How should I use pain medicine for bones, joints, and muscles?

Updated: Mar 7, 2020

Written by: Zoe Ziegler, PA-C and Alexander Riordan, MD

There are a number of medications for pain that are available to you over-the-counter. So, which medicines should you be taking and how often? Here is a list of common medications used to treat muscle and joint (musculoskeletal) pain listed in the order in which you should use them based on their possible side effects. Specific medical conditions could alter these recommendations so be sure to ask your physician if these are safe for you. If needing pain medicines frequently (multiple times daily), then we highly recommend you keep a written journal/log of when you took each medicine and the exact dose. Life is busy, and it is unhealthy to keep pain at the forefront of your mind at all times. So write it down and forget it until you are uncomfortable enough to need medicine next. That way you will have an easy and stress-free guide on what medicine(s) can be taken safely next.


Acetaminophen (Tylenol)

Take up to 1,000 mg every 8 hours as needed for pain.

Acetaminophen is a great first option for treating pain of any severity. It is an over-the-counter analgesic. Acetaminophen is one of the safest medicines on the planet, with very minimal few patients experiencing any side effects. It may work best when taken on a regular schedule throughout the day before your pain becomes too severe. If you have a known allergy to acetaminophen or have liver disease you should not take this medicine. You should not drink more than 2 alcoholic drinks per week when taking this medicine (both the medicine and the alcohol get processed through the liver). It is safe to take this medicine in combination with NSAIDs (see below) and opioids if prescribed/needed.

TAKE SECOND: Nonsteroidal Anti-Inflammatory Drugs or NSAIDs

***SAFETY NOTE: You must choose only ONE of the specific medicines in this category to take at a time. Do NOT mix and match (that would be too much of this type of medicine for your body). If your doctor prescribed one of the prescription strength NSAIDs, then you should NOT take ibuprofen, Advil, Motrin, naproxen, Aleve, or Naprosyn, for example. Any of the medicines in this category can cause anywhere from mild to severe stomach upset, or even ulcers if taken too frequently. If you experience mild stomach upset, you might try taking the medicine with food, or with medicines for acid reflux (heartburn). Acid reflux medicines can be found over-the-counter as well, and include medicines like Tums (calcium carbonate), Pepcid (famotidine), and Prilosec (omeprazole). If the stomach upset does not resolve with those simple fixes, then you should stop the medicine. Side effects you should contact a physician about urgently include: dark/black stools, bloody stools, severe nausea/vomiting, severe stomach pain that does not resolve, high fever. If you have high blood pressure (hypertension), diabetes, or kidney disease then it is likely that your primary care physician will recommend against taking significant amounts, or possibly any amount, of NSAIDs. Please consult with him or her regarding these medical conditions. Whenever taking ANY medicine (especially NSAIDs) you should drink plenty of water throughout the day; adequate hydration helps flush the medicine through your body more efficiently, and protects organ systems like your kidneys and liver.

***NOTE IF TAKING NSAIDs FOR A BROKEN BONE (FRACTURE): It is possible that heavy daily use of these medicines hurts your body's ability to heal bone. Taking them a couple times a day for a week or two after an injury is very unlikely to cause any harm though. After a couple of weeks, the hope would be that you are off medicine entirely, or once a day on only a few days a week if needed.

Ibuprofen (Advil, Motrin)

Take up to 600 mg every 6 hours OR 800 mg every 8 hours as needed for pain.

Ibuprofen is a good second option for treating pain with both anti-inflammatory and pain relieving effects. Some people find that 600 mg every 6 hours does not help the pain, so then we recommend using 800 mg but spacing the medicine out every 8 hours. Others find that they'd rather take the medicine more frequently so 600 mg every 6 hours can work best for them in those cases. Of course, try to space out the time between taking medicines as much as possible based on your comfort level.

Naproxen (Aleve, Naprosyn)

Take up to 500 mg every 12 hours as needed for pain.

Similar to ibuprofen (same class of medicine (NSAIDs)), naproxen works by reducing pain, discomfort and inflammation. This medicine suits people who don't wish to take a medication every 6 or 8 hours, and would rather space it out to just twice a day. If you experience pain at night, then naproxen may be worth a try since it will last longer than ibuprofen or acetaminophen. If this medicine is taken regularly for 2 weeks, and then slowly spaced out (weaned off), it can work very well to significantly calm down pain or swelling.

Prescription Strength NSAIDs (Meloxicam, Diclofenac)

The specifics on how often to take these medicines will be written on your prescription. Everything said above about naproxen can also be said about these medicines. They are strongest in this class of medicines, but that also means you might be more likely to experience side effects mentioned above. Therefore, patients should start by using over-the-counter medicines, and only ask their physicians about use of these prescription strength NSAIDs if those fail to provide an acceptable level of pain relief for you.

TAKE THIRD (only if prescribed)- Opioids: Tramadol, Vicodin or Norco (hydrocodone-acetaminophen), Oxycodone

These prescription pain medications are an option for only severe pain that is not relieved with the prior recommendations above. Many surgeons only prescribe these after a surgery or a severe fracture. As you've probably heard, there is an opioid epidemic in the U.S. that governmental agencies are cracking down on to try to help the issue. The government is tracking every one of these prescriptions that your physician writes, and they are tracking every prescription that you fill, where and when you fill it, who prescribed it, and how many pills you were given. See for further details.

Even though these medicines are the least safe on this list, they are sometimes necessary, and very effective for pain relief in severe situations. These medicines act on your pain receptors, so they do NOT help inflammation like NSAIDs might. Since opioids are more powerful medications, they also have more severe side effects such as addiction if taken for extended periods of time. It is usually best to only use these narcotic medicines for a few days, and at most 1-2 weeks. Anything longer than that puts you at risk for physical dependence on the medicine. Other very common side effects include consitpation (take with an over the counter stool softener and plenty of water), drowsiness or cloudy thinking, nausea, vomiting. Overdosing could cause you to stop breathing, so take and store these medicines VERY carefully. A log of when you took your last medicine is a MUST when taking medicines as powerful as these.

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