What are the recommended treatments for managing arthritic pain?

From the Guidelines

Managing arthritic pain typically involves a combination of medication, physical therapy, and lifestyle modifications, with a strong recommendation for exercise, weight loss, and topical nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line treatments, as supported by the 2019 American College of Rheumatology guideline for the management of osteoarthritis of the hand, hip, and knee 1.

Key Recommendations

• First-line medications: Over-the-counter pain relievers such as acetaminophen (Tylenol) at 325-650mg every 4-6 hours, not exceeding 3000mg daily, and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) at 200-400mg every 4-6 hours with food, or naproxen (Aleve) at 220-440mg twice daily.
• Topical treatments: Topical NSAIDs, such as diclofenac gel (Voltaren) applied to affected joints 3-4 times daily, can provide localized relief with fewer systemic side effects.
• Physical therapy: Focusing on joint-specific exercises to maintain mobility and strengthen supporting muscles.
• Weight management: Crucial as each pound lost reduces pressure on weight-bearing joints by 3-4 pounds.
• Heat and cold therapy: Temporarily reduces pain and inflammation, with applications of 20 minutes at a time.

Additional Considerations

• Corticosteroid injections: May be considered for persistent pain.
• Disease-modifying antirheumatic drugs: May be considered for patients with inflammatory arthritis.
• Lifestyle modifications: Include maintaining a healthy diet, avoiding tobacco, and engaging in regular physical activity.

Evidence-Based Approach

The recommendations are based on the most recent and highest-quality evidence, including the 2019 American College of Rheumatology guideline for the management of osteoarthritis of the hand, hip, and knee 1, and the 2022 American College of Rheumatology guideline for exercise, rehabilitation, diet, and additional integrative interventions for rheumatoid arthritis 1. These guidelines provide a comprehensive approach to managing arthritic pain, emphasizing the importance of a multidisciplinary treatment plan that incorporates medication, physical therapy, and lifestyle modifications.

From the FDA Drug Label

NSAID medicines are used to treat pain and redness, swelling, and heat (inflammation) from medical conditions such as: different types of arthritis menstrual cramps and other types of short-term pain

The recommended treatments for managing arthritic pain include NSAID medicines, which are used to treat pain and inflammation from medical conditions such as different types of arthritis.

• Key points to consider when using NSAID medicines for arthritic pain management:
  • Use exactly as prescribed
  • At the lowest dose possible
  • For the shortest time needed
  • Some NSAID medicines are sold in lower doses without a prescription (over-the-counter), but patients should talk to their healthcare provider before using over-the-counter NSAIDs for more than 10 days 2 2. Note that adalimumab (SQ) is also used to treat rheumatoid arthritis, but the provided text does not directly answer the question of recommended treatments for managing arthritic pain 3.

From the Research

Arthritic Pain Management

The management of arthritic pain involves various treatment strategies, including pharmacologic and non-pharmacologic approaches.

• Pharmacologic Treatments:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for the management of pain and inflammation 4, 5, 6, 7.
  • Disease-modifying antirheumatic drugs (DMARDs) are used as first-line therapy for newly diagnosed cases of rheumatoid arthritis (RA) and include methotrexate, hydroxychloroquine, sulfasalazine, and leflunomide 4, 5.
  • Biological-response modifiers, such as tumor necrosis factor-alpha (TNF-alpha) inhibitors, are used to target and inhibit specific molecules of the immune and inflammatory responses 4, 5.
  • Glucocorticoids are effective in controlling pain, inflammation, and stiffness related to RA 4, 5.

• Non-Pharmacologic Treatments:

  • Weight loss is recommended for patients with osteoarthritis (OA), especially when OA is in the weight-bearing joints 6.
  • Other non-pharmacologic modalities, such as tissue transplants and cytokine-modulating drugs, are emerging for the potential therapy of OA 6.
  • Combining non-pharmacologic and pharmacologic treatments is common in the management of OA 7.

• Combination Therapy:

  • The benefits of combination therapy for pain management in inflammatory arthritis are not well established, with most studies finding no significant difference between combination and monotherapy treatments 8.
  • However, some studies suggest that combination therapy may be beneficial for patients with persistent pain despite optimal disease suppression 8.

• Treatment Patterns and Pain Severity:

  • Treatment modalities differ by pain severity, with more patients with moderate or severe pain currently receiving prescription medications 7.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common current and ever received prescriptions, but are not associated with pain severity 7.
  • Acetaminophen recommendations, opioid prescriptions, and multiple prescription medications tried are numerically highest in the severe pain group 7.