What is the best medication for left knee pain?

Best Medication for Left Knee Pain

Start with acetaminophen (paracetamol) 4000 mg/day as your first-line medication for knee pain, and only escalate to NSAIDs if acetaminophen fails to provide adequate relief or if there are clear signs of inflammation such as joint effusion. 1

Initial Treatment Approach

• Acetaminophen (paracetamol) is the preferred first-line oral analgesic for knee pain, with demonstrated efficacy comparable to NSAIDs in most patients and superior safety profile 1
• The recommended dose is up to 4000 mg/day, which can be maintained long-term if effective 1, 2
• Acetaminophen showed only 1.5% adverse event rate in clinical trials and can be used safely for up to 2 years 1

When to Escalate to NSAIDs

If acetaminophen fails after an adequate trial (typically 2-4 weeks), progress to NSAIDs:

• Ibuprofen is the recommended first-line NSAID due to its favorable efficacy and safety profile 3
• Start with ibuprofen 1200-2400 mg/day divided doses 4, 5
• NSAIDs are particularly indicated when signs of inflammation are present, such as joint effusion or warmth 1

Alternative NSAID Options

• Topical NSAIDs (diclofenac) are an excellent alternative for patients who cannot tolerate oral NSAIDs, with impressive efficacy (effect size 0.91 vs placebo) 3
• Naproxen 750 mg/day is another option, showing greater pain reduction than acetaminophen (effect size 0.32-0.45) 1, 3
• Use the lowest effective dose for the shortest duration necessary 6, 2

Critical Safety Considerations

NSAIDs carry significant risks that must be weighed:

• Gastrointestinal ulcers and bleeding can occur without warning and may be fatal 6
• Risk increases with age, longer use, smoking, alcohol use, and concurrent corticosteroids or anticoagulants 6
• Cardiovascular risks including heart attack and stroke, particularly with prolonged use 6
• Renal toxicity is a concern, especially in older patients 2

Common Pitfalls to Avoid

• Do not start with NSAIDs as first-line therapy unless clear inflammatory signs are present—this violates guideline recommendations and exposes patients to unnecessary GI and cardiovascular risks 1
• Do not underdose acetaminophen—many patients receive inadequate trials with doses below 3000-4000 mg/day before being switched to NSAIDs 1, 2
• Do not use NSAIDs chronically at high doses—use the lowest effective dose for the shortest time, and consider on-demand dosing for variable pain 2
• Even severe knee pain responds comparably to acetaminophen and ibuprofen, so pain severity alone should not dictate NSAID use 1, 7

Comprehensive Management

Medication should be combined with non-pharmacological interventions:

• Weight reduction if obese 1
• Regular exercise, particularly quadriceps strengthening 1
• Patient education and physical therapy 1
• Assistive devices (canes, knee bracing, insoles) as needed 1

Special Circumstances

• For acute flares with effusion: consider intra-articular corticosteroid injection in addition to oral therapy 1
• For refractory cases: opioid analgesics may be considered when NSAIDs are contraindicated, ineffective, or poorly tolerated 1
• Age and comorbidities matter: older patients and those on multiple medications have higher NSAID complication rates and may benefit from staying on acetaminophen longer 3, 6