From the Guidelines
The American Academy of Orthopaedic Surgeons recommends a multi-faceted approach to knee pain control, prioritizing non-pharmacologic and pharmacologic therapies to improve the quality and efficacy of care, as outlined in their 2022 clinical practice guideline summary 1.
Overview of Recommendations
The goal of treatment is to provide pain relief and improve the patient's functioning, with most interventions associated with some potential for adverse outcomes, especially if invasive or surgical.
- For mild to moderate knee pain, start with over-the-counter medications like acetaminophen (Tylenol) at 325-650mg every 4-6 hours, not exceeding 3000mg daily, or NSAIDs such as ibuprofen (Advil, Motrin) at 200-400mg every 4-6 hours with food, or naproxen sodium (Aleve) at 220mg twice daily.
- Topical treatments like diclofenac gel (Voltaren) applied to the knee 4 times daily can provide localized relief with fewer systemic side effects.
- For more severe pain, your doctor may prescribe stronger NSAIDs or short-term opioids.
Non-Medication Approaches
Non-medication approaches are equally important:
- RICE therapy (Rest, Ice for 20 minutes several times daily, Compression with an elastic bandage, and Elevation above heart level)
- Physical therapy to strengthen supporting muscles
- Weight management to reduce joint stress
- Activity modification
- Assistive devices like knee braces or walking aids These approaches work by reducing inflammation, blocking pain signals, strengthening supporting structures, and decreasing mechanical stress on the knee joint.
Guideline Comparison
The ESCEO and OARSI 2019 guidelines for non-surgical management of knee osteoarthritis recommend education, structured exercise, and weight loss as core treatments, with topical NSAIDs as first-line treatments and oral NSAIDs and intra-articular injections for persistent pain 1. However, the American Academy of Orthopaedic Surgeons' 2022 guideline summary is the most recent and highest-quality study, and its recommendations should be prioritized 1.
Chronic Knee Pain Management
For chronic knee pain, regular follow-up with your orthopedic surgeon is recommended to adjust your pain management strategy as needed, taking into account the potential risks and benefits of each treatment option, as well as the patient's individual needs and preferences.
From the Research
Recommendations for Pain Control in Knee Pain
The American Academy of Orthopaedic Surgeons (AAOS) provides guidelines for the management of knee pain, which can be caused by various conditions such as osteoarthritis, patellofemoral pain, and meniscal tears.
- First-line management of osteoarthritis (OA) comprises exercise therapy, weight loss (if overweight), education, and self-management programs to empower patients to better manage their condition 2.
- Pharmacologic therapy for OA of the knee begins with analgesic medications and proceeds to topical analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) as needed 3.
- Intra-articular injections of corticosteroids can relieve pain and inflammation, but the effect is of short duration and such therapy should only be employed infrequently 3.
- A multimodal/multicomponent approach for knee OA therapy, including different combinations of non-pharmacological and pharmacological interventions, can provide benefit beyond single agents for the improvement of pain and other symptoms typical of knee OA 4.
- Tramadol/acetaminophen combination tablets can be used as add-on and maintenance therapy in knee osteoarthritis pain inadequately controlled by nonsteroidal anti-inflammatory drug (NSAID) 5.
Non-Pharmacological Interventions
Non-pharmacological interventions play a crucial role in the management of knee pain.
- Exercise therapy is recommended for patients with knee OA, patellofemoral pain, and meniscal tears 2.
- Weight loss is recommended for patients with knee OA who are overweight 2.
- Patient education and self-management programs can empower patients to better manage their condition 2.
- Assistive devices, such as canes or walkers, can be used to reduce stress on the knee joint 3.
Surgical Interventions
Surgical interventions may be necessary for patients with severe knee pain or those who have not responded to conservative management.