From the Guidelines
For knee osteoarthritis pain, I recommend a multi-faceted approach combining medication, physical therapy, and lifestyle modifications, prioritizing education, exercise, and weight loss as core treatments, as suggested by the most recent guidelines 1. The optimal management of knee osteoarthritis (OA) requires a combination of non-pharmacological and pharmacological treatment modalities, tailored to the individual patient's needs, taking into account factors such as age, comorbidity, and the presence of inflammation. Some key recommendations for the management of knee OA include:
- Education and exercise regimens to reduce pain and improve function
- Weight loss, if overweight, to reduce knee pressure
- Topical NSAIDs, such as diclofenac gel, for localized pain relief
- Oral NSAIDs, such as ibuprofen, for pain relief, with consideration of gastrointestinal risk and the use of gastroprotective agents or selective COX-2 inhibitors
- Intra-articular injections of corticosteroids for flare-ups of knee pain, especially if accompanied by effusion
- Consideration of joint replacement for refractory pain associated with disability and radiological deterioration. It is essential to note that the treatment of knee OA should be individualized, and the patient's preferences and values should be taken into account when making treatment decisions, as emphasized in the 2021 guidelines 1 and the 2020 US Department of Veterans Affairs/US Department of Defense clinical practice guideline 2.
From the Research
Artrosis Knee Pain Treatment Options
- The treatment of osteoarthritis-related knee pain can involve various pharmacological approaches, including topical, oral, and intraarticular treatments 3.
- For patients with mild osteoarthritis, topical nonsteroidal anti-inflammatory drugs (NSAIDs) can be recommended, while topical capsaicin can be used when other treatments are ineffective or contraindicated 3.
- In patients with moderate to severe osteoarthritis, oral NSAIDs are suggested at the lowest effective dose for the shortest possible duration to control symptoms, taking into account drug-related side effects and gastrointestinal, cardiovascular, and renal comorbidities 3.
Non-Pharmacological Interventions
- Non-pharmacological and non-surgical interventions, such as exercise therapy, can be effective in managing knee osteoarthritis, with resistance training showing the best positive effects on knee OA patients 4.
- Other interventions like pulsed electromagnetic fields and moxibustion have shown promise, but more studies are needed to fully recommend their use 4.
Evaluation and Treatment of Knee Pain
- Knee osteoarthritis is the most likely diagnosis of knee pain in patients aged 45 years or older who present with activity-related knee joint pain with no or less than 30 minutes of morning stiffness 5.
- First-line management of osteoarthritis comprises exercise therapy, weight loss (if overweight), education, and self-management programs to empower patients to better manage their condition 5.
Pharmaceutical Treatment of Osteoarthritis
- Oral and topical NSAIDs, including COX-2 inhibitors, are strongly recommended first-line treatments for osteoarthritis due to their ability to improve pain and function, but are associated with increased risks in patients with certain comorbidities 6.
- Intra-articular corticosteroid injections are generally recommended for osteoarthritis management and have relatively minor adverse effects 6.
Tramadol for Osteoarthritis
- Tramadol alone or in combination with acetaminophen probably has no important benefit on mean pain or function in people with osteoarthritis, although slightly more people in the tramadol group report an important improvement (defined as 20% or more) 7.
- Adverse events probably cause substantially more participants to stop taking tramadol, with the three most frequent adverse events being nausea, dizziness, and tiredness 7.