Best Arthritis Medication, Natural Remedies, Surgery & More

Best Arthritis Medication, Natural Remedies, Surgery & More

Pain when moving can be caused by a huge number of diseases. The reason may be in trauma, nerve diseases, tumors, congenital anomalies of the structure. A common culprit for pain in adults is arthritis, an inflammation of the joints.

This name is understood as a whole group of diseases in which inflammation spreads to all parts of the joint. The disease can occur in one joint or in several, with acute pain or in a chronic form, and also provoke tissue destruction.

Therapy includes getting rid of the pain syndrome, eliminating the cause of the disease and restoring the diseased joint.

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Experts’ Response

Pharmacy Mall, a leading source of trustworthy health information with an online portal recommends contacting a healthcare provider if you have joint pain, stiffness, or swelling persisting for at least several weeks, whether or not arthritis signs began suddenly or gradually. Only a medical specialist can diagnose arthritis. An accurate diagnosis is needed so that necessary treatment can begin. A rheumatologist (arthritis specialist) will help you understand all of your treatment options – their benefits and their risks.

Best Arthritis Medications: Latest Advances in Treatment

Below are the best arthritis pain medication according to leading U.S. healthcare providers. Each clinical form of disease requires an individual treatment regimen. But there are drugs that are prescribed for any form of the disease:


Non-steroidal anti-inflammatory drugs (NSAIDs) are a group of non-hormonal anti-inflammatory drugs.

The most commonly used drugs in pediatric practice are aspirin, analgin, diclofenac, ibuprofen, ketoprofen, napraxen, piroxicam, meloxicam, and nimesulide.

NSAIDs are available in tablets, capsules, injections, ointments, gels, suppositories.

NSAIDs have anti-inflammatory, analgesic and antipyretic effects. The main mechanism of action is inhibition of the formation of prostaglandins. Prostaglandins are tissue hormones that promote inflammation and the pain that accompanies it.

Non-steroidal anti-inflammatory drugs are indicated for inflammatory diseases of the joints (rheumatoid arthritis, rheumatism, ankylosing spondylitis, chronic gouty arthritis), degenerative diseases (deforming osteoarthritis, osteochondrosis), lumbago, sciatica, neuralgia, myalgia, diseases of extra-articular tissues (tendovaginitis, bursitis, rheumatic lesions of the soft tissues), post-traumatic pain syndrome accompanied by inflammation, postoperative pain, acute attack of gout, migraine attacks, renal and hepatic colic, infections of ENT organs, residual effects of pneumonia. There are also NSAIDs for topical use in case of injuries of tendons, ligaments, muscles and joints (to relieve pain and inflammation during sprains, dislocations, bruises).

2. Glucocorticosteroids (GCS)

GCS play an important role in the treatment of rheumatoid arthritis and other inflammatory joint diseases.

GCS injections are carried out in the joints to quickly relieve inflammation and pain and restore mobility. Small doses of corticosteroids usually do not cause serious side effects.

Doctors sometimes prescribe oral corticosteroids to relieve acute symptoms of arthritis. As the patient’s condition improves, the dose is gradually reduced.

GCS have dangerous side effects, especially when used for a long time. These include osteoporosis, cataracts and exacerbation of glaucoma symptoms, as well as impaired adrenal function.

3. Drugs for the basic therapy of rheumatic diseases

These standard rheumatoid arthritis drugs are widely used to prevent joint destruction in arthritis and to treat other rheumatic diseases such as lupus, ankylosing spondylitis, and Sjögren’s syndrome.

Unlike NSAIDs, drugs in this group can suppress the development of rheumatoid arthritis but do not affect its symptoms. It may take 3 to 6 months before improvement occurs. Therefore, basic therapy drugs are usually used together with NSAIDs or corticosteroids.

The selection of such drugs requires some time, because sometimes it is necessary to test the effectiveness of different drugs in this group to achieve a noticeable improvement.

One must remember that such drugs can also cause serious side effects, such as impaired immunity and damage to the gastrointestinal tract.

With normal tolerability of the drugs of basic therapy, it is very important to maintain the entire initial period of therapy, even if there is no visible improvement in the first few weeks. If improvement is observed, therapy may continue for several years.

4. Painkillers (analgesics)

These drugs relieve or relieve pain but do not fight inflammation, unlike NSAIDs. They are most often prescribed for the treatment of osteoarthritis and other non-inflammatory but painful forms of arthritis. Some of them are sold without a prescription. But in any case, these drugs should be used only after consulting a doctor.

Such preparations may contain paracetamol, codeine, aspirin (acetylsalicylic acid), or a combination of these substances. With proper use of these drugs, side effects rarely occur. Aspirin, however, can cause stomach pain (acetylsalicylic acid is also an NSAID), codeine can cause nausea and constipation. Do not exceed the dose recommended by your doctor, do not use the drug for a long period of time without consulting a doctor.

5. Janus Kinase (JAK) Inhibitors

Janus kinase inhibitors belong to a group of oral targeted synthetic DMARDs that act on the intracellular JAK/STAT system that mediates the effects of various cytokines and other molecules, in particular hematopoietic growth factors and some hormones.

Three Janus kinase inhibitors are currently registered for the treatment of rheumatic diseases, tofacitinib (rheumatoid arthritis [RA], psoriatic arthritis), baricitinib (rheumatoid arthritis), and upadacitinib (rheumatoid arthritis).

Janus kinase inhibitors modulate the activity of various biologically active molecules, the complete blockade of which can lead to the development of severe immunodeficiency and disruption of homeostasis. Accordingly, the purpose of the use of Janus kinase inhibitors is a reversible decrease in the activity of one or more isoenzymes, and not a complete “turn off” of the JAK / STAT system as a whole. The effectiveness of Janus kinase inhibitors is associated primarily with the suppression of JAK1 activity, and therefore drugs are being developed that have a higher selectivity for this enzyme compared to tofacitinib and baricitinib. These include filgotinib, upadacitinib, itacitinib, solcitinib, etc. It is believed that the use of selective JAK1 inhibitors can lead to improved outcomes in the treatment of RA and other autoimmune diseases, primarily by increasing its safety since some side effects of tsDMARDs develop into the results of the blockade of other Janus kinases.

Over-the-Counter (OTC) Arthritis Medication

Pain relief is one of the primary purposes of arthritis treatment, and most medical professionals recommend starting with over-the-counter options.

Some of the best over the counter arthritis medications include:

  • Tylenol (acetaminophen).
  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as Bayer (aspirin), Motrin (ibuprofen), and Aleve (naproxen).

Over-the-counter treatments that are not taken orally:

  • Topical skin creams. Some creams contain NSAIDs, such as diclofenac, or Voltaren gel, Zostrix (capsaicin/menthol).
  • Transcutaneous electrical nerve stimulation (TENS) may also help reduce pain. TENS may require a prescription and/or may be covered by insurance.

Prescription Medication for Arthritis

Depending on the severity of your arthritis symptoms when you first consult with your doctor, you might be prescribed one or more prescription drugs.

The best medication for arthritis pain that require a prescription include the following.

  • NSAIDs/COX-2 Inhibitors: Feldene (piroxicam), Indocin (indomethacin), Mobic (meloxicam), Clinoril (sulindac), Dolobid (diflunisal), Relafen (nabumetone).
  • Analgesics (Pain Medications): Tylenol (acetaminophen/codeine), OxyContin (oxycodone), Percodan (oxycodone/aspirin), Vicodin (hydrocodone/acetaminophen).
  • Corticosteroids: Deltasone (prednisone) and methylprednisolone (Medrol).
  • Disease-Modifying Anti-Rheumatic Drugs (DMARDs): methotrexate and Plaquenil (hydroxychloroquine).
  • Biologic Response Modifiers (Biologics): Biologic Response Modifiers (Biologics): Xeljanz, Olumiant), Otezla Enbrel (etanercept), Remicade (infliximab), Humira (adalimumab), Cimzia (certolizumab pegol), Simponi (golimumab), s Orencia (abatacept), Rituxan (rituximab).
  • Other Drugs: Zyloprim (allopurinol), Uloric (febuxostat), Colchicine, Cymbalta (duloxetine HCl).

Which arthritis medication is right for you?

You need to understand that the arthritis pills mentioned in our article are only part of a comprehensive treatment that involves any type of arthritis. This is by no means a panacea.

Most NSAIDs are sold exclusively by prescription. But even if you find a tool that is implemented freely, this does not mean that it can be used independently. Be sure to consult with your doctor first.

Each drug has its own indications, a list of contraindications and possible side effects. This should be studied prior to purchase and use. At the doctor’s appointment, it is also worth talking about your health features that are not related to arthritis. If you are pregnant or have a chronic disease of the digestive, cardiovascular systems, and so on, you should definitely notify the doctor about this. This will help you quickly and competently choose the drugs that are right for you.

Non-medication treatment for arthritis pain


In addition to physical therapy, clinical guidelines for the treatment of rheumatoid arthritis include the following recommendations:

  • avoid physical activity and stress;
  • dress warmly and not overheat in the sun;
  • reduce/avoid travelling to other climatic zones;
  • give up smoking and alcohol;
  • go to bed before midnight;
  • use special insoles (if there are deformations);
  • engage in swimming and other supportive sports.

Patients need alternation of rest and physical activity and proper nutrition.

Diet for arthritis

The dependence of exacerbations of RA on specific food products has not been identified. However, in addition to treating rheumatoid arthritis with drugs, doctors recommend sticking to an arthritis diet to increase the overall resistance of the body. This helps slow the progression of rheumatoid changes and keep inflammation under control.

  • replace fatty meat with northern and other marine fish (a source of omega-3 acids, which serve as a natural antioxidant and reduce the production of “inflammatory hormones” prostaglandins);
  • limit the consumption of salty, spicy, heavily seasoned foods that cause dehydration;
  • refuse to consume confectionery and sausage products, muffins and semi-finished products.

Fish and meat for rheumatoid arthritis are best steamed or in foil. Also, a diet for rheumatoid arthritis should be enriched with sources of proteins, vitamins and minerals:


Physiotherapeutic procedures help relieve pain, strengthen the muscles and ligaments that support the joint and increase the range of voluntary movements. Most techniques are used during remission and are contraindicated in case of exacerbation. However, magnetotherapy and drug electrophoresis are widely used to relieve inflammation in the acute phase.

  • electrophoresis with lidocaine;
  • cryotherapy;
  • ozone therapy, ozocerite;
  • amplipulse;
  • shock wave therapy;
  • phonophoresis;
  • ultrasound therapy;
  • radon, iodine-bromine, sodium chloride and hydrogen sulfide baths, mud therapy, other balneological methods;
  • mechano- and kinesiotherapy;
  • massage and manual therapy;
  • paraffin applications.

Physiotherapy can be done at home – to relieve pain, you can do ice compresses for 5-15 minutes.


Therapeutic massage for arthritis is a very important component of the complex fight against this joint disease. A professional massage for rheumatoid arthritis at home helps to improve the blood supply to the joints and adjacent muscles. In addition, massage accelerates the elimination of toxic substances from the body.
However, you must remember that therapeutic massage for arthritis can only be performed at a time when the disease is in stable remission.

It is customary to start a massage session with those joints that are least affected by the disease. However, if the patient has no strong pain, the massage therapist may decide to massage the affected joints as early as during the first treatment sessions.

Massage should be carried out daily, usually the session lasts no more than 15 minutes. All massage techniques should be performed in such a way that the patient does not experience any pain.

A professional massage combined with the best arthritis medication helps eliminate pain syndrome, improve the process of blood circulation and metabolism, maintain a state of remission, reduce swelling in the affected joints, and improve mobility of the affected limbs.

You must remember that a stable beneficial effect is possible only if the massage is performed by a highly professional specialist.


Gymnastics in rheumatoid arthritis serves as a prevention of contracture and helps maintain the range of motion in the joint. Its role in relieving inflammation is also important – the stronger the muscles, ligaments and tendons, the less the load on the structural elements of the joint and the easier the disease.

Clinical guidelines for the treatment of rheumatoid arthritis during an exacerbation allow only passive flexion-extension movements (when the patient performs movements in the joint manually, without loading the muscles), in some cases – swimming. Passive movements with severe soreness and muscle tone are best performed in a warm bath.

To preserve muscle mass and motor skills of the fingers, a patient should do the following hand exercises:

  • Place your hands on the tabletop with your palms down, and then raise your hands so that your palms are facing straight ahead. Drop your brushes. Repeat 10-15 times.
  • Place your hands on the table top, palms down, and then turn them over, palms up. Perform 10 times.
  • Connect each finger in turn with the tips of the thumb – from the index to the little finger and vice versa. Repeat 3-4 times.
  • Stretch your arms out in front of you and rotate your wrists first clockwise and then counterclockwise. Repeat 6-8 times. Then clench your fingers into fists and rotate your fists.
  • Take an apple, tennis ball or silicone expander ball and clasp it with the fingers of one hand, gently squeezing. Then do the exercise for the other hand. Repeat 5-6 times.

At the end of the session, rub your palms together.

This complex should be performed daily, and also do not forget about 5-minute warm-ups if your professional activity is associated with a load on your hands. If rheumatoid arthritis has affected other joints, you can perform the standard sets of exercises recommended for arthritis of these joints.

Important: Exercise therapy should not bring pain! When exercising through strength, you can only harm your joints!

Occupational therapy is also used as gymnastics for rheumatoid arthritis. In the remission stage, patients with damage to the interphalangeal and wrist joints should do activities that develop fine motor skills of the fingers and strengthen the muscles of the wrist and hand – for example, modeling from dough, clay or plasticine, exercises with an expander, sorting out the rosary. If the pathological process has affected the elbow and knee joints, you should think about purchasing profile special expanders.

Surgery for arthritis

Rheumatoid arthritis is a serious disease that can seriously complicate a person’s life. If the patient sees a doctor late, if the disease is running, then medical measures are no longer enough and one has to resort to surgical interventions. Recently, the quality and quantity of innovative surgical technologies have experienced rapid growth. Even such a specialization as rheumatism appeared in orthopedics, which deals with the restoration of joints destroyed by rheumatism. Patients feel much more confident after the operation, the destruction of the joint stops, and the quality of life improves.

Indications for surgery for rheumatoid arthritis:

  • Deformities that significantly limit the function of the joint.
  • Expressed ankylosis.
  • Pain.
  • Synovitis, bursitis, which are not amenable to drug treatment.
  • Rheumatic nodules that ulcerate constantly.
  • Pinched nerve due to synovitis.
  • Traumatization of the tendon.
  • Aseptic necrosis.

The type of surgery is selected by a doctor on an individual basis. Before deciding on surgery, you should conduct a full examination, weigh all the pros and cons, and be sure that the surgery will be as effective as possible in this situation.

There are different surgical options for arthritis:

  1. Endoprosthetics. As wear and tear on bone and cartilage increases, consideration should be given to replacing the joint or joints. The aim is to allow the patient to move again without pain and improve the quality of life. The range of materials for artificial joints is diverse – titanium, ceramics, metal or polyethylene. Sometimes a total joint arthroplasty is required, sometimes it is enough to replace only one component. It is important not to miss the right time for arthroplasty. The greater the loss of function prior to surgery, the more likely it is that full functionality will not be achieved after surgery. In addition, previously damaged and fragile bones may not provide good mechanical support for the prosthesis. Endoprostheses have a limited shelf life. There are two surgical interventions – cement technology and cementless. Their main difference is in the principle of fixation of the artificial joint. According to one method, the prosthesis is practically cemented into the bone, that is, the implant is fixed due to a special medical polymer cement. In the cementless method, the components of the prosthesis literally grow into healthy bone, so that the bone and the prosthesis become one. These prostheses are usually used for a longer time.
  2. Arthrodesis. This intervention occurs when joint replacement is no longer possible. The destroyed articular surfaces are removed, and the bones are fixed with plates, screws, wires, or nails until the joint becomes immobile. In place of the diseased joint, a single bone is formed that can withstand a serious load, since its position will be fixed in a physiologically favorable position for the body. The patient will get rid of the pain but will be forced to move with the help of assistive devices. This method is rarely resorted to, but in some cases it is the only way out of this situation.
  3. Arthroplasty. Arthroplasty is chosen in the case of destroyed articular surfaces but still well-preserved ligamentous apparatus, joint capsule and muscles. After removal of the destroyed parts of the joint, the articular surfaces are rearranged and replaced with the body’s own tissue (capsular tissue, adipose tissue, muscle fascia) or artificial hypoallergenic pads.
  4. Correction of the articular surface. In the case of large axial deviations, the goal of correcting the joint surface is to once again achieve a uniform load on all components of the joint or to move limited cartilage from the joint stress zone. The bone is then separated and stabilized with screws, plates, wires and nails in an adjusted position. The procedure is usually performed in younger patients and in combination with a synovectomy (removal of the thin inner lining of the joint).
  5. Synovectomy. Articular synovectomy may be considered if the articular surfaces remain intact and the disease continues to progress for more than six months despite medical therapy. The inflamed mucosa or the inflamed tendon sheath tissue is completely removed surgically. The procedure can be open or performed using arthroscopy. Thanks to this intervention, inflammation is reduced, although the arthritis is not cured.

Surgery for rheumatoid arthritis becomes necessary if the effect of conservative treatments is no longer sufficient. Modern surgical methods usually guarantee the patient’s recovery from arthritis, but one must carefully weigh all the pros and cons of the consequences of the surgery. The rehabilitation period after arthroplasty is very difficult, and the patient must tune in to a long recovery process. But, if the surgery is the only chance for recovery, if the person is patient and conscientious, then you should not worry too much. Modern arthroplasty and rheumatoid surgery have achieved great success and today can guarantee excellent results.

Complementary and Alternative Medicine (CAM)


Acupuncture, which is one of the main areas of traditional Chinese medicine, is being introduced more and more intensively into wide clinical practice every day. This method of reflex action is based on the introduction of special needles into biologically active points. It is an effective and safe treatment for inflammatory diseases of the musculoskeletal system. Arthritis acupuncture is a method of reflex action on the biologically active points and zones that are part of the energy channels and are directly related to the inflamed parts. Most acupuncture points are located in close proximity to numerous nerve endings, which determine the ability of the joints to respond to direct and indirect effects with an inflammatory response and pain.

Biofeedback techniques

Biofeedback (BFB) is a therapeutic psychological technique in which the patient learns to understand and control the reactions of his body, such as blood pressure, muscle tension, heartbeat and nerve impulses. Physiotherapists use this technique to help patients regain tissue sensation after a stroke, psychologists to relieve stress and relax patients, and other specialists to treat various types of pain.


Magnetotherapy is a treatment through the influence of a magnetic field, which is a new and promising direction in physiotherapeutic methods of treatment. The essence of this cure of ailments is the action of a magnetic field created by a specialized medical device that affects the diseased organism as a whole – general magnetotherapy, or its separate area, local magnetotherapy. Magnetotherapy is not a complicated treatment, and magnetotherapy procedures are painless and simple. Magnetotherapy treatment can be carried out at home. Only magnets are used for procedures in magnetotherapy. Their impact is effective, and at the same time – completely harmless. In the course of scientific research, it has been established that magnetism, whether permanent or electromagnetic, is extremely beneficial for the human immune system and energy regeneration. These properties are used in magnetotherapy to treat many ailments and relieve pain. Using medical devices for magnetic therapy, it is possible to improve the condition of the body as a whole, to strengthen the immune system, increase the level of energy in the body, normalize peripheral circulation, eliminate or significantly reduce pain, prevent the negative effects of stress, neurosis, depression and other psychogenic diseases.


The method helps to enter a relaxed, calm state, which reduces the body’s response to stress. You can meditate while sitting still and focusing on your breath or mantras (a set of frequently repeated words). You can also meditate while walking or jogging. Proper meditation techniques, such as yoga, promote calm breathing, slow brain waves, reduce muscle tension, and slow heart rate. Meditation reduces the body’s response to chemicals that are produced in the body during pain.

Tai chi

Traditional Chinese tai chi exercises have been shown to reduce pain symptoms, fatigue, stiffness, and improve balance and overall sense of well-being among people with arthritis. Orthopedists at the University of North Carolina (USA) see significant benefits of tai chi for patients with all types of arthritis, including fibromyalgia, rheumatoid arthritis, and osteoarthritis. The doctors noted that traditional Chinese gymnastics help reduce pain symptoms, improve physical indicators of movement, reduce fatigue, and improve well-being. Physiologists believe that the technique can serve as a good tool for the prevention and treatment of joint diseases.


Yoga is a great opportunity to treat arthritis. In addition to physiological improvement, classes in Eastern philosophy will help reduce stress associated with illness, reduce pain, and increase the flexibility of articular joints. Yoga consists of spiritual, mental and physical practices when a person is able to control the physiological functions of the body through loads without excessive effort. By loading the inflamed joints, a person gives them mobility. Yoga also stimulates regenerative and metabolic processes in the body, thereby restoring cartilage tissue, strengthening muscles and joints, improving blood circulation, reducing pain. It also removes swelling, tones muscles, and helps lose excess weight. Medical studies have shown that arthritis patients those who use yoga practice regularly improved not only their physical but also the psycho-emotional state. Muscle spasms go away, the joints work normally – they are mobile.

Omega-3 fatty acids (fish oil)

This natural substance is useful for joints and ligaments. Omega-3 fatty acids (fish oil) are easily absorbed, actively participating in metabolic processes responsible for the renewal of bones, ligaments and tendons. Due to the lack of these bioactive substances, many people of all ages suffer from diseases of the musculoskeletal system, which disappear with regular use of fish oil. Its benefits in rheumatoid arthritis are proven by medical studies. The product is prescribed as part of complex therapy for poor nutrition. Regular use of this dietary supplement relieves the symptoms of arthritis, which allows you to take fewer drugs that have side effects.

Chondroprotectors (glucosamine and chondroitin)

Chondroprotectors are a group of drugs that have a stimulating effect on cartilage tissue, promoting its regeneration, and also inhibits subsequent destruction. Chondroitin sulfate promotes the synthesis of collagen and proteoglycan, due to which new chondrocytes are formed. It also reduces the activity of enzymes that damage cartilage, improves anabolism in cartilage tissue, stimulates the production of hyaluronic acid, inhibits its premature decay, improves the quality and volume of intra-articular fluid, relieves inflammation, slows down the process of destruction cartilage. Glucasamine is involved in the synthesis of heparin, hyaluronic acid, chondroitin and other substances necessary for the normal functioning of cartilage, stimulates the activity of chondrocytes, relieves inflammation, swelling, acts as an antioxidant, helps reduce the activity of catabolic enzymes that have a destructive effect on the joint. A similar mechanism of action of chondroprotectors on the joint determines their therapeutic effect in relation to arthritis. The combination of two active ingredients in different preparations may vary, so only a doctor can select them and prescribe a dosage.

Frequently Asked Questions

What is the main cause of arthritis?

Most forms of arthritis are caused by a fault in the immune system that causes the body to attack its own tissues in the joints. This may be inherited genetically. Other forms of arthritis can be caused by problems with the immune system or by a metabolic condition, such as gout.

What is the best medication for rheumatoid arthritis pain?

Methotrexate is usually the first medicine given for rheumatoid arthritis, often with another DMARD and a short course of steroids (corticosteroids) to relieve any pain. These may be combined with biological treatments.

What is the best pain medication for severe arthritis?

NSAIDs are the most effective oral medicines for severe arthritis. They include ibuprofen (Motrin, Advil) naproxen (Aleve) and diclofenac (Voltaren, others). All work by blocking enzymes that cause pain and swelling.

What is the best medication for spinal arthritis?

The best medication for spinal arthritis are:

  • Simple, non-opioid analgesics: acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.
  • Compound analgesics: these are made from a combination of two drugs that work together to relieve pain.

What is the safest anti-inflammatory drug for arthritis? 

Celecoxib is considered safe for long-term arthritis pain. It does less damage to the stomach than other NAIDs.


So, what is the best arthritis medication? The most effective treatment for arthritis depends on the form of the disease. First of all, it is necessary to eliminate the primary causes of arthritis, then treat the disease that caused arthritis directly.

Arthritis can be treated with antibiotics. Non-steroidal, anti-inflammatory drugs administered intraarticularly are also used. When carrying out treatment, it is necessary to pay great attention to physiotherapeutic procedures and therapeutic exercises, which are necessary to maintain joint mobility and preserve muscle mass.

If drug treatment does not give positive results, then surgical intervention may be recommended.

The diagnostic potential of the best US clinics for rheumatology makes it possible to conduct a comprehensive examination of patients, which is necessary for making an accurate diagnosis.

If you start therapy in the initial stages, the disease is easily treatable. The most important thing is to pay attention to all changes in the body in order to consult a doctor in time and prevent complications.

Category: General Issues

Tags: Arthritis, healthcare, Medication, Medicine, Treatment