From the Guidelines
The patient should be treated with a combination of naproxen 500 mg and methocarbamol 500 mg for pain and muscle relaxation, provided with a knee brace for support, and advised to rest and limit activities that exacerbate the pain, as this approach addresses both the physical aspects of the injury and the patient's anxiety, and is supported by the most recent and highest quality study 1. The treatment plan includes ordering an ultrasound to further evaluate the knee, which is a reasonable next step given the patient's persistent pain and normal x-ray findings, as recommended by the American College of Radiology 1.
- The patient's negative physical examination tests, including anterior drawer, posterior drawer, varus stress, and Clarke's sign, suggest that the pain is not due to a ligamentous or meniscal injury.
- The use of naproxen, an NSAID with anti-inflammatory properties, and methocarbamol, a muscle relaxant, targets both pain and potential muscle tension contributing to discomfort, and is consistent with the recommendations of the US Department of Veterans Affairs/US Department of Defense clinical practice guideline for the non-surgical management of hip and knee osteoarthritis 1.
- The knee brace provides stability during the healing process, while activity modification prevents further irritation to the injured tissues, and is supported by the evidence-based guideline for the management of osteoarthritis of the knee (nonarthroplasty) 1.
- A follow-up appointment will be scheduled to assess progress and review ultrasound results, allowing for adjustments to the treatment plan as needed, and ensuring that the patient receives timely and effective care.
From the Research
Treatment of Knee Pain
- The patient was prescribed naproxen 500 mg and methocarbamol 500 mg to alleviate knee pain, which is consistent with the study 2 that reviewed the data supporting the use of OTC naproxen to effectively treat various types of acute pain.
- The use of naproxen for acute pain is also supported by the study 3, which compared the efficacy and safety of naproxen 500 mg twice daily versus naproxen 500 mg as needed for treatment of ankle sprain.
- The patient was also advised to rest and limit activities that exacerbate the pain, which is a common recommendation for managing knee pain.
Use of Ultrasound
- An ultrasound of the patient's left knee was ordered to further evaluate the cause of the knee pain, which is a common diagnostic tool used in physical therapy to manage pain and aid in the healing of soft tissue.
- The study 4 found that therapeutic ultrasound may provide additional benefits to physical therapy regimens in terms of symptom relief in individuals with knee osteoarthritis, although the overall quality of the evidence was very low.
- Another study 5 compared the effects of ultrasound combined with transcutaneous electrical nerve stimulation (UltraTENS) with phonophoresis of piroxicam (PhP) in symptomatic knee osteoarthritis, and found that both treatments were effective for relieving pain and improving functionality.
Medication Efficacy
- The study 6 compared the efficacy and safety of naproxcinod (375 and 750 mg) with naproxen 500 mg and placebo for treatment of osteoarthritis, and found that naproxcinod demonstrated superior efficacy over placebo for treatment of OA and was well tolerated over 1 year.
- The use of naproxen 500 mg was also found to be effective in reducing pain and edema in patients with ankle sprain, with no significant difference compared to the twice daily regimen, while possessing a better safety profile and lower total drug use 3.