Painkillers in later life with arthritis: safer use and what to check (UK guide)

Name: Painkillers in Later Life With Arthritis: Safer Use (UK)
Creator: Louis Maxwell

Written by Louis Maxwell — First Contact Practitioner, HCPC PH128483.

Clinical review status: not yet recorded

Painkillers can still help arthritis in later life, but they need more care as you get older, because the body clears medicines more slowly, you are more likely to take other medicines that interact, and side effects such as drowsiness, constipation, stomach bleeding and kidney strain matter more. For osteoarthritis, NICE puts exercise first, recommends an anti-inflammatory gel for knee osteoarthritis, and says oral anti-inflammatories should be used at the lowest effective dose for the shortest time, with stomach protection. NICE also says paracetamol and weak opioids such as codeine should…

This page explains why pain medicines need extra care with age. It does not give doses — always follow the leaflet and your prescriber. For how each medicine works, see our painkillers and NSAIDs guide. For a full check of everything you take, see pharmacist medication reviews.

Why age changes things

Kidneys and liver work more slowly, so some medicines stay in the body longer
More medicines means more interactions — blood thinners, blood pressure tablets, steroids and some antidepressants all matter when choosing a painkiller
Side effects hit harder — drowsiness or dizziness can lead to a fall, constipation can be severe, and confusion can be mistaken for something else
Stomach bleeding risk from anti-inflammatories rises with age, and it can happen without warning signs

None of this means you should put up with pain. Untreated pain makes people move less, sleep badly and lose strength. It means choosing carefully and reviewing regularly.

What NICE says for osteoarthritis

Exercise, and weight management where relevant, are the core treatments; pain medicines should support exercise, not replace it
Offer an anti-inflammatory gel (a topical NSAID) for knee osteoarthritis, and consider one for other joints — gels put much less medicine into the bloodstream than tablets. See topical NSAIDs
If gels do not work or are unsuitable, consider an anti-inflammatory tablet at the lowest effective dose for the shortest time, with stomach protection such as a proton pump inhibitor. See when you need stomach protection
Do not routinely offer paracetamol or weak opioids, unless only used now and then for short-term relief and other medicines are unsuitable. NICE says there is no strong evidence of benefit for paracetamol in osteoarthritis. See paracetamol: what the evidence says
Do not offer strong opioids for osteoarthritis, because the risks outweigh the benefits

Inflammatory arthritis such as rheumatoid arthritis is different: painkillers ease symptoms but do not control the disease. If pain or swelling is building up, contact your rheumatology team rather than just taking more painkillers.

Anti-inflammatories (NSAIDs): who should ask first

The NHS advises checking with a pharmacist or doctor before taking ibuprofen or other NSAID tablets if you have:

had a stomach ulcer or bleeding
kidney, liver or heart problems, including heart failure, or high blood pressure
asthma that has been made worse by anti-inflammatories before
a blood thinner such as warfarin or apixaban, or a steroid tablet

Do not take two anti-inflammatories together, and remember that some cold and flu remedies contain ibuprofen. If you take low-dose aspirin for your heart, ask a pharmacist before adding an NSAID. More detail: NSAIDs: benefits, risks and safer use.

Paracetamol: check for hidden doubles

Paracetamol is in many combination products, including co-codamol and lots of cold and flu remedies. Taking two of these together is a common way to take too much by accident. Read every label, and ask a pharmacist if you weigh under 50kg (about 8 stone), have liver problems or drink alcohol regularly, as you may need a lower dose. If you think you have taken too much, go to A&E straight away, even if you feel well.

Codeine and other opioids

Codeine (including in co-codamol), tramadol and stronger opioids can cause drowsiness, dizziness, confusion and constipation, all of which raise the risk of a fall. They can also lead to dependence. Do not drive if you feel drowsy. If you have taken them regularly for a while, do not stop suddenly — ask your GP how to reduce them safely. See stopping medicines safely.

Nerve pain medicines

Gabapentin and pregabalin are sometimes prescribed for nerve-type pain. They can cause dizziness, sleepiness and unsteadiness, especially when you start or when the dose goes up. Tell your GP if you feel wobbly, and do not stop them suddenly.

Ways to need fewer tablets

Regular strength and movement — see arthritis pain relief
Heat or cold packs used safely, and pacing your day
Physiotherapy, which can be self-referred in many areas
A plan for flare days — see what to do in a flare-up

When to get help

Ask a pharmacist before buying any new painkiller or remedy, and for a review if you take five or more medicines
See a GP if you feel dizzy, drowsy or confused, are constipated for more than a few days, or your pain is not controlled. Do not stop or change prescribed medicines yourself. If sleep is a problem too, see sleeping tablets and falls
Contact NHS 111 for new stomach pain or indigestion while taking anti-inflammatories, or new confusion
Call 999 or go to A&E if you are vomiting blood or have black, sticky poo, have severe breathing problems or drowsiness after taking an opioid, or think you have taken too much paracetamol

You can report suspected side effects to the MHRA Yellow Card scheme.

Frequently asked questions

Is paracetamol the safest painkiller for older people?

Paracetamol has fewer side effects than many painkillers, but NICE says there is no strong evidence that it helps osteoarthritis pain. For knee or hand osteoarthritis an anti-inflammatory gel is often tried first. Ask your GP or pharmacist what suits you.

Can I use ibuprofen gel if I cannot take ibuprofen tablets?

Often, because much less reaches the bloodstream, but check with a pharmacist first, especially if you have had a reaction to an anti-inflammatory before.

Why does my GP want to reduce my painkillers?

Usually because the risks have grown or the benefit is small. A good review agrees a plan with you and adds other ways to manage pain. You can ask for a review at any time.

Sources and further reading

Educational information for people in the United Kingdom — not a diagnosis or personal medical advice. Charity no. 1218461. Pending clinical review. Everyone's situation is different, so always follow the advice of your own GP, pharmacist, physiotherapist or rheumatology team. If you feel very unwell, call 999 or go to A&E. For urgent advice, contact NHS 111.

Continue with related help

Painkillers and NSAIDs — how each medicine works
Topical NSAIDs — gels for knee and hand pain
NSAIDs — benefits, risks and safer use
Paracetamol — what the evidence says
Medication reviews — a pharmacist check of everything you take
Stopping medicines safely — step by step
Pain relief — non-drug options

Last updated 2026-10-21. This is general information, not a substitute for personalised medical advice.