My Favorite Things at the Pharmacy - Arthritis Edition

5 Medicine Cabinet Remedies for Aches, Pains & Skeletal Health

Nov 19, 2024

ICYMI 👉

A patient in her 60s recently came in to ask me about her arthritis. “Everything hurts,” she told me. Her stiff, achy hands and swollen knees were limiting her daily life and activities. Her joints also made her feel older than her actual age.

We talked about the nature of osteoarthritis—that it happens when the protective cartilage that cushions the ends of bones wears down over time, leading to pain, stiffness, and reduced mobility—and how it most commonly affects weight-bearing joints like the knees, hips, and spine, and tends to worsen with age.

The plan? First, we discussed the benefits of ice and rest. Taking a few days off her walking routine and regularly applying a bag of frozen peas to her knees would reduce pain and inflammation. I also referred her to an orthopedist for X-rays. This would help determine the treatment course, ranging from oral anti-inflammatory medications, steroid injection(s) into the knee, regular physical therapy, or, if severe enough, joint replacement surgery.

“What about my hands?” she asked.

I explained that small, everyday movements, such as gripping and typing, can contribute to cartilage wear over time. It turns out her decades of piano playing—plus genetic factors and a broken finger in high school—had caused her knuckles to become knotty and stiff.

“Is there anything else I can do on my own?” she wondered, realizing the chronic nature of arthritis. So, I took her through

My 5 Favorite Pharmacy Fixes for Arthritis Pain (from head to toe):

The Gel and Cream Aisle:

Diclofenac gel (and other topical NSAIDs)

Oral medications aren’t the only option for pain like arthritis. And that’s good because oral NSAIDs such as Advil, Aleve, and Ibuprofen can have potentially serious downsides, particularly in patients with a history of gastrointestinal ulcers or bleeding, kidney or liver disease or with a sensitive stomach.

But now we can offer patients a topical gel like diclofenac gel (brand name Voltaren). This gel was originally available by prescription only in the U.S. However, in 2020, the FDA approved a lower-strength version of diclofenac gel (1%) for over-the-counter use. (The 2% dose is available by prescription only.)

This gel provides pain relief with fewer systemic side effects and is effective for joint pain, especially in hands and knees. The gel works by inhibiting enzymes called cyclooxygenases (COX-1 and COX-2). These enzymes are involved in the production of prostaglandins, chemicals that promote inflammation, pain, and swelling in the body. By blocking COX enzymes and reducing prostaglandin production, diclofenac decreases inflammation and relieves pain directly in the area where it’s applied, allowing for targeted pain relief with fewer systemic side effects than oral NSAIDs.

Capsaicin Cream

Capsaicin, the active compound in chili peppers, works by depleting substance P, a neurotransmitter involved in transmitting pain signals to the brain. Several studies have shown that capsaicin cream can effectively reduce pain and improve function in people with osteoarthritis, especially in the knees and hands. A meta-analysis of clinical trials published in May 2024 found capsaicin cream to be more effective than a placebo for joint pain reduction.

The pain relief from capsaicin cream is generally gradual, often taking a few weeks of consistent use. It is usually recommended to apply capsaicin cream 3-4 times a day for optimal results. However, its effectiveness can vary widely person to person. Also note that the cream may cause a burning sensation when first applied, though this typically diminishes with regular use.

Glucosamine and Chondroitin Supplements

These two need more compelling data for me to recommend them more enthusiastically, however I don’t discourage people from trying them—particularly the chondroitin—and many of my patients swear by glucosamine and chondroitin, taken separately and together.

The current medical trial evidence is mixed. Some studies suggest modest benefits, while others show little to no effect, making it not much different from a placebo. A 2020 meta-analysis concluded that glucosamine alone did not significantly reduce pain in patients with osteoarthritis, although it may have some benefit in improving joint space narrowing over time. Chondroitin appears to show a more promising benefit, with evidence suggesting it can provide moderate relief of pain and improve function in OA. Some studies indicate that chondroitin might reduce joint inflammation and protect cartilage. Combining both has been shown in some trials to have a modest effect in improving symptoms, although results are inconsistent.

Turmeric (Curcumin) Supplements

Turmeric has been recommended by healers for millennia. Recently it has become popular as a dietary supplement, often sold as curcumin—a chemical compound found in dried turmeric—for its anti-inflammatory properties, particularly on joints.

Personally, I start dreaming about my favorite chili recipe when a patient asks me about turmeric, however it does seem to reduce arthritis related joint pain and stiffness, even though it may take a few weeks for the effects to be noticeable. Most studies of turmeric (curcumin) have been small and poorly designed, however an extensive review of turmeric supplements published last year suggested that the supplements were probably helpful for osteoarthritis.

Fish Oil (Omega-3 Fatty Acids)

Fish oil is a hot topic these days. While recent research suggests an association between fish oil, atrial fibrillation and stroke, omega-3 fatty acids, especially EPA and DHA found in fish oil, have anti-inflammatory properties that may help reduce joint pain and stiffness associated with osteoarthritis. A meta-analysis of randomized controlled trials has shown that omega-3 supplementation significantly alleviates arthritis pain. Additionally, fish oil may improve joint function, particularly in younger OA patients. While further studies are needed to confirm long-term benefits, many studies suggest that fish oil could be a beneficial adjunct therapy for managing OA symptoms.

For best results, it is typically recommended to take around 2,700 mg of omega-3 fatty acids daily, often achieved through supplements or by eating fatty fish like salmon.

Final thoughts

Each of the above remedies also may be used for sports injuries and for general aches and pains. How well they work for non-arthritis-related muscle and joint pain will vary widely from person to person. Of course before using any dietary supplement, you should check that it has been verified by trusted third-party organizations like the U.S. Pharmacopeia, NSF or ConsumerLab.com. As always, it's important to consult with your doctor before starting any new supplement.

What about heat for skeletal pain? In general, heat is most effective at relieving muscle tension, whereas ice is an anti-inflammatory for angry joints. What about collagen supplements for joint and bone health? The short story is that the evidence is weak to support its use for osteoarthritis (and for osteoporosis). What about Icy-hot and Tiger balm? These don’t do much for overall joint health but might provide some tingly, temporary relief.

Unfortunately arthritis and joint pain is common and can be debilitating. Hopefully this provides some useful information for any of you suffering out there.

What are your questions? I’m all ears!