Features May 2018 Issue

Pain Relief for Knee Arthritis

No drug or other therapy alone will relieve symptoms of knee osteoarthritis. It requires a comprehensive approach.

Osteoarthritis in the knee is very common, especially as we get older, typically causing achy pain, mild swelling and stiffness after inactivity. Many people reach for a bottle of pills, mostly nonsteroidal anti-inflammatory drugs (NSAIDs) (such as ibuprofen [Motrin®, Advil®] or naproxen [Aleve®]), to relieve symptoms.

While you can take pain-relieving drugs, they should be used cautiously and only as one part of a more comprehensive approach. “Each person is unique, so we have to formulate an individualized treatment plan,” says Cleveland Clinic sports medicine physician Carly Day, MD.

Most Important

For people who are overweight or obese, the most effective treatment is weight loss. This is not surprising because every extra pound of weight adds two to four pounds of excess pressure on the knees. “Losing weight is probably the most difficult part of the treatment puzzle, but it’s also the most important,” says Dr. Day.

A weight loss program should include both diet and exercise. Some people have difficulty exercising to lose weight because their knees hurt. But any type of exercise can help, even strengthening the upper body.

Physical Therapy

knee therapy

© stevecoleimages | Getty Images

A physical therapist is a key member of the healthcare team for knee osteoarthritis.

Physical therapy is definitely beneficial. “Improving range of motion and strength in the knee are helpful, but physical therapy for knee osteoarthritis has a large focus on strengthening the hips,” says Dr. Day. Weak hips put more pressure on the knees. If your hips are strong, when you get up from a chair or go up and down stairs your knees have less work to do.

You also need to work on strengthening the muscles in the thigh (quadriceps). Everyone with knee osteoarthritis should consult a physical therapist, according to Dr. Day. Not only will you be taught the right kinds of exercises, a physical therapist also provides valuable instruction about using assistive devices (such as a cane or walker) and modifying activities (such as climbing stairs or getting in and out of a car) to reduce pain.

Exercise

In addition to physical therapy, it’s important to incorporate regular exercise into your daily routine. “Joints are built to move,” says Dr. Day. The evidence shows that people who are least active have more arthritis pain than people who do some form of exercise.

Choose lower-impact activities, such as walking, bicycling, swimming or exercising in a pool.

Bracing

Often a knee brace can help. “There’s evidence to show that even a simple compression sleeve can decrease pain,” says Dr. Day. These are a good way to start because you can get one at the drugstore.

You can also talk to your doctor about a more customized unloader brace. These take pressure off a portion of the joint. The brace that’s right for you will depend on the severity and location of arthritis, whether primarily in the inner or outer side of the joint or in the kneecap.

Supplements

For people with milder pain, Dr. Day suggests trying supplements, such as the combination of glucosamine and chondroitin.

The evidence is mixed, but these supplements are safe. So they might be worth trying. However, people with a shellfish allergy may not be able to tolerate them. Any effect won’t kick in right away. Dr. Day recommends trying them for six to eight weeks. “If you notice improvement, great; if not, then stop it,” she says.

The spice turmeric has anti-inflammatory properties, and there is some evidence for its usefulness for painful knee arthritis. You can add turmeric to your food or take it as a supplement. It can thin blood, so people who take a blood-thinning medication should not use turmeric.

Pain Medications

leg abduction

Illustration by Alayna Paquette

There are two types of over-the-counter pain medications that can be used for osteoarthritis. Acetaminophen (Tylenol®) is a pain reliever but not an anti-inflammatory. It may help with mild knee pain.

NSAIDs can be more effective because they both relieve pain and reduce inflammation. However, they come with potential side effects and risks. NSAIDs can irritate the lining of the stomach, which may lead to an ulcer or other stomach problems. They also can impair kidney function. Some NSAIDs can increase blood pressure. They also may increase risk for heart disease.

Because of the risks, Dr. Day cautions against using NSAIDs regularly over long periods of time. Instead, she uses NSAIDs for her patients in two ways. First, people who have a flare-up of pain can take them regularly (meaning every 4 to 6 hours, depending on the drug) for three to five days and then stop. Second, they can be used over the long term, but only occasionally, maybe a couple of times a week as needed.

If you’re taking NSAIDs several times a day for long periods of time, Dr. Day advises reducing their use by maximizing the other treatment strategies. She also suggests trying a topical NSAID, such as diclofenac (Voltaren Gel®, Pennsaid®), which has fewer potential side effects.

Opioid pain relievers are discouraged for long-term treatment of chronic knee pain. “The milder narcotic tramadol might be appropriate for occasional use in some people,” says Dr. Day.

Injections

If the strategies above don’t provide enough relief, injection therapy is an option with low risk. A corticosteroid injection delivers this anti-inflammatory drug directly to the knee. The benefits are typically short lived. But results vary from person to person. “I tell my patients the pain relief can last anywhere from a week to a year,” says Dr. Day. One cautionary note with corticosteroids is the potential to increase blood sugar, which is a concern for people with uncontrolled diabetes.

For a possibly longer lasting effect, an injection of hyaluronic acid (also called viscosupplementation) can be tried. “Hyaluronic acid is a substance that healthy joints have a lot of and arthritic knees don’t,” says Dr. Day. It takes longer to start working than a corticosteroid injection, but the effect often lasts six months to a year.

Two other injection therapies are platelet-rich plasma (PRP) and stem cells, neither of which is covered by insurance. PRP involves drawing some blood, spinning it in a centrifuge, and injecting part of it into the knee. “There’s currently more science backing up the effect of PRP than stem cells,” says Dr. Day.

If you’re not able to get your symptoms under control with a combination of the measures described above, it could be time to talk to your doctor about surgery.

Comments (1)

In the article above, there is a problem with the physics in the sentence: "This is not surprising because every extra pound of weight adds two to four pounds of excess pressure on the knees. " Weight is a FORCE. pressure is a FORCE/UNIT AREA. Also what is the source of the "two" to "four" multiplier for added weight? Is it impact stresses?

Posted by: Drnevich | May 11, 2018 10:23 AM    Report this comment

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