Gout attacks: Pain relief

Photo of hands on a computer keyboard
PantherMedia / Robert Kneschke

Gout attacks are one of the most painful joint problems. Anti-inflammatory painkillers and steroids can help relieve the pain. The gout medication colchicine is another option – but it has a slower effect.

Gout is caused by high uric acid levels. If the amount of uric acid in the body is too high, crystals may start to form in the joints and cause a painful gout attack. The pain and swelling are usually at their worst 6 to 12 hours after an attack starts. It usually takes about a week for the swelling to go down and the joint to recover. Acute pain can be relieved with anti-inflammatory painkillers or short-term steroid treatment. These medications start working within one hour.

Non-steroidal anti-inflammatory drugs (NSAIDs)

Anti-inflammatory painkillers include drugs like diclofenac, ibuprofen, indomethacin, naproxen and etoricoxib. These drugs are also called non-steroidal (NSAIDs). Some of them are available over the counter from pharmacies, while others are prescription-only. NSAIDs can effectively relieve the pain of a gout attack. Although acetylsalicylic acid (the drug in medicines like Aspirin) is an NSAID, it's not well suited for treating gout. On the contrary: Research suggests that taking a low dose of acetylsalicylic acid can increase the risk of a gout attack.

The most common side effects of NSAIDs include stomach and bowel problems such as diarrhea and nausea. Etoricoxib is somewhat better tolerated than other NSAIDs.

Peptic (stomach) ulcers are a rare side effect of NSAIDs. People who already have a higher risk of developing peptic ulcers can combine NSAIDs with drugs called proton-pump inhibitors (e.g. omeprazole). Proton-pump inhibitors protect the mucous lining of the stomach in order to help prevent ulcers.

Steroids (corticosteroids)

Steroids are typically taken in the form of tablets (oral steroids). Studies have shown that they are about as effective in relieving pain as NSAIDs are. Usually, the steroid prednisolone is used for five days at a dose of 3 to 4 tablets per day, each of which contain 10 mg of the active ingredient.

Prednisolone is better tolerated than most anti-inflammatory painkillers, especially by the stomach and bowel. One relatively rare side effect is a temporary rash.

Corticosteroid tablets have a bad reputation because they have serious side effects if you take them for a long period of time. But there’s no need to fear these side effects if you use them for the short-term treatment of a gout attack.

Colchicine

Colchicine is an herbal medication made from the autumn crocus plant. It is believed to stop immune cells that are involved in inflammations from entering the joints. Colchicine can effectively relieve acute gout. It's important to start the treatment within the first 36 hours of the gout attack.

Colchicine isn't used that much nowadays because it can take up to 24 hours to have its full effect. But it’s an alternative option for people who don't tolerate the other medications or who can't take them for other reasons.

Treatment with colchicine involves taking a total of four tablets that each have 0.5 mg of the drug in them. Two tablets are taken together first, and then the third tablet is taken after one hour. The fourth tablet is taken one hour after the third one. Most people tolerate this total colchicine dose of 2 mg well.

Medical societies advise people not to take higher doses of colchicine because it then very commonly leads to side effects such as diarrhea, nausea and vomiting. Also, according to what is currently known about the medication, higher doses aren't more effective. At any rate, it's important not to take more than the maximum daily dose of 6 mg.

Comparing the medications

Previous studies have shown the various medications to be equally effective. Gout attacks are typically treated with an NSAID such as naproxen or the steroid prednisolone. Depending on how severe the pain is, these two types of medication can be combined.

The choice of medication will also depend on your personal situation. NSAIDs, for example, are not suitable for people who are taking anticoagulants (anti-clotting medication) or who have stomach or bowel conditions, or kidney failure. Steroids may not be an option for people with diabetes or acute infections.

Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM). Akute Gicht in der hausärztlichen Versorgung (S1-Leitlinie). AWMF-Registernr.: 053-032b. September 2013.

Qaseem A, Harris RP, Forciea MA. Management of Acute and Recurrent Gout: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med 2017; 166(1): 58-68.

Shekelle PG, FitzGerald J, Newberry SJ, Motala A, O'Hanlon CE, Okunogbe A et al. Management of Gout. March 2016. (AHRQ Comparative Effectiveness Reviews; Volume 176).

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

Comment on this page

What would you like to share with us?

We welcome any feedback and ideas. We will review, but not publish, your ratings and comments. Your information will of course be treated confidentially. Fields marked with an asterisk (*) are required fields.

Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

Updated on May 17, 2018
Next planned update: 2021

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

How we keep you informed

Follow us on Twitter or subscribe to our newsletter or newsfeed. You can find all of our films online on YouTube.