What role do analgesics and anti-inflammatory medications play in the management of osteoarthritis?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

In the management of osteoarthritis (OA), pharmacological treatments should be used alongside non-pharmacological approaches and to support therapeutic exercise, at the lowest effective dose for the shortest possible time ,.

  • Topical Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): A topical NSAID, such as ibuprofen 5% gel, should be offered for knee OA and considered for OA affecting other joints ,. These are clinically effective for pain relief, cost-effective, and carry a minimal risk of adverse effects, as they do not increase the risk of gastrointestinal adverse events ,.
  • Oral Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): If topical NSAIDs are ineffective or unsuitable, oral NSAIDs can be considered ,. When prescribing oral NSAIDs, potential gastrointestinal, renal, liver, and cardiovascular toxicity must be considered, along with the person's risk factors, including age, pregnancy, current medication, and comorbidities . A gastroprotective treatment, such as a proton pump inhibitor (PPI), should be offered concurrently ,. While effective in reducing pain and stiffness, oral NSAIDs are associated with significant morbidity and mortality due to adverse effects on various body systems .
  • Paracetamol: Paracetamol should not be routinely offered . It may be considered infrequently for short-term pain relief only if all other pharmacological treatments are contraindicated, not tolerated, or ineffective ,. There is no strong evidence of benefit for paracetamol, with studies showing little to no efficacy in OA management ,. However, it is less likely than NSAIDs to cause gastrointestinal adverse events .
  • Weak Opioids (e.g., Codeine): Similar to paracetamol, weak opioids like codeine should not be routinely offered . They can be considered for infrequent, short-term pain management if other drug treatments are contraindicated, not tolerated, or ineffective ,. Strong opioids are not recommended for OA pain management, as their risks outweigh the benefits ,.

It is important to review the continuation of treatment based on clinical need .

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