Over-the-counter anti-inflammatory painkillers like ibuprofen and naproxen are the most common and effective first-line medicines for tendonitis. They reduce both pain and swelling, and most people can start them at home without a prescription. But the right medicine depends on whether your tendon problem is a fresh injury or a long-standing issue, because inflammation plays a very different role in each.
Why the Type of Tendon Problem Matters
Tendonitis and tendinosis sound similar but respond differently to medication. Tendonitis is inflammation from micro-tears that happen when a tendon is suddenly overloaded, like a weekend of aggressive gardening or a sharp increase in running mileage. The tendon is actively inflamed, so anti-inflammatory medicines work well.
Tendinosis, on the other hand, is a slow degeneration of the tendon’s collagen fibers from chronic overuse. Inflammatory cells are rarely found in tendinosis tissue. That means anti-inflammatory drugs may relieve your pain temporarily, but they won’t fix the underlying problem. Worse, ibuprofen has been linked to impaired collagen repair, which could actually slow healing of a chronically damaged tendon. If your pain has lingered for weeks or months, you may be dealing with tendinosis rather than true tendonitis, and your treatment plan should look different.
Ibuprofen vs. Naproxen: Choosing an OTC Option
Ibuprofen and naproxen sodium are the two most widely used over-the-counter options for tendon pain. Both belong to the same drug class (NSAIDs) and work by blocking the chemicals that cause swelling and pain. The practical difference is timing.
Ibuprofen (200 mg tablets) is taken as one to two tablets every four to six hours, up to 1,200 mg per day. It kicks in relatively fast but wears off quickly, so you may find yourself dosing multiple times throughout the day. Naproxen sodium (220 mg tablets) lasts longer. You take one to two tablets every 8 to 12 hours, with a daily limit of 660 mg. For tendon pain that nags all day, naproxen’s longer duration means fewer pills and more consistent relief.
Both drugs perform similarly in head-to-head comparisons for musculoskeletal pain. If you have a preference based on past experience, that’s a reasonable guide. Aspirin also has anti-inflammatory effects, but it’s less commonly recommended for tendon issues specifically because its blood-thinning properties are more pronounced.
How Long You Can Safely Take NSAIDs
Don’t use over-the-counter NSAIDs continuously for more than 10 days for pain unless a healthcare provider has told you otherwise. This isn’t an arbitrary cutoff. NSAIDs irritate the stomach lining, and the longer you take them, the higher your risk of developing ulcers or gastrointestinal bleeding. Common side effects during even short-term use include bloating, heartburn, stomach pain, and nausea.
Watch for warning signs of more serious problems: black or tarry stools, blood in your urine, severe stomach pain, or vomit that looks like coffee grounds. These suggest internal bleeding and need immediate attention.
You should avoid NSAIDs altogether if you have kidney disease, liver cirrhosis, or congestive heart failure. They’re also not safe to combine with blood-thinning medications. Women who are trying to conceive should skip NSAIDs as well, since they can interfere with conception.
Topical Anti-Inflammatory Gels
Topical NSAID gels (like diclofenac gel, available over the counter in many countries) deliver the drug directly to the painful area. For tendons close to the skin’s surface, such as the Achilles, wrist tendons, or the outside of the elbow, a topical gel can provide meaningful relief with far less drug entering your bloodstream. This makes it a better choice if you’re concerned about stomach side effects or if you only have pain in one specific spot. It won’t work as well for deeper tendons like the rotator cuff, where the drug can’t penetrate far enough.
Steroid Injections for Stubborn Pain
When oral painkillers aren’t enough, corticosteroid injections are a common next step. A doctor injects a synthetic version of cortisol directly into or near the inflamed tendon. The steroid suppresses the local immune response, which can dramatically reduce pain and swelling within days.
The relief is real but temporary, and there are limits. Most people shouldn’t get more than three steroid injections in the same area per year, with at least three months between shots. Repeated injections carry a meaningful risk: corticosteroids have been shown to inhibit collagen repair and are associated with later tendon tears. For chronic tendon problems (tendinosis), steroids may actually make the structural damage worse over time, even as they mask the pain.
Platelet-Rich Plasma (PRP) Injections
PRP involves drawing your own blood, concentrating the platelets, and injecting them into the damaged tendon. The idea is that growth factors in platelets stimulate tissue repair. The evidence is mixed, but it’s promising for certain tendons.
The strongest support is for lateral epicondylitis (tennis elbow). In the largest study on the topic, 230 patients who had failed at least three months of conservative treatment received PRP. At 24 weeks, 71.5% reported significant pain improvement, compared to 56.1% in the control group. Residual tenderness was also cut nearly in half. There’s moderate evidence supporting PRP for patellar tendinopathy (jumper’s knee) as well.
For Achilles tendinopathy and rotator cuff tendinopathy, though, the current evidence doesn’t support routine use. PRP is typically reserved for chronic cases that haven’t responded to other treatments, and it’s not covered by all insurance plans.
Nitroglycerin Patches
One lesser-known option for chronic tendon problems is a nitroglycerin (GTN) patch, which delivers nitric oxide through the skin. Nitric oxide plays a role in collagen synthesis and tendon remodeling. In clinical trials, patients who applied a low-dose patch (1.25 mg over 24 hours) to the tender area daily saw significantly better outcomes than those doing rehabilitation alone.
For tennis elbow, 81% of patients using the patches were pain-free during daily activities at six months, compared to 60% with rehab alone. For Achilles tendon problems, it was 78% versus 49%. Shoulder tendinopathy showed the most dramatic improvements, particularly in strength. These patches require a prescription and can cause headaches as a side effect, but they offer a non-invasive option for tendons that aren’t responding to standard treatment.
Supplements for Tendon Repair
Vitamin C and collagen supplements have attracted attention for tendon healing. Vitamin C is essential for your body to produce collagen, the main structural protein in tendons. Clinical data on a combination of type I collagen, vitamin C, and mucopolysaccharides suggests this mix promotes the body’s own production of healthy collagen, potentially improving both symptoms and the structural condition of damaged tendons.
These supplements are unlikely to resolve tendonitis on their own, but they may support the healing process alongside other treatments, particularly for chronic tendon issues where the goal is rebuilding degraded tissue rather than just calming inflammation. The evidence is still growing, so think of supplements as a complement to your primary treatment, not a replacement.
Matching Medicine to Your Stage of Healing
For a fresh, acutely painful tendon (less than a few weeks), NSAIDs are your best starting point. Take them consistently for a few days rather than sporadically, combine them with rest and ice, and you’ll give the inflammation its best chance to settle. If pain persists beyond 10 days of NSAID use, it’s time to see a provider who can evaluate whether you’re dealing with something more than simple inflammation.
For chronic tendon pain lasting months, the picture shifts. Anti-inflammatories become less useful and potentially counterproductive. Treatments that promote tissue remodeling, like eccentric exercises, PRP for specific tendons, or nitroglycerin patches, are more likely to address the root problem. A steroid injection might buy you a window of reduced pain to engage in physical therapy, but it shouldn’t be the long-term plan.