Management Options for Knee Pain
The optimal management of knee pain requires a combination of pharmacological and non-pharmacological treatment modalities tailored to the individual patient, with first-line treatment including exercise therapy, weight management, education, and self-management programs. 1, 2, 3
Initial Assessment and Diagnosis
- Knee pain can result from various conditions, with osteoarthritis (OA), patellofemoral pain, and meniscal tears being among the most common causes 3
- Evaluation should include assessment of pain characteristics, signs of inflammation, functional limitations, and impact on daily activities 1, 4
- Radiographic imaging is not recommended for all patients with knee pain but should be considered for persistent symptoms 1
Non-Pharmacological Management
Exercise Therapy
- Exercises, especially those directed towards increasing quadriceps strength and preserving normal knee mobility, are strongly recommended for knee pain management 2, 1
- Hip and knee strengthening exercises are particularly beneficial for patellofemoral pain 1, 5
- Regular exercise programs have shown significant improvement in pain reduction and functional outcomes 3
Weight Management
- Weight reduction is essential for overweight patients with knee pain, as increased weight directly correlates with pain severity 6, 1
- Even modest weight loss can significantly reduce symptoms and slow disease progression in knee OA 3
Supportive Devices and Physical Modalities
- Appropriate footwear, assistive devices (sticks), and insoles can provide additional support and pain relief 2, 1
- Knee braces have demonstrated clinical efficiency in reducing pain perception and improving quality of life 5
- Physical therapy interventions including diathermy and ultrasound may provide additional benefit 5
Education and Self-Management
- Regular education about the condition and self-management strategies are essential components of knee pain management 2, 1
- Patient empowerment through education helps better manage symptoms and improve outcomes 3
Pharmacological Management
First-Line Medication
- Paracetamol (acetaminophen) is the recommended first-line oral analgesic for knee pain and should be tried before other medications 2, 1
- It has demonstrated significant improvement in pain at rest compared to placebo and has a favorable safety profile 2, 6
NSAIDs
- NSAIDs (oral or topical) should be considered in patients unresponsive to paracetamol, especially those with effusion 2, 1
- Ibuprofen has been shown to be effective for controlling pain and inflammation in osteoarthritis 7
- Topical NSAIDs have demonstrated clinical efficacy with a better safety profile than oral NSAIDs 6
Other Pharmacological Options
- Symptomatic slow-acting drugs for osteoarthritis (SYSADOA) including glucosamine sulfate, chondroitin sulfate, and hyaluronic acid may be effective, but with relatively small effect sizes 2, 8
- Tramadol and opioids should be used cautiously due to their poor risk-benefit profiles 9
Interventional Procedures
Intra-articular Injections
- Intra-articular corticosteroid injections are indicated for acute exacerbations of knee pain, especially if accompanied by effusion 2, 6
- These injections have been shown to be effective for short-term pain relief 9
- Hyaluronic acid injections may be considered, though evidence for their effectiveness is mixed 2, 9
Radiofrequency Procedures
- Radiofrequency (conventional and cooled) of the genicular nerves can be effective when conservative treatments fail 8
Surgical Management
- Joint replacement should be considered for refractory pain associated with disability and radiological deterioration 2
- Arthroscopic surgery has shown no benefit in knee osteoarthritis and is not recommended 9
- Surgical referral for knee joint replacement should only be considered after exhausting appropriate conservative options 3