Best Practices for Pain Management of Knee Osteoarthritis

With treatment costs for knee osteoarthritis (OA) reaching $185.5 billion annually,[1] research efforts to discover more effective, cost-efficient treatments have increased considerably in recent years. In fact, the Osteoarthritis Research Society International identified 64 systematic reviews, 266 randomized control trials and 21 new economic evaluations of OA interventions conducted between Jan. 2006 and Jan. 2009 alone.[2]

With evolving information and newly available treatment options, the following three simple steps can help physicians stay on track with best practices.

1. Weigh available therapy options and guidelines.

It goes without saying that every patient is different, and so, too, is their pain. An effective medical approach to pain management can help patients stave off the need for surgery. The American Academy of Orthopaedic Surgeons (AAOS) recommends either acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) to help control pain from OA of the knee.[3] It is noted that NSAIDs appear to reduce pain significantly more than acetaminophen; however, NSAIDs may have serious gastrointestinal side effects.[4]

NSAID side effects may be reduced by using topical, rather than oral, formulations. For patients with increased GI risk — those aged 60 or older, with comorbid medical conditions or with a history of GI problems — topical NSAIDs are recommended by AAOS.[5] Studies show that topical NSAIDs are as effective as, and possibly safer than, oral formulations.[6],[7] A recent analysis of two pooled studies showed patients receiving topical NSAIDs — such as those in liquid, gel or patch form — had significantly fewer GI-related adverse events than with oral NSAIDs.[8]

2. Optimize treatment with complementary, non-medical activities.

Increasingly, evidence points to lifestyle changes, alongside pharmacological treatment, as critical to relieving knee OA pain. Particularly for patients who present with moderate or severe pain, and who have already tried over-the-counter pain medicines without success, non-medical interventions such as physical therapy, exercise and water therapy can bolster pain control in order to improve function.

Not surprisingly, weight loss also plays a key role. Studies have shown consistently that weight loss can lessen pain and improve physical function.[9] Excessive loading on joints may lead to greater pain, and, in a vicious cycle, faster progression of the disease and the joint cannot be strengthened when inactive. For this reason, improving physical function has become a key goal in knee OA pain management.

Read the full article at Becker’s Orthopedic and Spine Review.