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Do not increase a dose, combine pain relievers, or stop a prescribed medicine on your own. Bring the questions below to the appointment and agree on how long to try the plan, what improvement to look for, and when to call back.
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Start with a complete medication review
Medication decisions are safer when your clinician can see everything that might affect the choice. Make one list before the appointment and include:
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- Every prescription medicine, including medicines taken only occasionally.
- Over-the-counter pain relievers, cold remedies, sleep products and combination medicines.
- Vitamins, minerals, herbal products and other supplements.
- The strength, directions, usual time of day and how often you actually take each product.
- Any medicine you recently stopped, started or received from another clinician.
Bring the containers or photographs of the labels if possible. Ask: “Can we review everything I take, including nonprescription medicines and supplements, for interactions or duplicate ingredients?” A pharmacist can perform the same kind of medication reconciliation and may be able to check products while your doctor focuses on the broader treatment plan.
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Look specifically for duplicate ingredients
Acetaminophen (also called paracetamol in some countries) can appear in more than one product. An OA tablet, a cold medicine and a sleep product may each contain it. Two products can therefore add up to more than you intended even when you followed each label separately. Ask: “Could I be doubling up on acetaminophen or an NSAID in another product?” Check labels and confirm a safe total amount with a clinician or pharmacist rather than calculating it yourself.
Ask before adding an over-the-counter medicine
“Over the counter” does not mean risk-free or automatically compatible with a prescription. Ask whether an OTC product duplicates your prescription, changes bleeding or blood-pressure risk, affects kidney or liver function, or should be avoided with your other medicines. Arthritis Foundation medication guidance specifically advises checking before adding an OTC medicine to a prescription NSAID.
Explain your goal in measurable terms
“Less pain” is useful, but a specific functional goal gives you and your clinician a way to judge whether treatment is worthwhile. Describe what OA prevents or makes difficult: walking to the shops, climbing stairs, opening jars, sleeping, working at a keyboard or exercising. Say when pain occurs, how long it lasts, what makes it better or worse, and whether stiffness or reduced movement is the larger problem.
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Then ask: “What improvement should I expect, and when should we decide whether it is working?” Agree on a review point and on what counts as enough benefit to continue. Keep a short record of pain, activity, sleep and unwanted effects during the trial so the discussion is based on your usual days rather than memory of the worst day.
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Clarify the next step before you leave
Ask what to do if relief is incomplete, wears off, or causes a side effect. The plan might involve changing the route, stopping a trial, addressing another cause of pain, or combining medicine with non-drug care. You should know who to contact, how soon, and which symptoms require urgent help.
Ask how your medical history changes NSAID risk
Nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce OA pain for some people, but oral NSAIDs have important gastrointestinal and cardiovascular risks. The Arthritis Foundation notes that gastrointestinal bleeding and cardiovascular events are serious concerns and advises the lowest effective dose for the shortest possible time. This is a prompt for an individualized review, not a universal dosing instruction.
Ask: “What dose and duration are safest for me, given my medical history?” Also ask: “Does my history of stomach ulcers, kidney disease, heart disease, blood thinners, or other medicines change whether an NSAID is appropriate?” Tell the clinician about previous bleeding, high blood pressure, heart problems, kidney or liver disease, allergies, pregnancy or plans for pregnancy, and any prior reaction to an NSAID. Your clinician may need information not listed here, so do not treat this as a complete screening checklist.
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Discuss the medicines that can alter the balance
Blood thinners and antiplatelet medicines can make bleeding concerns more important. Some treatments for blood pressure, fluid retention or other chronic conditions may matter when kidney function or blood pressure is being considered. Do not assume that a medicine taken for years is irrelevant; include it on the list and let the prescriber or pharmacist assess the combination.
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Know which symptoms need prompt attention
Ask your clinician to name the warning signs that apply to the chosen product. Depending on the medicine, urgent assessment may be needed for signs of gastrointestinal bleeding, a severe allergic reaction, chest pain, sudden shortness of breath, or markedly reduced urine. Do not wait for a routine follow-up if you develop a symptom your clinician has described as urgent.
Compare topical and oral NSAIDs by joint and exposure
The joint affected matters. A medicine applied to the skin must reach the painful tissues, while an oral medicine circulates throughout the body. The American College of Rheumatology (ACR)/Arthritis Foundation guideline explains that topical NSAIDs should be considered before oral NSAIDs when appropriate because local treatment has less systemic exposure. Less systemic exposure does not mean no systemic risk, and a topical product still needs to be used exactly as directed.
| Option | What the guideline or evidence says | Questions for your clinician |
|---|---|---|
| Topical NSAID for knee OA | Strongly recommended by the ACR/Arthritis Foundation guideline. | Is the skin intact, is this joint suitable, and how will we judge benefit and irritation? |
| Topical NSAID for hand OA | Conditionally recommended by the same guideline; the decision depends on your circumstances and response. | Will hand washing, skin sensitivity or the number of painful joints affect how I can use it? |
| Topical NSAID for hip OA | Unlikely to work well because the hip joint lies deep beneath the skin. | What other medicine or non-drug option is more likely to reach the painful area? |
| Oral NSAID | May help pain but exposes the whole body and requires review of gastrointestinal, cardiovascular, kidney and interaction risks. | Why is an oral option appropriate for me, and what is the shortest useful trial? |
The guideline’s exact recommendation is: “Topical NSAIDs are strongly recommended for patients with knee OA and conditionally recommended for patients with hand OA.” The strength differs by joint and evidence; it does not establish one universally best medicine for every person.
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A topical diclofenac gel is one example of a topical NSAID; in the United States, the Arthritis Foundation drug guide discusses OTC Voltaren Arthritis Pain. Product status, labeling and availability vary by country and can change. An OTC label is not an individualized safety assessment. Ask whether the product is suitable for your skin, other medicines and medical conditions, and follow the local label or your clinician’s instructions rather than borrowing directions from another product.
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Get precise instructions for safe use
Before starting or changing a medicine, ask your clinician to write down the plan in terms you can follow:
- Product and route: Confirm the exact medicine, formulation and whether it is oral or topical.
- Dose and timing: Ask how much to use, how often and whether it should be taken with food or at a particular time.
- Trial length: Ask how many days or weeks to try it before judging the result.
- Maximum and missed dose: Ask what limit applies and what to do if you forget a dose. Do not double up unless specifically instructed.
- What not to combine: Confirm which OTC pain relievers, cold products, supplements or prescription medicines should not be used together.
- Monitoring: Ask whether you need blood-pressure checks, laboratory tests or a medication review.
- Stop or call instructions: Ask which side effects mean stop and call promptly, which require emergency care, and which can be discussed at the next visit.
- Follow-up: Put the review date or trigger in your calendar and know which office or pharmacist to contact.
Do not self-escalate because pain remains after one dose, and do not continue indefinitely simply because a product is available without a prescription. If the planned trial is not helping enough, contact the clinician rather than adding another pain reliever on your own.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.Ask about alternatives and combinations beyond medication
Medication is only one part of OA management. Ask whether physical therapy, strengthening, range-of-motion work, weight management where relevant, activity modification, braces or other supports could help the specific joint and goal you described. These options may reduce the amount of medicine needed or improve function when a medicine alone is insufficient.
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Prepare for the appointment efficiently
Bring a one-page summary
- The painful joint or joints and your main activity goal.
- When symptoms began, what aggravates them and how they affect sleep or function.
- Your complete medicine and supplement list, including occasional use.
- Allergies and past side effects or bleeding problems.
- Relevant diagnoses such as ulcer history, kidney disease or heart disease.
- Home readings or records your clinician has asked you to track, such as blood pressure or symptoms.
Use a question checklist
- What is the intended benefit, and how soon should I notice it?
- Which dose and duration fit my health history?
- Is a topical treatment reasonable for this joint, or is the joint too deep for it to work well?
- Could any of my medicines or supplements interact or duplicate an ingredient?
- What side effects should I watch for, and which are urgent?
- What is our review date and the next step if the result is inadequate?
If you cannot attend with the full list, send it through the practice’s approved communication method or ask a pharmacist to review it. Keep the final instructions with your medicines so another clinician can see the current plan.
How to judge whether the plan is working
Success is not limited to a lower pain number. At the agreed review, compare the goals you set: Can you walk farther, use your hand more easily, sleep better or complete daily tasks with less limitation? Record unwanted effects as carefully as benefits. A medicine that lowers pain but causes unacceptable problems may not be a workable long-term choice.
Tell the clinician if there is no meaningful improvement by the agreed point, if benefit fades, or if function worsens. That information supports a safer adjustment than silently increasing the dose or layering on another product.
Questions to ask word for word
- “Can we review everything I take, including nonprescription medicines and supplements, for interactions or duplicate ingredients?”
- “What improvement should I expect, and when should we decide whether it is working?”
- “What dose and duration are safest for me, given my medical history?”
- “Does my history of stomach ulcers, kidney disease, heart disease, blood thinners, or other medicines change whether an NSAID is appropriate?”
- “Would a topical NSAID be a reasonable option for the joint that hurts?”
- “Could I be doubling up on acetaminophen or an NSAID in another product?”
- “What should I do if the medicine is not helping enough or I notice a side effect?”
There is no single medication proven best for every person and every OA joint in the cited guidance. A sound decision matches the joint, your medical history, other medicines, treatment goals and response, then includes a clear safety and follow-up plan.
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