What to Do During a Gout Attack: Immediate Relief and Pain Management

A gout attack can strike suddenly, often in the middle of the night, bringing intense pain that can make even the lightest touch unbearable. Knowing what to do in those critical first hours can make a significant difference in how quickly you recover and how much pain you experience.

Immediate Steps During a Gout Attack

1. Take Your Prescribed Medication Immediately

If your doctor has prescribed medication for acute gout attacks, take it as soon as symptoms begin:

NSAIDs (like indomethacin, naproxen, or ibuprofen) - Reduce inflammation and pain
Colchicine - Most effective when taken within 12-24 hours of symptom onset
Corticosteroids (like prednisone) - For those who can't take NSAIDs

Important: Don't wait to see if symptoms improve. Early treatment leads to faster relief.

2. Rest the Affected Joint

Avoid putting weight or pressure on the inflamed joint:

Stay off your feet if your toe, ankle, or knee is affected
Use crutches if necessary to avoid bearing weight
Cancel physical activities and rest completely

Movement and pressure can worsen inflammation and prolong the attack.

3. Elevate the Joint

Raise the affected joint above heart level:

Prop your foot on pillows while lying down
Use a footstool when sitting
Keep the joint elevated as much as possible

Elevation helps reduce swelling by improving blood flow and drainage.

4. Apply Ice (Carefully)

Cold therapy can provide significant pain relief:

Wrap ice or a cold pack in a thin towel
Apply for 20 minutes at a time
Wait at least 30 minutes between applications
Never apply ice directly to skin

Note: Some people find heat more soothing. Listen to your body and use what works for you.

5. Keep the Joint Exposed

The affected joint is often extremely sensitive to touch:

Don't cover it with heavy blankets
Wear loose, non-restrictive clothing
Create a "tent" with sheets to avoid contact if needed

Even the weight of a bedsheet can be agonizing during an acute attack.

6. Stay Hydrated

Drink plenty of water throughout the attack:

Aim for 8-12 glasses per day
Water helps flush uric acid from your system
Avoid alcohol and sugary drinks

Dehydration can worsen symptoms and prolong the attack.

7. Avoid Anti-Inflammatory Foods

While beneficial long-term, certain changes during an attack can help:

Skip high-purine foods completely
Avoid alcohol entirely
Limit fructose and sugary foods
Stick to low-purine, anti-inflammatory options

Pain Management Strategies

Over-the-Counter Options

If you don't have prescription medication:

Ibuprofen (Advil, Motrin) - 600-800mg every 6-8 hours
Naproxen (Aleve) - 500mg twice daily

Avoid aspirin - it can actually raise uric acid levels and worsen symptoms.

Natural Pain Relief

While not as effective as medication, these may provide supplemental relief:

Cherry juice - May help reduce inflammation
Epsom salt soak - Warm (not hot) water with Epsom salts
Ginger tea - Natural anti-inflammatory properties
Turmeric - Anti-inflammatory supplement or added to food

Distraction Techniques

Managing pain perception:

Practice deep breathing exercises
Try meditation or guided imagery
Watch movies or shows to distract from pain
Listen to calming music

When to See a Doctor Immediately

Seek medical attention if:

This is your first gout attack (needs proper diagnosis)
Pain is severe and unmanageable with medication
You develop a fever (could indicate infection)
The joint becomes very red, hot, and swollen beyond typical gout
Symptoms don't improve after 3-4 days of treatment
You can't take NSAIDs or other standard treatments

An infected joint can mimic gout but requires different treatment. When in doubt, get it checked.

What NOT to Do

Avoid these common mistakes:

❌ Don't wait to take medication - Early treatment is crucial ❌ Don't massage the joint - This can worsen inflammation ❌ Don't apply heat initially - Can increase swelling ❌ Don't drink alcohol - Interferes with uric acid excretion ❌ Don't start uric acid-lowering drugs during an attack - Can prolong symptoms ❌ Don't try to "walk it off" - Rest is essential

How Long Will It Last?

With proper treatment:

Mild attacks: 3-5 days
Moderate attacks: 1-2 weeks
Severe untreated attacks: Several weeks

Early treatment significantly shortens duration and reduces pain intensity.

Preventing Future Attacks

After recovering from an acute attack:

Follow up with your doctor about long-term management
Take uric acid-lowering medication as prescribed
Track your triggers using an app like Gout Guru
Adjust your diet to avoid high-purine foods
Stay hydrated consistently
Maintain a healthy weight through gradual changes

Recovery Phase

As the attack subsides:

Gradually resume activity - Don't rush back to full movement
Continue hydration - Keep flushing uric acid
Eat anti-inflammatory foods - Cherries, berries, vegetables
Rest adequately - Your body needs time to heal
Schedule a follow-up - Discuss prevention with your doctor

Long-Term Management

Frequent attacks indicate a need for better uric acid control:

Daily uric acid-lowering medication (allopurinol, febuxostat)
Consistent dietary modifications
Regular monitoring of uric acid levels
Lifestyle changes for sustainable management

Track Your Attacks

Understanding your attack patterns helps prevention:

Note what you ate in the 24-48 hours before
Record any stress or physical triggers
Track medication effectiveness
Monitor attack frequency and severity

Download Gout Guru to log your symptoms, track triggers, and identify patterns that help you avoid future attacks.

The Bottom Line

A gout attack is intensely painful, but with prompt action, proper medication, rest, and elevation, you can significantly reduce both the severity and duration. Don't suffer in silence—take medication immediately, rest the joint, and consult your doctor about preventing future episodes.

The key to long-term success is not just managing attacks when they happen, but preventing them through consistent uric acid control and lifestyle management.