaches and vomiting; it can cause miscarriage and should never be given to pregnant women).� One prescription product, approved in just the past few years, combines the NSAID diclofenac sodium with misoprostol and is marketed under the name Arthrotec. One of the newest NSAIDs, celecoxib (Celebrex), are reported to be easier on the stomach than older NSAIDs.

• NSAIDs also can interact with other drugs, even over-the-counter preparations.� Antacids, for example, can decrease the absorption of NSAIDs, reducing their pain-fighting effect.� Prescription medicines also can have adverse effects when mixed with NSAIDs.� NSAIDs can augment the action of diuretics, lithium, oral hypoglycemic agents and phenytoin (Dilantin).

• It is extremely important to follow all the label instructions and cautions when taking NSAIDs and to consult with your health care provider if you have any concerns.

Oral Tramadol (Ultram). Available for moderate to severe pain.�

Comments: When introduced to the United States in 1966, the U.S. Food and Drug Administration classified tramadol as a non-narcotic drug. However, some cases of addiction have been reported. Tramadol also has been linked to seizures in susceptible individuals, especially when the drug is given at high doses.� The risk of seizure is higher in patients who are also taking antidepressant drugs such as desipramine (Norpramine) or doxepin (Sinequan).� Caution also has been advised with well-known antidepressants fluoxetine hydrochloride (Prozac), sertraline hydrochloride (Zoloft) and paroxetine (Paxil). 

Narcotic Drugs - Opioids. When pain is extreme, narcotic drugs derived from opium may be prescribed. For arthritis, the most common narcotics prescribed are propoxyphine (Darvon), codeine (Tylenol #3 or #4) or hydrocodone (Vicodin and Lorcet), although oxycodone (Percodan and Percocet) is being prescribed more often now.� These narcotic drugs bring swift pain relief, allowing the patient more activity during the day and better sleep at night.

Comments: Opioids can have side effects and may lead to dependency, but rarely addiction.� Prescribing them should be done only when more conservative treatment has failed, and a patient understands the risks and rewards involved in their use. Opioids are being used more often in advanced arthritis. (See the Arthritis Library for more information about opioids.)

Mixed Agonists/Antagonists (Synthetic Narcotics). This class of drugs is used at times for arthritis pain.� They include pentazocine (Talwin-NX or Talace), nalbuphine (Nubain), butorphanol (Stadol or Stadol NS) and buprenorphine (Buprenex). Only pentazocine is available in oral form and likely to be useful on in some cases of advanced arthritis.�

Comments: This group of drugs has what is called a "low ceiling effect," meaning a small dose may be helpful, but more can cause complications. They also cannot be mixed with strong natural opioids.

Viscosupplements. Two agents have been approved by the FDA for osteoarthritis of the knee.� They are injected into the knee to replace the hyaluronic acid, a substance that gives the knee joint viscosity, and which appears to break down in osteoarthritis.

The two viscosupplements currently on the market are Hyalgan and Synvisc.� For Hyalgan, five injections over 6-10 weeks are needed, and for Synvisc, only three injections are needed.

Glucosamine sulfate. One of the most exciting recent developments in arthritis treatment, glucosamine has been shown to relieve pain and potentially rebuild damaged cartilage. Available without a prescription, glucosamine is found in high concentrations in seashells, from which glucosamine is harvested. Glucosamines are used by the body to manufacture proteoglycans, substances that hold collagen threads together. Collagen is an element of cartilage.� Some studies have shown that glucosamine sulfate actually "feeds" the joints and stimulates regrowth at the cellular level.� Glucosamine sulfate also matches NSAIDs in providing long-lasting pain relief, researchers have found ¡ª and without NSAIDs' side effects.

A powdered form of glucosamine sulfate, which can be mixed into juice, is expected to be available soon.� Glucosamine sulfate is used to treat patients of all ages and all stages of osteoarthritis.

fioricetsoma.com has much cheaper online tramadol and soma, fioricet pain relief drugs. You can shop there.