From the Guidelines
For knee pain treatment, the most effective approach is to combine non-pharmacological and pharmacological treatment modalities, with a focus on sustained weight loss, exercise, and the use of oral nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen, as recommended by the most recent and highest quality study 1.
Key Recommendations
- Sustained weight loss is beneficial for patients with knee osteoarthritis, particularly those who are overweight or obese, as it can reduce pain and improve function 1.
- Exercise, such as gentle exercises like swimming or cycling, can help strengthen muscles around the knee without high impact, and physical therapy focusing on quadriceps and hamstring strengthening can provide stability.
- Oral NSAIDs or acetaminophen can be used to manage pain, with NSAIDs being more effective but also carrying a higher risk of gastrointestinal adverse events.
- Intra-articular injections, such as corticosteroid injections, may be considered for patients with acute exacerbations of knee pain, especially if accompanied by effusion.
Non-Pharmacological Interventions
- Weight reduction can significantly reduce knee pain by decreasing pressure on the joint, with each pound lost reducing knee load by four pounds.
- Physical therapy can help improve function and reduce pain, particularly when combined with exercise and weight loss.
- Knee braces may be considered for support during activities, especially for patients with persistent pain.
Pharmacological Interventions
- Acetaminophen can be used as a first-line treatment for knee pain, with a recommended dose of 325-650mg every 4-6 hours (not exceeding 3000mg daily).
- NSAIDs, such as ibuprofen or naproxen, can be used for patients who do not respond to acetaminophen, with a recommended dose of 200-400mg every 4-6 hours with food (maximum 1200mg daily).
- Topical NSAIDs, such as diclofenac gel, can be applied to the affected area 2-4 times daily for additional pain relief.
From the FDA Drug Label
CLINICAL PHARMACOLOGY Ibuprofen tablets contain ibuprofen which possesses analgesic and antipyretic activities. Its mode of action, like that of other NSAIDs, is not completely understood, but may be related to prostaglandin synthetase inhibition In clinical studies in patients with rheumatoid arthritis and osteoarthritis, ibuprofen tablets have been shown to be comparable to aspirin in controlling pain and inflammation and to be associated with a statistically significant reduction in the milder gastrointestinal side effects
Knee Pain Treatment: Ibuprofen tablets have been shown to be effective in controlling pain and inflammation in patients with osteoarthritis, which may include knee pain.
- The analgesic and antipyretic activities of ibuprofen make it a suitable option for treating knee pain.
- However, it is essential to carefully evaluate the patient's medical history and current condition before prescribing ibuprofen for knee pain treatment.
- Patients should be monitored for signs and symptoms of gastrointestinal ulceration and bleeding, as well as other potential side effects. 2
From the Research
Knee Pain Treatment Options
- Conservative treatment is often the first-line approach for knee pain, including osteoarthritis, patellofemoral pain, and meniscal tears 3, 4, 5
- Exercise therapy, weight loss, education, and self-management programs are recommended for osteoarthritis 3, 4
- Hip and knee strengthening exercises, foot orthoses, and patellar taping are recommended for patellofemoral pain 3
- Conservative management, including exercise therapy, is also appropriate for most meniscal tears 3
Interventional Therapies
- Intra-articular injections of corticosteroids and radiofrequency ablation of the genicular nerves have been shown to be effective for chronic knee pain 6
- Hyaluronic acid infiltrations are conditionally recommended 6
- Platelet-rich plasma infiltrations, chemical ablation of genicular nerves, and neurostimulation have limited evidence and can be considered in a study setting 6
Surgical Options
- Surgical referral for knee joint replacement can be considered for patients with end-stage osteoarthritis after using all appropriate conservative options 3
- Knee arthroscopy to remove unstable meniscus tears or foreign bodies, as well as osteotomy for unicompartmental arthrosis, are surgical joint-preserving therapies 5
- The decision to perform joint-preserving and joint-replacement options should be made multidisciplinary 6
Treatment Guidelines
- A combined conservative therapy, including weight reduction, physical therapy, self-management education programs, and pharmacological treatment, is recommended for knee osteoarthritis 4
- Consensus guidelines on interventional therapies for knee pain have been developed to standardize treatment and provide a framework for practitioners to compare and contrast different options 7