What are the home management strategies for chronic knee pain?

From the Guidelines

Managing chronic knee pain at home requires a multifaceted approach that prioritizes weight management, exercise, and self-management programs, as strongly recommended by the 2020 American College of Rheumatology guideline 1.

Key Recommendations

• Weight loss of 5-10% of body weight can significantly improve symptoms, and combining weight loss with exercise programs enhances efficacy 1.
• Self-efficacy and self-management programs are strongly recommended, using a multidisciplinary approach that includes education, skill-building, and exercise goals 1.
• Tai chi is strongly recommended for patients with knee OA, due to its holistic impact on strength, balance, and fall prevention, as well as depression and self-efficacy 1.
• Cognitive behavioral therapy (CBT) is conditionally recommended for patients with knee OA, as it may reduce pain and improve health-related quality of life 1.

Exercise and Physical Therapy

• Regular exercise, such as low-impact activities like swimming, cycling, or walking, can help strengthen muscles supporting the knee without causing additional strain 1.
• Physical therapy is suggested as part of a comprehensive management plan for patients with osteoarthritis of the knee, and may include bracing with soft braces or valgus or varus knee braces to improve pain and self-reported physical function 1.

Pharmacotherapy

• Topical nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended for patients with pain associated with osteoarthritis of the knee 1.
• Acetaminophen and/or oral NSAIDs are suggested for pain associated with osteoarthritis of the hip and knee, while duloxetine may be considered as an alternative or adjunctive therapy for patients with inadequate response or contraindications to acetaminophen or NSAIDs 1.

Additional Measures

• Applying ice or heat therapy, using knee braces or compression sleeves, and elevating the legs while resting can help reduce inflammation, relieve stiffness, and decrease pressure on the knee joint.
• Avoiding prolonged standing or sitting and maintaining a healthy weight can also help alleviate chronic knee pain.

From the FDA Drug Label

Directions • adults and children 12 years of age and older: apply 3 to 4 drops of medicated oil to the affected area 1 to 2 times daily. After applying the product, a warm pad may be placed on the affected area for 10 minutes and then massage as shown in the illustrations. Directions Adults and children 18 years of age and older: Apply a thin film of cream to affected area and gently rub in until fully absorbed. Unless treating hands, wash hands thoroughly with soap and water immediately after application. For best results, apply 3 to 4 times daily.

For chronic knee pain management at home, two options are available:

• Menthol (TOP) 2: Apply 3 to 4 drops of medicated oil to the affected area 1 to 2 times daily, followed by a warm pad and massage.
• Capsaicin (TOP) 3: Apply a thin film of cream to the affected area 3 to 4 times daily. Key considerations:
• Age restrictions apply for both products, with menthol suitable for children 12 years and older, and capsaicin for adults and children 18 years and older.
• It is essential to follow the directions and warnings for each product to ensure safe use.

From the Research

Chronic Knee Pain Management at Home

Chronic knee pain can be managed at home using various methods, including:

• Exercise therapy, which is a first-line management option for osteoarthritis and patellofemoral pain syndrome 4
• Weight loss, which is recommended for patients with osteoarthritis and a body mass index greater than 25 kg per m2 4, 5
• Oral analgesics, such as nonsteroidal anti-inflammatory drugs and acetaminophen, which can be used initially to manage chronic knee pain 6, 5
• Topical analgesics, such as topical NSAIDs, capsaicin, and lidocaine, which can be used to treat chronic pain conditions, including osteoarthritis and musculoskeletal pain 7

Non-Pharmacological Interventions

Non-pharmacological interventions, such as:

• Physical therapy, which is the foundation for treating knee osteoarthritis and patellofemoral pain syndrome 4, 5
• Foot orthoses, which can be helpful for anterior knee pain 4, 5
• Knee braces, which may be effective for stabilizing traumatic knee ligament and tendon tears, but their effectiveness for chronic knee pain is uncertain 5

Pharmacological Interventions

Pharmacological interventions, such as:

• Intra-articular injections of corticosteroids, which are effective for short-term pain relief in patients with osteoarthritis 8, 5
• Hyaluronic acid injections, which have a controversial benefit and recommendations vary 8, 5
• Regenerative injections, which may improve pain and function in patients with chronic knee tendinopathies and osteoarthritis, but more research is needed 5