Colchicine
Colchicine is made from the crocus plant. It’s not a painkiller but it’s often very effective at damping down the inflammation caused by the crystals touching the joint lining. As with NSAIDs, colchicine tablets should be taken as close as possible to the beginning of an attack, and certainly within the first 24 hours of the attack starting, otherwise it may not be effective. Your doctor may let you keep a supply so you can start taking them at the first signs.
The recommended dose of colchicine is 0.5 mg two to four times per day, depending on your size, age and whether you have other health problems. Some people are unable to take colchicine because they have side-effects such as nausea, vomiting or diarrhoea. For this reason it’s best to start at a low dose and only increase it if there’s no upset.
You shouldn’t take colchicine at the same time as NSAIDs. Colchicine can interact with many other drugs (including statins for high cholesterol) but your doctor will advise whether this means you should avoid colchicine or temporarily adjust your other medications.
You can also take colchicine in the longer term at a dose of 0.5 mg once or twice a day to reduce your risk of having attacks in the future. However, like NSAIDs, colchicine won’t reduce the urate level in your blood, so it won’t help to get rid of the urate crystals or prevent long-term joint damage.
Steroids
If an acute attack of gout doesn’t improve with NSAIDs or colchicine or if you’re at risk of side-effects from these drugs, your doctor may prescribe a steroid injection into the joint or muscle, or a short course of steroid tablets (usually no more than a few days).
Other treatments
Putting an ice pack on the affected area can reduce some of the swelling, heat and pain. They’re very safe, but make sure that you don’t put the pack directly onto your skin to avoid burning or irritating your skin. You can buy reusable cooling pads from sports shops and chemists, or you can use a pack of frozen peas, wrapped inside a damp towel. You should always use ice packs alongside any drug treatments your doctor has prescribed.
Resting the painful joint also takes some of the edge off severe pain. A cage over the affected foot or knee to take the weight of the bedclothes at night can help.