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Tips for Pain Management in Knee OA

21st October 2021

Has your knee osteoarthritis surgery been delayed due to the lockdown? Or, do you experience excruciating pain in the knee but feel like it is too early in your life to get surgery? Either way, you are probably looking for ways to relieve that pain so you can go on with your life. There are some ways to fix the knee OA temporarily and help relieve your pain and symptoms. Depending on your anatomy and condition, you can delay the need for surgery for months and sometimes even years.

Healthy Lifestyle

We know you are probably tired of hearing the same tips while suffering from knee OA, but the importance of being a healthy weight cannot be emphasised enough. It is really simple; the less weight you carry, the less strain on your knee joints, and the less your pain will be.

If you are overweight or obese, shifting to a healthy lifestyle is more urgent for pain relief. Exercise and diet are two ways where you can accomplish controlled and healthy weight loss. Either of these lifestyle changes works, but the best outcome is when both lifestyle modifications are implemented together. Balancing diet and exercise has been shown in many clinical trials. In one such trial with 400 participants over 18 months, those who combined regular exercise and diet showed the greatest reduction in compressive knee-joint force and self-reported pain [1].

It is important that you get advice from your doctor or clinician who understands your individual needs, and create a weight loss plan that combines a healthy diet and low-impact exercises, that is specifically designed for you. You can also find many expert articles on food and exercise on our site, we also provide downloadable information guides you can take to your GP.


It is important that you get advice from your doctor or clinician who understands your individual needs, and create a weight loss plan that combines a healthy diet and low-impact exercises, that is specifically designed for you. You can also find many expert articles on food and exercise on our site, we also provide downloadable information guides you can take to your GP.

Pain Medications

Depending on the severity of your condition, your doctor may prescribe you pain medication to accompany the healthy diet & exercise duo. The pain relievers can come in the form of tablets, pills, or creams. Below are the main types of medication for pain relief.

Acetaminophen

For mild to moderate pain, your doctor could suggest Acetaminophen (paracetamol, e.g., Tylenol), which inhibits the COX enzyme. When the enzyme is inhibited, it can’t produce prostaglandins, chemicals that cause you to feel pain. The ideal dosage is 3000 milligrams per day. Overuse of acetaminophen has been associated with liver damage [2], so you should avoid exceeding this amount.

NSAIDs

If you have noticeable and painful inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) can be more helpful. Unlike acetaminophen, NSAIDs work on multiple COX enzymes, so they can alleviate inflammation, fever, and pain. The main types of NSAIDs are ibuprofen, naproxen, diclofenac, and celecoxib. While some of them are over-the-counter drugs, others require prescriptions. As with any medication, NSAIDs must be taken with strict precaution. Excessive NSAID use could cause adverse effects, such as stomach irritation and bleeding [3], as well as increased risk of heart attack [4] and kidney failure [5].

Opioids

Prescription opioids, such as hydrocodone and oxycodone, are used for very severe cases, e.g., when you are in unbearable pain and waiting for a joint replacement. Opioids work by binding to the opioid receptors on your nerve cells. When these receptors are blocked, your perception of pain will be reduced greatly. However, opioids have severe side effects, ranging from extreme drowsiness to nausea and constipation. More importantly, your body can develop a tolerance, making you addicted in the long run [6]. Because of the associated risks, opioids are really the last resort when it comes to pain management.

The main takeaway here is to always consult with your doctor before taking any medication. Your doctor will know what type of drug will work best for your specific condition.

Knee Braces

Knee braces are one of the most helpful tools for managing knee pain, and a non-invasive solution. Your doctor or physiotherapist can recommend you for a knee brace if the osteoarthritis has caused significant degeneration on one side of the knee. Braces work by unloading the weight from the damaged part of your knee joint and redistributing it across the healthier side of the knee. This reduces the pain, maintains a healthy alignment across the joint, and can improve your range of motion.

There are several types of knee braces with different working mechanisms. NICE recommends non-invasive treatments for OA in the first instance including off-loading knee braces. Unloader One is the most studied OA knee brace in the world take a look at the Unloader one here: www.ossur.com/en-gb/bracing-and-supports/unloader

Alternative Remedies

Whether you are waiting for a knee replacement surgery or wanting to delay it as much as possible, you could find relief in some alternative treatments. Massage therapy and acupuncture could contribute to pain relief by improving circulation around the joints, reducing muscle tension, and releasing hormones that ease the pain. Although more research is needed to substantiate their benefits for knee osteoarthritis, a few studies shown their effectiveness in pain management [7][8].

You could also try yoga, mindfulness, and tai chi techniques. A growing body of evidence has shown that yoga movements coordinated with mindful breathing can decrease pain and stiffness while improving mobility [9][10]. That said, not every yoga is suitable for knee OA. You should always opt for restorative practices with a slow pace, such as Hatha, yin, and kundalini. Vinyasa and other yoga flows involve intense movement, which could backfire and make the pain even worse.


[1] Messier, Stephen P., et al. "Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial." Jama 310.12 (2013): 1263-1273.

[2] Jaeschke, Hartmut, Yuchao Xie, and Mitchell R. McGill. "Acetaminophen-induced liver injury: from animal models to humans." Journal of clinical and translational hepatology 2.3 (2014): 153.

[3] Sostres, Carlos, et al. "Adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs, aspirin and coxibs) on upper gastrointestinal tract." Best practice & research Clinical gastroenterology 24.2 (2010): 121-132.

[4] Marsico, Fabio, Stefania Paolillo, and Pasquale P. Filardi. "NSAIDs and cardiovascular risk." Journal of cardiovascular medicine 18 (2017): e40-e43.

[5] Winkelmayer, Wolfgang C., et al. "Nonselective and cyclooxygenase-2-selective NSAIDs and acute kidney injury." The American journal of medicine 121.12 (2008): 1092-1098.

[6] Hser, Yih-Ing, et al. "Long-term course of opioid addiction." Harvard review of psychiatry 23.2 (2015): 76-89.

[7] Kim EJ, Lim CY, Lee EY, Lee SD, Kim KS: Comparing the effects of individualized, standard, sham and no acupuncture in the treatment of knee osteoarthritis: a multicenter randomized controlled trial. Trials 2013, 14:129.

[8]Nelson NL, Churilla JR. Massage Therapy for Pain and Function in Patients With Arthritis: A Systematic Review of Randomized Controlled Trials. Am J Phys Med Rehabil. 2017 Sep;96(9):665-672. doi: 10.1097/PHM.0000000000000712

[9] Zettergren, Kathleen K., Jennifer M. Lubeski, and Jaclyn M. Viverito. "Effects of a yoga program on postural control, mobility, and gait speed in community-living older adults: a pilot study." Journal of geriatric physical therapy 34.2 (2011): 88-94.

[10] Deepeshwar, Singh, et al. "Effect of yoga based lifestyle intervention on patients with knee osteoarthritis: a randomized controlled trial." Frontiers in psychiatry 9 (2018): 180.

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