Intervention Maps · Osteoarthritis · Creams and pills
Creams or pills?
Bottom line
Topical anti-inflammatory creams are often used first for knee osteoarthritis because they can ease pain with less whole-body risk. Guidelines also favor topical treatment for the hand when medicine is needed. Oral anti-inflammatories can help too, but they bring more stomach, kidney, and cardiovascular risks. Acetaminophen is a weaker option. Opioids generally have an unfavorable balance of benefit and harm for routine osteoarthritis care. None of these medicines has been shown to change the joint disease itself.
What this is
This page is about everyday pain medicines: anti-inflammatory creams and gels, anti-inflammatory pills, acetaminophen, and opioids. It isn't a shopping list of brands, and it isn't a plan to start or stop a medicine on your own.
Injections are different decisions. They have their own pages.
Creams and gels
Guidelines strongly support anti-inflammatory creams and gels, often called topical NSAIDs, for many people with knee osteoarthritis. For hand osteoarthritis, guidelines also favor topical treatment when medicine is needed, although recommendations are not identical across guidelines.
You apply them to the painful joint. Some of the drug still enters the body, but compared with pills they tend to cause fewer people to stop because of side effects.
They are a better fit when the problem is one or two joints you can reach. They are a poorer fit when many joints hurt at once, or when someone can't apply a cream reliably.
Pills
Oral NSAIDs, anti-inflammatory pills, can reduce osteoarthritis pain. That benefit is real. So is the risk conversation: stomach, kidney, and cardiovascular risks matter especially when someone already has conditions or takes medicines that raise those risks.
Guidelines still include them as a symptom option. That's not the same as saying they're harmless, or that everyone should move from a cream to a pill as a next automatic step.
Which pill, what dose, and whether they are safe for you is a clinician and pharmacist question. This page doesn't rank molecules.
Acetaminophen
Acetaminophen (paracetamol) is a weaker option for osteoarthritis pain. It may still be used. It isn't equal to anti-inflammatory creams or pills.
Opioids
Opioids generally have an unfavorable balance of benefit and harm for routine osteoarthritis care. Some guidelines leave a limited place for tramadol in selected circumstances, but that is very different from making opioids a usual pain strategy.
What taking part usually involves
- For a cream: applying it regularly to the joint, and noticing whether pain changes without assuming more is always better.
- For a pill: a plan that includes how long it will be used, and which stomach, kidney, or cardiovascular issues already matter for you.
- A check-in, rather than an open-ended prescription with no review.
What this does not do
These medicines treat symptoms. They haven't been shown to rebuild cartilage or slow the disease the way some rheumatoid arthritis medicines can.
A steroid shot, a gel shot, and these creams or pills are not interchangeable.
Evidence consulted Open sources
Key sources used to prepare this answer. This is not a citation for every sentence.
- Kolasinski et al. 2019 ACR/Arthritis Foundation OA guideline
- NICE NG226. Osteoarthritis in over 16s
- AAOS. Management of osteoarthritis of the knee (non-arthroplasty), 2021
- Bannuru et al. 2019 OARSI non-surgical management guideline
- Kloppenburg et al. 2018 EULAR hand OA recommendations
- da Costa et al. NSAIDs and opioids for knee and hip OA (BMJ, 2021)
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