Ever since the pharmaceutical giant Merck withdrew its famed pain reliever Vioxx from the market last fall, the roughly four million Texas adults who suffer from arthritis have been left with a confounding conundrum: Are any company’s pain pills safe these days? After all, Vioxx was supposed to be a miracle drug. It’s not addictive (like opiates), and it causes less stomach ulceration than aspirin or ibuprofen. But a study that linked Vioxx users to a greater risk of heart attacks and strokes has put the drug out of business and suddenly called into question its prescription competitors, Celebrex and Bextra. Relax, says David Karp, a rheumatologist at the University of Texas Southwestern Medical Center at Dallas, who insists that even with Vioxx gone there are still plenty of ways to find relief without risk.

First, read the darn label. Studies have shown that 20 percent of Vioxx patients simply took too much of the stuff, exponentially increasing their cardiovascular risk. Take exactly what the doc advises. Says Karp, who is still prescribing Celebrex for patients who benefit from the drug, but only in the lowest effective doses (along with Bextra, it hasn’t yet been linked to heart problems): “Every patient who takes arthritis medication on a chronic basis needs to discuss the various risks with his physician.”

Remember the old new thing. Backed by a multimillion-dollar ad campaign touting its wonders, it’s no mystery how Vioxx became the pain reliever of choice among arthritis patients. But according to Karp, acetaminophens such as Tylenol can handle arthritis pain for about 30 percent of its sufferers just as well as any new drugs. Again, you have to watch how many pills you pop. Overuse of acetaminophens can cause liver toxicity, and according to a study by the American College of Emergency Physicians, abuse of over-the-counter pain medications is responsible for more than 103,000 hospitalizations and more than 16,000 deaths per year.

Memorize this name: Etodolac. Ask your doctor about this generic pain reliever, one that got lost in the aforementioned advertising blizzard for Vioxx. In one study of Veterans Affairs patients, Etodolac showed great promise in relieving pain and, like Vioxx, is not addictive or a significant cause of stomach bleeding or ulcers. And there are no reports thus far of a link between Etodolac and cardiovascular disease.

Get alternative. Look for the supplements glucosamine and chondroitin in the vitamin aisle at your local supermarket. Both are naturally occurring constituents of human cartilage, and some research suggests that both can have a modest impact on osteoarthritis and joint pain. Karp also recommends that some patients consider acupuncture. The once-marginalized ancient art, which uses tiny needles to interrupt the flow of pain impulses along “meridians” in the nervous system, has now acquired enough credibility that most major health care plans cover the practice.

Ditch the gelcaps altogether. There is one pain reliever that doesn’t involve swallowing pills or the risk of a single side effect: diet and exercise. “It has been suggested,” says Karp, “that proper weight, proper work, and proper play can prevent up to 75 percent of osteoarthritis cases.”