Osteoarthritis Pain Treatment Options

Managing pain from OA of the knee without surgery

If you’re living with knee osteoarthritis (OA), you’ve likely tried supplements, over-the-counter or non-prescription treatments for joint pain relief.

But with the help of your doctor, you may also decide to try other medications that may help with OA knee pain and improve your joint function or range of motion. Ideally, you may find that your daily activities become easier.

Man getting his knee examined by doctor

To provide effective treatment options for patients with osteoarthritis of the knee who don’t want to (or can’t) go through with surgery, the Osteoarthritis Research Society International (OARSI) created treatment recommendations for patients and healthcare professionals. These documents were created by expert physicians who rigorously reviewed the science behind 60 potential OA treatments.

The OARSI expert medical panel collaborated with a “Patient Panel” consisting of three osteoarthritis patients who commented and suggested relevant additions to the final report.

Did you know?

It’s common for medical organisations to gather, review, and discuss many clinical studies (this is called a systematic review). Together, they make expert treatment recommendations and best practices. These are shared with others physicians to help them manage conditions like osteoarthritis and provide appropriate treatment options.

Don’t hesitate to discuss various osteoarthritis treatment options with your doctor when it comes to getting pain relief. And remember, it may take some time to discover what may work for you to relieve knee pain.

Education & exercise

The initial treatments recommended for the majority of individuals with OA are a combination of arthritis education and land-based exercise programs. (This may also be combined with or without dietary weight management). Exercises may include strengthening and/or cardio and/or balance training/neuromuscular exercise, or mind-body exercise like tai chi or yoga.

If the above osteoarthritis treatments do not prove to be effective for you, other osteoarthritis treatment options exist including:

  • swimming and aquatic exercise (though individuals with frailty are at potential risk of accidental injury)
  • gait aids to help your mobility (walking sticks, canes, walkers, etc.)
  • therapy sessions to help change your thoughts and behaviours of your pain
  • self-management programs offering guidance through diet, stress management, treatment options, and other lifestyle activities to take an active role in your managing OA.

Now, let’s discuss some of the pharmacological osteoarthritis treatment options which can accompany these exercises.

A multimodal treatment approach combining various treatment options for osteoarthritis (such as diet, exercise, medication, viscosupplementation, and bracing) may provide nonsurgical options to relieve pain in the knee joint, and may also be suitable for individuals whose surgery is cancelled or delayed.

  • NSAIDS are non-steroidal anti-inflammatory drugs which may be taken two different ways.

    Topical NSAIDs: Creams or gels you can apply to the affected area. These medications are intended to relieve pain and swelling in osteoarthritis.

    Oral NSAIDs: Nonsteroidal anti-inflammatory drugs such as aspirin are intended to temporarily relieve pain and inflammation associated with arthritis.

    Safety info:
    Talk you your doctor about the risks vs benefits of each treatment option for you. You can also review the product information for a complete list of side effects.

    With topical NSAIDs, there is possibility of adverse effects, particularly if you already have a history of stomach ulcers or are taking an oral NSAID. The common side effects include dry skin or rash. Use can also result in cardiovascular issues (like increased blood pressure and worsening of congestive heart failure), and may cause stomach and bowel problems (such as ulceration, perforation, obstruction and bleeding).

    With oral NSAIDs, common side effects include digestive issues such as bloating, nausea, stomach pain, stomach bleeding, heartburn, constipation and diarrhea. Caution should be used in those with cardiovascular issues like heart failure or high blood pressure, individuals with digestive (gastrointestinal) issues, and those at risk of kidney problems. Drowsiness and skin sensitivity to sunlight may also occur with prescription options.

  • PPIs and COX-2 inhibitors: In addition to an NSAID, your doctor may also add a PPI (proton pump-inhibitor) or a COX-2 inhibitor. While the NSAIDs work to address pain, these add-on medications can help reduce stomach acid production to heal or reduce your risk of gastric ulcers from NSAID use. This is especially helpful for individuals with gastrointestinal issues such as acid reflux, irritable bowel syndrome, etc.

    Safety info:
    Talk you your doctor about the risks vs benefits of each treatment option for you. You can also review the product information for a complete list of side effects. The following side effects have been reported: muscle pain, belching, constipation, diarrhea, dizziness, dry mouth, gas, headache, indigestion, insomnia, nausea, rash, vomiting, weakness. Using PPIs for a year or more may increase risks of broken bones or cause a growth in the stomach (polyp).

  • Intra-articular corticosteroids (IACS): A type of joint injection treatment that is used to relieve pain and decrease inflammation.

    Safety info:
    Talk you your doctor about the risks vs benefits of each treatment option for you. You can also review the product information for a complete list of side effects. Potential side effects may include allergic reactions (such as anaphylaxis), cardiovascular issues (such as heart attack, high/low blood pressure, blood clots), skin issues (such as swelling, rash, redness, itching, gastrointestinal issues (such as stomach bleeding, nausea, vomiting, abdominal pain), musculoskeletal issues (such as a loss of muscle mass or joint pain), neurologic effects (such as seizures, headache, a sensation of skin tingling or burning), etc. Other side effects may also occur.

  • Intra-articular hyaluronic acid (IAHA): A hyaluronic acid injection is a pain reliever injected into the knee joint. Hyaluronic acid is naturally present in joint fluid (called synovial fluid). It is intended only for use by a physician to treat pain associated with osteoarthritis. Viscosupplementation with IAHA is a treatment to decrease pain and discomfort, allowing more extensive movement of the joint.

    Safety info:
    Talk you your doctor about the risks vs benefits of each treatment option for you. You can also review the product information for a complete list of side effects. Pain or swelling in the injected joint and allergic reactions (like anaphylactic reaction) may occur after injections. Rarely, rash, hives, itching, fever, nausea, headache, dizziness, chills, muscle cramps, a burning or prickling sensation, swelling of the lower legs or hands, malaise, respiratory difficulties, flushing and facial swelling have been reported.

These are just some of the pain relief options that may be appropriate for your OA knee pain. For a complete list of therapeutic options, benefits, and any associated risks, be sure to talk to your doctor.

Take action: Manage your osteoarthritis pain

There are many potential causes of joint pain, especially in weight-bearing joints like the hips, knees & ankles. But if your osteoarthritis story includes knee problems or even hip osteoarthritis, ask your healthcare provider what treatment options or pain medications may ease pain and could be right for you. Talk to your doctor about exploring a multimodal treatment approach, where you can combine various treatment options for osteoarthritis such as diet, exercise, medication, viscosupplementation, bracing, etc.

Asking for an x-ray of the affected joint while standing at a physical examination is a good place to start if you're experiencing symptoms of osteoarthritis or arthritis pain. Make sure to take one while standing for knee OA, so your doctor can see the space between the bones and examine the cartilage. Certain risk factors like carrying excess body weight, being female, obesity, and having a damaged joint due to injury are commonly linked to this form of arthritis.

You might consider consulting a physical therapist, physiotherapist, or occupational therapist to discuss your mobility, appropriate low impact and strengthening exercises, and physical therapy. This may be especially relevant if you've had a knee injury – one of the common causes of knee pain. A physiotherapist can help you with personalized exercises. A Certified Orthotist or brace fitter can provide you with a brace, orthosis or orthotic.

In general, low-impact exercises like tai chi are well-suited for this type of arthritis to avoid joint injury. Overall, physical activity or exercise programs are also very complementary to other treatments, as is maintaining a healthy weight (or weight loss if necessary). Consult a fitness and nutrition specialist to help find the right exercise and diet plan for you. Don't underestimate the impact that lifestyle changes can have!

You can also visit an orthopedic clinic or specialist to assess joint damage (or for general medical advice). Or your family physician may be able to refer you to a medical professional who specializes in the care of joints, ligaments and bones, or a musculoskeletal specialist. This may include sports medicine physicians, orthopedic surgeons, rheumatologists, and physiatrists.

Be sure to discuss and weigh the benefits against any potential side effects of treatment you're considering, and ask about options that may be tried before knee replacement surgery or joint replacement surgery (also known as arthroplasty). It's your own wellness and quality of life, so don't hesitate to speak up about painful joints, OA pain, arthritis symptoms in general, or your treatment plan!

Share this article by accessing your social media account