What are the most effective medications for knee pain. How do over-the-counter and prescription drugs compare for treating knee discomfort. What potential side effects should patients be aware of when taking pain relievers for knee issues.

Understanding Knee Pain: Causes and Symptoms

Knee pain is a common complaint that can arise from various causes, ranging from acute injuries to chronic conditions. Understanding the root cause of knee discomfort is crucial for determining the most appropriate treatment approach.

Common Causes of Knee Pain

• Osteoarthritis
• Rheumatoid arthritis
• Overuse injuries
• Bursitis
• Tendinitis
• Ligament tears (ACL, MCL, PCL)
• Meniscus tears
• Fractures
• Patellofemoral pain syndrome

Is knee pain always a sign of a serious condition? Not necessarily. While some knee pain can indicate significant injury or disease, many cases are the result of minor strains or overuse that can be treated with conservative measures. However, persistent or severe knee pain should be evaluated by a healthcare professional to rule out more serious underlying issues.

Over-the-Counter Pain Relievers for Knee Discomfort

For mild to moderate knee pain, over-the-counter (OTC) medications can often provide sufficient relief. These medications are readily available and can be effective for managing pain and inflammation associated with knee problems.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs are a popular choice for knee pain relief due to their ability to reduce both pain and inflammation. Common OTC NSAIDs include:

• Ibuprofen (Advil, Motrin)
• Naproxen sodium (Aleve)
• Aspirin

How do NSAIDs work to relieve knee pain? NSAIDs function by inhibiting the production of prostaglandins, which are chemicals in the body responsible for inflammation, pain, and fever. By reducing prostaglandin production, NSAIDs help alleviate discomfort and swelling in the affected knee joint.

Acetaminophen

Acetaminophen, also known as paracetamol, is another OTC option for knee pain relief. While it does not have anti-inflammatory properties, it can effectively reduce pain and fever.

Can acetaminophen be as effective as NSAIDs for knee pain? In some cases, yes. For individuals who cannot take NSAIDs due to stomach sensitivity or other contraindications, acetaminophen can be an excellent alternative for pain management. However, it may not be as effective for conditions where inflammation is a significant factor.

Prescription Medications for Severe Knee Pain

When OTC medications are insufficient to manage knee pain, healthcare providers may prescribe stronger medications. These prescription options can offer more potent pain relief but also come with a higher risk of side effects.

Prescription-Strength NSAIDs

Higher doses of NSAIDs may be prescribed for more severe knee pain. These can include:

• Diclofenac (Voltaren)
• Meloxicam (Mobic)
• Celecoxib (Celebrex)

Are prescription NSAIDs more effective than their OTC counterparts? Generally, prescription NSAIDs can provide stronger pain relief due to their higher dosages. However, they also carry an increased risk of side effects, particularly gastrointestinal issues and cardiovascular risks.

Opioid Pain Relievers

In cases of severe acute pain or post-surgical recovery, opioid medications may be prescribed for short-term use. These include:

• Codeine
• Tramadol
• Oxycodone

Why are opioids not typically used for long-term knee pain management? Opioids carry a high risk of dependence and addiction, making them unsuitable for chronic pain management. Their use is generally limited to short periods and under close medical supervision.

Topical Treatments for Localized Knee Pain

Topical medications can be an effective option for treating knee pain, especially when the discomfort is localized to a specific area. These treatments are applied directly to the skin over the affected joint.

OTC Topical Treatments

• Capsaicin creams
• Menthol rubs
• Salicylate creams

How do topical pain relievers work? Topical treatments work through various mechanisms. Capsaicin, for example, depletes substance P, a neurotransmitter that sends pain signals. Menthol creates a cooling sensation that can distract from pain, while salicylates have mild anti-inflammatory effects when absorbed through the skin.

Prescription Topical Medications

For more potent topical relief, doctors may prescribe:

• Diclofenac gel (Voltaren gel)
• Lidocaine patches

Are topical treatments as effective as oral medications for knee pain? Topical treatments can be highly effective for localized knee pain, especially for conditions like osteoarthritis. They have the advantage of delivering medication directly to the affected area while minimizing systemic side effects. However, for deep joint pain or widespread inflammation, oral medications may be more appropriate.

Corticosteroid Injections for Knee Pain Management

Corticosteroid injections are a powerful tool in the management of knee pain, particularly for conditions involving inflammation such as rheumatoid arthritis or severe osteoarthritis flares.

How Corticosteroid Injections Work

Corticosteroids are potent anti-inflammatory medications that, when injected directly into the knee joint, can provide significant relief from pain and swelling. Common corticosteroids used for knee injections include:

• Triamcinolone
• Methylprednisolone
• Betamethasone

How long do the effects of a corticosteroid injection last? The duration of relief can vary significantly between individuals. Some patients may experience relief for several months, while others may only have a few weeks of reduced pain. Generally, the effects of a corticosteroid injection can last anywhere from 6 to 12 weeks.

Potential Risks and Limitations

While corticosteroid injections can be highly effective, they are not without risks. Potential side effects include:

• Temporary increase in pain after injection
• Skin discoloration at the injection site
• Thinning of nearby bone (osteoporosis)
• Weakening of tendons
• Increased blood sugar levels in diabetic patients

Why are there limitations on the frequency of corticosteroid injections? Due to the potential for joint damage with repeated use, most doctors limit corticosteroid injections to 3-4 times per year in a single joint. Overuse of these injections can lead to cartilage breakdown and potentially accelerate joint degeneration.

Hyaluronic Acid Injections for Knee Osteoarthritis

Hyaluronic acid injections, also known as viscosupplementation, are another injectable treatment option primarily used for knee osteoarthritis. This treatment aims to supplement the natural synovial fluid in the knee joint, which acts as a lubricant and shock absorber.

How Hyaluronic Acid Injections Work

Hyaluronic acid is a naturally occurring substance in joint fluid. In osteoarthritis, the quantity and quality of this fluid decrease. Injections of hyaluronic acid can:

• Improve joint lubrication
• Reduce inflammation
• Potentially stimulate the body’s own production of hyaluronic acid

How soon can patients expect relief after hyaluronic acid injections? Unlike corticosteroid injections, which often provide rapid relief, the effects of hyaluronic acid injections typically develop more gradually. Patients may start to notice improvement in pain and function within a few weeks, with maximum benefit often seen around 8-12 weeks after treatment.

Types of Hyaluronic Acid Products

Several hyaluronic acid products are available for knee injections, including:

• Synvisc and Synvisc-One
• Euflexxa
• Orthovisc
• Monovisc

Do all hyaluronic acid products require the same number of injections? No, the number of injections can vary depending on the specific product. Some require a series of weekly injections (typically three to five), while others are formulated as a single injection. Your healthcare provider will recommend the most appropriate option based on your individual case and the product characteristics.

Emerging Therapies for Knee Pain

As medical research advances, new treatments for knee pain continue to emerge. While some of these therapies are still in experimental stages, they offer promising alternatives for patients who have not found relief with traditional treatments.

Platelet-Rich Plasma (PRP) Therapy

PRP therapy involves injecting a concentration of a patient’s own platelets to accelerate healing of injured tendons, ligaments, muscles, and joints. This treatment is gaining popularity for various orthopedic conditions, including knee osteoarthritis.

How does PRP therapy work for knee pain? PRP contains growth factors that are thought to stimulate healing and potentially regenerate tissue. When injected into the knee joint, these growth factors may help to reduce inflammation, promote tissue repair, and potentially slow the progression of osteoarthritis.

Stem Cell Therapy

Stem cell therapy for knee pain typically involves harvesting stem cells from the patient’s own body (usually from bone marrow or fat tissue) and injecting them into the affected knee joint. The goal is to use the regenerative potential of stem cells to repair damaged cartilage and reduce inflammation.

Is stem cell therapy an approved treatment for knee pain? While stem cell therapy shows promise, it is still considered experimental for knee osteoarthritis and other types of knee pain. Many studies are ongoing to determine its efficacy and long-term safety. Patients considering this treatment should be aware that it is not yet FDA-approved for knee conditions and may not be covered by insurance.

Gene Therapy

Gene therapy is an innovative approach that aims to modify the genetic material of cells to treat or prevent disease. In the context of knee pain, particularly osteoarthritis, researchers are exploring ways to use gene therapy to:

• Enhance cartilage repair
• Reduce inflammation
• Modify pain signaling pathways

When might gene therapy become available for knee pain treatment? Gene therapy for knee conditions is still in early research stages. While it shows potential, particularly for conditions like osteoarthritis, it will likely be several years before these treatments become widely available. Extensive clinical trials are needed to ensure safety and efficacy before gene therapies can be approved for general use.

Complementary and Alternative Approaches to Knee Pain Relief

While medications play a crucial role in managing knee pain, many patients find additional relief through complementary and alternative approaches. These methods can often be used alongside traditional medical treatments to enhance overall pain management and improve knee function.

Physical Therapy and Exercise

Physical therapy is a cornerstone of knee pain management, particularly for conditions like osteoarthritis, patellofemoral pain syndrome, and post-injury recovery. A tailored exercise program can help to:

• Strengthen muscles supporting the knee
• Improve flexibility and range of motion
• Enhance joint stability
• Reduce pain and stiffness

What types of exercises are most beneficial for knee pain? Low-impact activities such as swimming, cycling, and water aerobics are often recommended as they provide cardiovascular benefits without putting excessive stress on the knee joint. Specific strengthening exercises for the quadriceps, hamstrings, and hip muscles can also be highly beneficial.

Acupuncture

Acupuncture, a key component of traditional Chinese medicine, involves inserting thin needles into specific points on the body. Some studies suggest that acupuncture may help relieve knee pain, particularly in cases of osteoarthritis.

How might acupuncture help with knee pain? The exact mechanisms are not fully understood, but acupuncture is thought to work by stimulating the release of endorphins (natural pain-relieving chemicals) and affecting the way the nervous system processes pain signals. While more research is needed, many patients report significant pain relief from acupuncture treatments.

Dietary Supplements

Various dietary supplements have been studied for their potential benefits in managing knee pain, particularly in the context of osteoarthritis. Some commonly used supplements include:

• Glucosamine and chondroitin
• Omega-3 fatty acids
• Turmeric (curcumin)
• Boswellia

Are dietary supplements effective for knee pain? The evidence for dietary supplements in treating knee pain is mixed. While some patients report significant benefits, clinical studies have shown varied results. It’s important to note that dietary supplements are not regulated as strictly as medications, and their quality and efficacy can vary. Patients should always consult with a healthcare provider before starting any new supplement regimen.

Mind-Body Techniques

Mind-body techniques can be valuable tools in managing chronic knee pain. These approaches can help patients cope with pain, reduce stress, and improve overall well-being. Some effective mind-body techniques include:

• Meditation
• Yoga
• Tai Chi
• Biofeedback

How do mind-body techniques contribute to pain management? These practices can help reduce the perception of pain by promoting relaxation, reducing stress, and improving body awareness. Additionally, gentle movements involved in practices like yoga and tai chi can improve flexibility and strengthen muscles around the knee, potentially leading to reduced pain and improved function.

Best medication for knee pain: Types and side effects

Several medication options are available to treat knee pain, including over-the-counter drugs, prescription options, and injections.

Knee pain can start slowly and gradually worsen over time. The medication a person takes to treat knee pain will depend on the cause and severity of the pain.

There are many potential causes of knee pain, including:

• overuse
• arthritis
• Baker’s cyst
• infection in the joint
• bursitis
• torn cartilage
• strain or sprain

This article looks at the best medication for knee pain, home remedies, prevention of knee pain, and when to contact a doctor.

People may treat mild to moderate knee pain with over-the-counter (OTC) medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen.

NSAIDs relieve inflammation and help with pain management. Some types of NSAIDs are available OTC to treat mild to moderate pain.

OTC NSAIDs includeibuprofen, available under brand names such as Motrin and Advil, and naproxen sodium, available under the brand name Aleve.

Dosage

An adult can take ibuprofen at 800–1,200 milligrams (mg) per day. For naproxen sodium, the daily dose should not be more than 1,375 mg.

A person should follow the instructions on the medication guide and never exceed the recommended daily dose.

Precautions

NSAIDs may increase the risk of stroke or heart attack, which may occur suddenly. These risks may be even higher in people who:

• smoke
• have previously had a heart attack or stroke
• have diabetes or high cholesterol

Doctors also associate NSAIDs with a risk of ulcers and holes and bleeding in the intestine and stomach. These risks may be higher for people who drink alcohol frequently, are older adults, or have other health conditions.

The risks associated with NSAIDs may increase for people who take the medication for a long time.

NSAIDs may also interact with certain medications, including:

• other NSAIDs
• anticoagulants, such as warfarin
• oral steroids, such as prednisone
• selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine and citalopram
• serotonin-norepinephrine reuptake inhibitors (SNRIs), such as duloxetine

Read on for the differences between SSRIs and SNRIs.

Potential side effects

NSAIDs such as naproxen may cause side effects, which can include:

• diarrhea
• bloating and gas
• constipation
• ringing in the ears
• dizziness
• drowsiness
• nervousness

People should speak with a medical professional to discuss the potential side effects of NSAIDs.

Acetaminophen is an analgesic or pain reliever that also reduces fever. Some people take acetaminophen to reduce pain caused by osteoarthritis, a type of arthritis that affects the joints, including the knee. People also take acetaminophen to relieve other mild to moderate pain.

Examples of medications that contain acetaminophen include:

• Panadol
• Tylenol
• Actamin
• FeverAll

Dosage

The maximum amount of acetaminophen a person should take in one dose is 1,000 mg. A person should not take more than 4,000 mg per day.

Precautions

If a person takes too much acetaminophen, there is a risk of liver damage. This may be severe, require a liver transplant, or be fatal.

Potential side effects

Possible side effects include:

• rash
• itching
• hives
• swelling in the:
  • tongue
  • face
  • throat
  • ankles
  • feet
  • legs
• blistering or peeling skin
• difficulty swallowing or breathing
• hoarseness

People should speak with a doctor if they experience these symptoms after taking acetaminophen.

A person may require stronger medication for more severe pain, which a doctor can prescribe. These may include higher dosage NSAIDs and COX-2 inhibitors, also called coxibs.

Examples of prescribed NSAIDs include:

• high dose ibuprofen
• high dose naproxen
• diclofenac (Voltaren)

Examples of coxibs include celecoxib (Celebrex) and etoricoxib. A person can take these medications as tablets orally or apply them to the knee as a gel or cream.

Dosage

According to the National Library of Medicine, the maximum daily dose of each medication is:

• ibuprofen: 2,400 mg
• naproxen: 1,000 mg
• naproxen sodium: 1,375 mg
• diclofenac: 150 mg
• celecoxib: 400 mg
• etoricoxib: 60 mg

Precautions

People who take NSAIDs or coxibs are at risk of gastrointestinal problems. There is a greater risk of complications if a person:

• drinks alcohol frequently
• takes corticosteroids
• takes SSRIs
• takes blood thinning medication
• takes several anti-inflammatory pain relief medications together
• has had stomach bleeding or gastritis
• has gastrointestinal conditions, such as Crohn’s disease or ulcerative colitis
• has a bacterial infection with Helicobacter pylori, which can cause ulcers
• is 65 years or older

Potential side effects

Side effects of prescription NSAIDs and coxibs may include:

• indigestion and stomach pain
• gas and bloating
• ulcers
• constipation
• gastritis
• sore throat
• dizziness
• cold symptoms

If a person experiences any of these symptoms and is at high risk, they should consult a medical professional.

If a person has severe pain from injury or illness, such as arthritis, a doctor may administer an injection to treat the pain. Doctors may recommend hydrocortisone or hyaluronic acid injections.

Hydrocortisone injection

This type of injection is a corticosteroid. A doctor may administer a hydrocortisone injection directly into the knee joint.

This medication can treat knee pain from various causes, including injury, arthritis, and bursitis. The injection helps reduce swelling and pain and makes movement easier.

Dosage

A person may be able to have injections in the knee up to four times a year. The dosage can vary between 5 mg and 50 mg of hydrocortisone.

Precautions

Hydrocortisone may not be suitable for people who:

• have an infection
• have or have had depression
• have been in recent contact with a person who has:
  • measles
  • shingles
  • chickenpox
• have recently had vaccinations or are having vaccinations soon
• are pregnant, breastfeeding, or trying to become pregnant

Hydrocortisone may also cause complications in people who have:

• high blood pressure
• diabetes
• osteoporosis
• glaucoma
• unhealed wounds

People should speak with a doctor about the injections’ potential risk factors and complications.

Potential side effects

Side effects of hydrocortisone injections may include pain and swelling at the injection site and bruising.

Serious side effects include:

• signs of infection such as:
  • fever
  • chills
  • sore throat
  • ear or sinus pain
• depression or mood swings
• puffy face or weight gain in the upper belly or back
• swelling and throbbing in the legs or arms
• chest pain
• confusion and sleepiness
• changes to vision

A person can speak with a medical professional if experiencing any of the side effects described above.

Hyaluronic acid

A doctor may inject hyaluronic acid into the knee to increase the supply of the acid. This can help relieve pain and may improve other symptoms of conditions that affect the knee joint, such as osteoarthritis.

Dosage

Depending on which hyaluronic acid a doctor uses, they may administer one to five injections over several weeks.

Precautions

If a person is pregnant or breastfeeding, they should let a doctor know before starting this medication. People should also inform a doctor if they develop an infection in the knee or a skin problem.

Potential side effects

Side effects of hyaluronic acid injection may include pain and swelling at the injection site and difficulty moving the knee immediately after the injection. These symptoms are usually temporary, and applying ice helps ease the pain.

Less common side effects include:

• bleeding
• blistering
• burning or coldness
• discoloration of skin
• hives or rash
• joint infection
• inflammation
• itching or stinging
• lumps
• numbness and tingling
• redness, soreness, and tenderness
• ulceration and warmth at the injection site

People should seek medical attention if they experience mild or more severe reactions.

Knee pain may sometimes go away on its own. If the pain is not severe, a person may be able to treat it at home by:

• putting as little weight as possible on the knee
• avoiding standing for a long time
• using an ice pack on the knee for up to 20 minutes every 2–3 hours
• taking acetaminophen

Learn more about the home remedies for knee pain.

To help prevent knee pain, a person can:

• balance rest and exercise
• maintain a moderate body weight
• wear suitable footwear with arch supports

A person should contact a doctor about knee pain if:

• the pain is severe
• there is swelling in the knee
• there is no improvement after a week
• there is no movement
• the knee cannot bear weight
• the knee locks or buckles

The medication a person receives for knee pain can depend on the cause and severity of the pain.

A person may take OTC medication for mild to moderate pain, such as ibuprofen or naproxen. If the pain is more severe, a person may require medication prescribed by a doctor, such as a higher dose of NSAID or COX-2 inhibitors. A doctor may sometimes administer injections and inject hydrocortisone or hyaluronic acid into the affected area.

A person can also treat knee pain at home by resting, raising the knee, and applying ice.

Osteoarthritis of the knee: Which painkillers are effective? – InformedHealth.org

Created: July 18, 2019; Next update: 2021.

Osteoarthritis pain can often be treated effectively with anti-inflammatory painkillers. But higher doses are often needed. Due to the possible associated risks, it’s recommended that the painkillers be taken as needed rather than all the time.

Osteoarthritis is typically treated with painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs). These medications have an anti-inflammatory and pain-relieving effect. Examples of NSAIDs include diclofenac, ibuprofen and naproxen. Two other anti-inflammatory painkillers with a similar effect are celecoxib and etoricoxib. These are COX-2 inhibitors (also known as coxibs). They are taken as tablets or directly applied to the painful joint in the form of a gel or cream.

Some NSAIDs can be bought at pharmacies without a prescription – for example, to treat a headache or menstrual pain. To achieve noticeable pain relief in osteoarthritis, though, higher doses are often needed, and they have to be prescribed by a doctor.

NSAIDs and coxibs can relieve pain effectively, but they can also have side effects. The risk of serious side effects depends on your age and any other medical conditions you may have. But anti-inflammatory painkillers aren’t suitable for everyone. People who already have other illnesses, like kidney problems or stomach ulcers, may not be able to take them or may have to go for regular check-ups. Sometimes reducing the dose is enough. Other reasons not to take NSAIDs or coxibs may include interactions with certain medications like acetylsalicylic acid (ASA). Alternatively, you can apply a cream or gel with a drug like diclofenac to your knee. Studies show that this can effectively relieve pain in some people with osteoarthritis of the knee. The drug etofenamate is available in the form of a cream or gel too. But its effectiveness hasn’t been studied in good-quality studies.

Some people worry too much about the possible risks associated with painkillers. A few also worry about becoming dependent on them. But unlike opiate-based painkillers (opioids), NSAIDs and coxibs have no addictive effect. Other people worry that taking painkillers might prevent them from feeling alarm signals sent by their bodies. There’s no medical reason to worry, though: Chronic pain tells you much less about the condition of your joints than you might think.

It’s best to use anti-inflammatory painkillers in addition to other treatments, like exercise therapy. If you’re thinking of taking painkillers right before exercising, it’s a good idea to ask your doctor first.

How are NSAIDs and coxibs used?

There are a number of different NSAIDs and coxibs. The table below lists the names and doses of the drugs that are most commonly used to relieve osteoarthritis pain:

Experts recommend that you only use these medications when the pain is bad rather than using them continuously. That can lower the risk of side effects.

It’s best to start at a low dose and increase it if necessary. It’s important not to exceed the maximum daily dose of a drug.

What can I expect from NSAIDs and coxibs?

Anti-inflammatory painkillers don’t always make the pain go away completely, but they usually relieve it. A group of researchers from Bern analyzed high-quality studies on the effects of NSAIDs, coxibs, and acetaminophen (paracetamol) in osteoarthritis – a total of more than 70 studies with almost 60,000 participants. The most effective painkillers were diclofenac (150 mg per day) and etoricoxib (60 mg per day). Acetaminophen isn’t effective for osteoarthritis.

Whether or not a drug works will also depend on whether you have any other medical conditions and are using any other medication. That’s why it’s helpful to talk with your doctor before starting a treatment. She or he may check your kidney function, among other things, to make sure that you can safely use certain medications.

How common are side effects when taking NSAIDs and coxibs?

The most common side effects of anti-inflammatory painkillers are stomach problems. They range from minor problems like indigestion and stomach ache to more serious problems like gastritis (inflammation of the stomach lining), ulcers, and bleeding in the stomach or bowel (gastrointestinal bleeding). Taking medications with a meal can help.

Medications to protect the stomach, like omeprazole or pantoprazole, can effectively prevent gastrointestinal problems. They are from a group of drugs known as proton pump inhibitors (PPIs) and reduce the production of acid in the stomach. Studies show that this makes gastrointestinal complications relatively rare:

• When taken for one year together with a PPI, high-dose diclofenac or etoricoxib lead to gastrointestinal complications in 0.2 to 0.4% of people.

• This risk is higher with high-dose ibuprofen or naproxen, at 0.6 to 1.6%.

Proton pump inhibitors can interfere with the effects of other medications, though. There’s also some evidence to suggest that the long-term use of PPIs can increase the risk of bone fractures.

High-dose NSAIDs and coxibs can also increase the likelihood of developing cardiovascular diseases such as heart attacks and strokes: by less than 1% per year. Naproxen is an exception. In studies, this medication had little influence on the risk of cardiovascular diseases.

What are the possible reasons not to take NSAIDs and coxibs?

Various factors increase the risk of gastrointestinal problems. These problems are more common in people who

• are over 65 years old,

• have already had gastritis, an ulcer or stomach bleeding,

• have a bacterial infection with Helicobacter pylori,

• drink a lot of alcohol,

• take blood-thinning heart medicines, for example anticoagulants like warfarin or acetylsalicylic acid (the drug in medicines like “Aspirin”),

• take corticosteroids (“steroids”),

• take a selective serotonin reuptake inhibitor (SSRI) antidepressant,

• take several anti-inflammatory painkillers at the same time, or

• have certain gastrointestinal conditions like Crohn’s disease or ulcerative colitis.

If your risk of stomach bleeding or other serious complications is very high, it can be a good idea to talk with your doctor about other treatments.

People who have cardiovascular disease or several risk factors for it should also carefully consider the advantages and disadvantages of treatment with an NSAID or coxib. Treating pain with naproxen may be a good option for them since it doesn’t affect the heart or the circulatory system.

Is the painkiller metamizole (“Novalgin”) an alternative?

Metamizole is a fever-reducing and inflammation-reducing painkiller similar to NSAIDs. But there are no studies on its effectiveness in people with osteoarthritis or comparing it with other treatments. Although this drug is often used in Germany, it’s not approved for the treatment of osteoarthritis and is not recommended by medical societies.

The use of metamizole is the subject of debate because it can lead to a rare but serious side effect known as agranulocytosis. This side effect causes a big drop in the number of certain white blood cells in the body, which can be life-threatening. Possible signs of agranulocytosis are fever, sore throat, and inflamed mucous membranes. The risk of this side effect is estimated to be far below 0.1%.

Are opioid painkillers helpful in osteoarthritis?

Opioids are prescription painkillers that are used in emergency and intensive care to induce anesthesia and to treat cancer-related pain. Morphine is the best-known opioid drug. Other opioids include buprenorphine, codeine, hydromorphone, oxycodone, tapentadol, tilidine and tramadol.

Opioids can relieve acute pain very effectively. But, contrary to popular belief, this is not true for chronic osteoarthritis pain: Studies now show that they often don’t help in osteoarthritis any better than NSAIDs do. There’s also some evidence that they could become less effective after only a few weeks.

Opioids may be a good choice if several drugs are needed for the short-term treatment of severe pain or to bridge the time until surgery. They’re also an option for people who can’t take NSAIDs.

When it comes to osteoarthritis pain, though, opioids shouldn’t be used routinely or for longer time periods. They can cause side effects like constipation, nausea, lack of sexual desire, dizziness, and tiredness, as well as affect your ability to drive. There’s also a low risk of a life-threatening overdose. So it’s very important to follow your doctor’s instructions on how to take them, and not to increase the dose without talking to your doctor first. The same is true for opioid skin patches (fentanyl patches).

Experts recommend not using opioids for longer than one to three months because they can be physically addictive. According to estimates from studies, about 6% of people become addicted after using them for a longer time.

The use of opioids is not recommended for people who already have a headache disorder, fibromyalgia, inflammation of the pancreas, inflammatory bowel disease or an addiction problem.

Sources

• Bhala N, Emberson J, Merhi A, Abramson S, Arber N, Baron JA et al. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet 2013; 382(9894): 769-779. [PMC free article: PMC3778977] [PubMed: 23726390]

• Busse JW, Craigie S, Juurlink DN, Buckley DN, Wang L, Couban RJ et al. Guideline for opioid therapy and chronic noncancer pain. CMAJ 2017; 189(18): E659-E666. [PMC free article: PMC5422149] [PubMed: 28483845]

• Da Costa BR, Nüesch E, Kasteler R, Husni E, Welch V, Rutjes AW et al. Oral or transdermal opioids for osteoarthritis of the knee or hip. Cochrane Database Syst Rev 2014; (9): CD003115. [PubMed: 25229835]

• Da Costa BR, Reichenbach S, Keller N, Nartey L, Wandel S, Jüni P et al. Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: a network meta-analysis. Lancet 2017; 390(10090): e21-e33. [PubMed: 28699595]

• Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie (DGOOC). S2k-Leitlinie: Gonarthrose. AWMF-Registernr.: 033-004. January 18, 2018.

• Häuser W, Bock F, Engeser P, Tölle T, Willweber-Strumpf A, Petzke F. Langzeitanwendung von Opioiden bei nichttumorbedingten Schmerzen. Dtsch Arztebl Int 2014; 111(43): 732-740. [PMC free article: PMC4238316] [PubMed: 25404530]

• Hurley M, Dickson K, Hallett R, Grant R, Hauari H, Walsh N et al. Exercise interventions and patient beliefs for people with hip, knee or hip and knee osteoarthritis: a mixed methods review. Cochrane Database Syst Rev 2018; (4): CD010842. [PMC free article: PMC6494515] [PubMed: 29664187]

• Smith SR, Deshpande BR, Collins JE, Katz JN, Losina E. Comparative pain reduction of oral non-steroidal anti-inflammatory drugs and opioids for knee osteoarthritis: systematic analytic review. Osteoarthritis Cartilage 2016; 24(6): 962-972. [PMC free article: PMC4996269] [PubMed: 26844640]

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Osteoarthritis of the knee – Articles Ortoland

The cartilages of the knee joint absorb shocks, distribute the compressive forces that occur during loading, and protect the joints from abrasion. Arthrosis of the knees, pain occurs due to thinning and damage to the cartilage. Constant, intense, aching pain interferes with physical activity, worsens overall well-being.

What is knee arthrosis?

Arthrosis of the knee (gonarthrosis, osteoarthritis) is a progressive disease with cartilage destruction, pathological changes in the ligaments and pericartilaginous bones, and thickening of the joint capsule. The elasticity of cartilaginous tissues decreases, smooth sliding is disturbed, the bones rub against each other during movement. The joints are destroyed slowly, the discomfort is replaced by painful sensations when walking, bending the knees. Acute pain in arthrosis occurs at an advanced stage, when osteophytes (bone growths) formed on the articular surface block movement.

Types of pain in case of arthrosis:

• Starting – appears during movements after rest or sleep, stops after 20–25 minutes.
• Congestive – occurs at night against the background of stagnation of the synovial fluid, increased intraosseous pressure.
• Mechanical – disturbs after exertion, disappears after rest

Incidence rate

Due to the pressure of body weight on the knee joints, loads from movement, the disease leads among deforming arthrosis. Articular pathology in most cases develops after 40 years, is diagnosed in 27% of the population at the age of 50 years. After 65 years, radiological signs of gonarthrosis are detected in 85% of the population. Articular cartilage is more commonly affected in women. During menopause, the production of estrogens, hormones that maintain the integrity of cartilage tissue, decreases. 70% of patients complain of pain in arthrosis of the knee joint, 80% of patients have limited mobility.

Causes of deforming arthrosis

According to scientists, early wear of cartilage is caused by defects in type II collagen (about 50% of cartilage mass), flat feet, and knee dysplasia. The age-related decrease in collagen production leads to the drying of cartilage. But in most cases, changes can be pushed back with the right lifestyle. Many older people have minor joint problems. And for some, at the age of 50, severe pain with arthrosis reached a critical point and limited their ability to work.

Risk factors that increase the likelihood of developing gonarthrosis:

Insufficient water intake.

There are no vessels in the cartilage tissue; the substances necessary for nutrition come from the synovial fluid. With insufficient water, the volume of synovia decreases. Cartilage loses elasticity, cracks, friction in the joint capsule increases, pain and a characteristic crunch occur. To maintain cartilage tissue and mitigate the course of the disease, drink at least 2 liters of water per day.

Intense physical activity.

To maintain freedom of movement, after 40 years, you need to unload the joints. Wear shoes with shock-absorbing soles, alternate long-term static loads with sitting or walking, and wear a knee brace for heavy loads.

Low physical activity.

Cartilage tissues receive less oxygen and nutrients, muscles lose strength. They help relieve pain in arthrosis of the knees, stimulate the supply of nutrients to the periarticular tissues: swimming, hiking, skiing, Nordic walking, cycling.

Overweight.

Extra pounds 4 times increase the likelihood of arthrosis, meniscus ruptures, microtraumas of cartilage occur more often. Slow down the rate of destructive processes, help reduce weight: limited salt intake, vegetables and herbs, aspic dishes, dairy products, low-fat cheeses, lean meat.

Symptoms of gonarthrosis

The severity and duration of symptoms, external changes in the knee joint, what pains occur with arthrosis, depend on the stage of the destructive process.

I stage.

Changes in the cartilage are insignificant, the surface becomes dry, microtraumas appear. The x-ray shows osteophytes (bone growths). Pain occurs after physical exertion, when climbing stairs, knee aches in wet weather. The patella is not deformed, morning stiffness disappears after a few movements.

II stage.

The cartilaginous layer becomes thinner, disappears in some areas. The synovium becomes inflamed. X-ray examination reveals multiple osteophytes, narrowing of the joint space, thickening of the bone tissue. Worried about swelling and deformity of the knee, excruciating pain when bending and moving, severe aching when the weather changes, after hypothermia. There is stiffness, crunching and clicking in the joints. In the second stage of arthrosis, aching pains at night lead to insomnia, pain sensations do not go away at rest.

In the photo (stages 1-4). The last picture shows the destruction of the bone tissue.

Stage III.

The cartilage is destroyed almost completely, the knee increases in size, the gait becomes unstable, and lameness appears. The crunch in the knees is audible even to others. It is difficult to overcome short distances, climb stairs without relying on a cane, get on the bus. The radiograph shows destroyed menisci and ligaments, extensive ossification, deformed articulating surfaces. Cutting pain bothers when moving and at rest, worse after walking 500 meters. Decreased ability to self-care.

Stage IV .

In the absence of adequate treatment, non-compliance with the recommendations, the cartilage is completely destroyed, the bones of the knee grow together. Motor ability is lost, disability occurs.

Arthrosis pain: what to do, what mistakes not to make

With the appearance of starting pains, a crunch, you need to contact a therapist, rheumatologist or orthopedist. Symptoms of gonarthrosis can be confused with arthritis (inflammatory process), gout (salt deposition). Each pathology has a different treatment. Only a doctor after x-rays, ultrasound of the knee can differentiate diseases.

The main methods of treatment:

• NSAIDs are prescribed for arthrosis to relieve pain, inflammation. New generation drugs are less toxic, stimulate the production of intercellular substance of cartilage.

• Corticosteroid injections are used for inflammation of the synovium.

• Hyaluronic acid injections stimulate cartilage repair, reduce pain, improve knee joint mobility. After intra-articular injection of hyaluronate, pain does not bother about six months.

• Antienzymatic drugs inhibit the production of cartilage-destroying enzymes.

• Chondroprotectors slow down the degenerative process, activate the restoration of cartilage tissue.

• Exercise therapy helps to eliminate spasms, strengthen weakened muscles, reduce pain, and improve joint mobility.

• Shock wave therapy eliminates osteophytes. Reduced pain, increased range of motion.

• Myostimulation reduces venous congestion, pain syndrome, improves metabolism.

• Ultraphonophoresis enhances the action of hormonal, anti-inflammatory drugs (hydrocortisone, dimexide).

• Plasmolifting is used to regenerate cartilage tissue. After the introduction of plasma into the joint, the production of synovial fluid improves, microtraumas heal, pain recedes.

• Kinesio taping – elastic bands relieve stress and soreness, improve blood circulation.

• Endoprosthetics is indicated for arthrosis of the 3rd and 4th stages. The service life of the endoprosthesis is from 15 years.

You can relieve pain in arthrosis of the joint at home with analgesics and non-steroidal drugs. Nise quickly eliminates pain, swelling, does not interfere with the restoration of cartilage. Weakens arthralgia Ketoprofen ointment, Diclopentil tablets, Ibuprofen. Reduces pain for 6-8 hours Ketorolac. To unload the knee joint, you can use knee pads, custom-made orthopedic insoles.

In order for the prognosis for arthrosis of the knee to be favorable, consult a doctor at the initial manifestations of the disease. Conservative treatments will support the functionality of the knee joint.

Author: Serdyuchenko Sergey Nikolaevich
Doctor orthopedist-traumatologist of the highest category

causes, effects and treatments

Contents

• 1 Knee pain: causes, complications, treatment
  • 1. 1 Problems causing knee pain
  • 1.2 Symptoms of knee pain
  • 1 .3 How to diagnose knee disease: basic methods
  • 1.4 Methods for the treatment of knee pain
  • 1.5 Alternative methods for the treatment of the knee joint
    • 1.5.1 Herbs and oils
    • 1.5.2 Compresses
    • 1.5.3 Proper nutrition
  • 1.6 Treatment of knee pain without medication
  • 1.7 Knee surgery e: everything you need to know
    • 1.7. 1 Indications for surgery
    • 1.7.2 How surgery works
    • 1.7.3 Consequences of surgery
  • 1.8 Rehabilitation therapy after knee surgery
  • 1.9 How to prevent knee pain
    • 1.9.1 1. Exercise regularly
    • 1.9.2 2. Maintain a normal body weight
    • 1.9.3 3. Wear comfortable shoes
    • 1.9.4 4. Warm up and stretch before exercise

    9001 2 1.9.5 5. Seek medical attention at the first symptoms of knee pain

  • 1.10 Consequences of ignoring knee pain
  • 1. 11 Sports and knee pain: how to minimize the risk of injury
  • 1.12 Related videos:
  • 1.13 Q&A:
    • • 1.13.0.1 What is knee pain?
      • 1.13.0.2 What causes knee pain?
      • 1.13.0.3 What are the consequences of ignoring knee pain?
      • 1.13.0.4 How can I treat knee pain at home?
      • 1.13.0.5 What medicines can be used to treat knee pain?
      • 1.13.0.6 When should I see a doctor?

Find out what causes knee pain, what conditions can cause it, and what to do to prevent serious complications. Doctor’s advice and home remedies for knee pain.

The knee joint is one of the largest and most stressed joints in the human body, connecting the thigh and lower leg. It provides support for the weight of the body and also allows for flexion and extension of the leg. However, even a healthy person may experience problems with the knee, which can be accompanied by unpleasant pain symptoms and increased sensitivity to high load.

The causes of knee pain can be very diverse. It can be trauma, age-related changes, arthritis, rheumatoid arthritis, inflammation, and even cancer. In addition, there are a number of diagnostic methods that can help in determining the causes of pain in the knee.

In this article we will look at the causes, consequences and methods of treatment of pain in the knee joint. You will learn what factors can affect pain symptoms, as well as how to properly care for your knee to prevent further problems and diseases.

Problems that cause knee pain

Osteoarthritis of the knee: is a condition where the cartilage on the surface of the joints wears away, resulting in the cushion surfaces losing their damping capacity. This can cause severe pain and burning in the knee.

Injury: Like any part of the body, the knee can be damaged and injured by a blow, fall or twist. Severe ordeals can lead to sprains, torn cartilage in joints, torn muscles, or a condition known as knee bursitis that causes pain and swelling.

Nerves: Patients who have meniscal injuries, lacrimal glands, cartilage inflammation, and knee deformity often suffer from nerve tension, which can cause knee pain or simply tenderness in that area.

Infections: any infectious disease can cause knee pain. Knee pain due to acute sepsis, which affects tissues in different parts of the body, usually occurs in the presence of high body temperature and other symptoms, such as headaches, nausea and vomiting.

It is important to understand that knee pain can be caused by many different things. If pain occurs, you should consult a doctor for examination and correct determination of the cause.

Symptoms of knee pain

Knee pain can present with different symptoms, depending on the cause. However, the most common symptoms are:

• pain on movement – the person feels pain when walking, climbing stairs, squatting or jumping;
• limitation of movement – pain in the knee may be accompanied by a feeling of stiffness and limitation of movement in the joint;
• swelling and redness – in some diseases of the knee joint, swelling and redness of the skin may occur at the site of pain;
• crackling or popping sound – during certain movements, for example, when bending and extending the knee, a person may feel a crackling or popping sound in the knee joint;
• muscle weakness – sometimes pain in the knee can be accompanied by a feeling of weakness in the muscles of the leg, which makes it difficult to move.

How to diagnose knee disease: basic methods

Knee pain can cause various chronic diseases, as well as injuries, injuries and fractures. To correctly diagnose a disease of the knee joint, you need to see a doctor and go through several basic research methods:

1. Physical Examination – In the first stage, the doctor performs a visual and tactile examination of the knee, determines the nature and degree of pain, possible reduced mobility and the presence of swelling.
2. X-ray is the most common method of diagnosing the knee joint and shows certain skeletal structures. So, on an x-ray, you can see the presence of various changes in the structure and functioning of the knee, such as fractures, deformities, etc.
3. Ultrasound examination – ultrasound waves help to visualize the condition of the soft tissues, blood vessels and joint fluid around the knee. Ultrasound allows you to accurately determine the causes of pain and features of movement in the knee joint.
4. Magnetic Resonance Imaging is a more accurate diagnostic method that provides more detailed information about the anatomical structures of the knee joint. This research method helps to identify all the characteristics and degree of damage to the joint.

As a result, it is possible to determine the causes and methods of treatment of diseases of the knee joint only after a complete and comprehensive examination. A doctor’s consultation, as well as the optimal combination of diagnostic and treatment methods, will quickly and effectively get rid of pain and restore knee functionality.

Treatments for knee pain

Non-radical treatments:

• Non-steroidal anti-inflammatory drugs reduce inflammation and pain.
• Physiotherapeutic methods: magnetotherapy, ultrasound, laser therapy accelerate metabolic processes and improve blood circulation in the joint.
• Massage and exercise therapy help to strengthen the muscles around the knee joint and reduce stress on it.

Surgical methods:

• Joint arthroscopy: a minimally invasive procedure in which an optical device is inserted into the joint to diagnose and treat damage.
• Knee replacement: using an implant to replace damaged tissue.
• Surgery to correct damaged ligaments.

Traditional Treatments for the Knee

Pain in the knee can lead to serious problems that can restrict movement and impair quality of life. Alternative therapies can help reduce pain and improve joint function.

Herbs and oils

Herbs such as wild arnica, chamomile and burdock can help relieve knee pain. They can be used in the form of ointments, tinctures or compresses. You can also use shrub oil, which has anti-inflammatory properties. To do this, just apply a small amount of oil on the knee joint and massage it until completely absorbed.

Compresses

Compresses can reduce swelling and relieve pain in the knee joint. Compresses can be made from vegetable oils, honey, clay, cabbage leaves, ginger rhizomes or onions. Compresses made from mustard powder can also help improve joint circulation, increase mobility, and reduce pain.

Proper nutrition

Equally important is proper nutrition in the treatment of knee pain. One way is to eat foods containing chondroitin and glucosamine, which can help reduce inflammation and stimulate cartilage growth. It is also highly recommended to reduce your consumption of alcohol and smoking to avoid deterioration of the joints.

• Weight management
• Maintaining a healthy lifestyle
• Regular exercise to strengthen the muscles of the legs and pelvis
• Massage, stretching and yoga to improve joint mobility

Treatment of knee pain without medication

900 02 Knee pain is common in people regardless of age. Doctors often recommend medications to reduce pain, reduce inflammation, and heal injuries. However, there are other methods that allow you to eliminate knee pain without the use of drugs.

Another method is to change the diet. Some foods contain substances that can increase inflammation and cause knee pain. A diet rich in vegetables, fruits, and leafy greens can help fix the problem.

It is important to take time to rest and relax so as not to strain the muscles and joints of the knee. Massage is also an indispensable method of treating knee pain. Massage helps improve blood circulation, relaxes muscles and reduces inflammation.

• Exercise: leg twists, knee extension, squats, imitation of cycling
• Nutrition: rich in vegetables, fruits and green leaves
• Rest and relaxation: stress avoidance, massage

90 018

Knee surgery: all what you need to know

Indications for surgery

Knee surgery is a serious step in the treatment of the disease. Usually, indications for surgery arise when conservative treatment does not work and pain in the knee increases over time. Surgery may be necessary if the patient suffers from damage to the meniscus, cartilage, development of arthritis, or inflammation of the joint.

How the operation works

The most common methods of knee surgery are arthroscopy and total knee replacement. In the first case, the surgeon makes a minimal incision and inserts an arthroscope – a small camera with instruments – that allows you to examine the joint and perform a minimally invasive operation. The second method, total arthroplasty, consists in replacing the diseased knee joint with an artificial one.

Consequences of surgery

After knee surgery, the patient must wait for some time to recover. A little pain and swelling after surgery is a normal reaction of the body and the consequences of the use of anesthesia. The arthroscopy method usually has a shorter recovery time compared to total arthroplasty. In the conditions of a high-quality rehabilitation center, anyone can return to an active lifestyle a few months after the operation, subject to the restrictions and recommendations established by the doctor.

Rehabilitation Therapy After Knee Surgery

Knee surgery may be required in case of injury, arthritis or other conditions. However, the recovery process does not end with the operation. Sometimes a long period of rehabilitation therapy is required to restore the full functionality of the joint.

The recovery process after knee surgery can take several months or even years. However, proper rehabilitation therapy can significantly improve the rehabilitation period and lead to faster recovery of knee joint function.

How to prevent knee pain

1. Get regular physical activity

Lack of movement can cause pain in the knee and other joints. Regular physical activity such as running, cycling, walking, swimming or yoga is recommended. This will help strengthen muscles and joints, which will reduce the risk of injury.

2. Maintain normal body weight

Excess weight puts extra pressure on the knee joints. To prevent knee pain, it is recommended to maintain a normal body weight. Regular exercise and a healthy diet can help achieve this goal.

3. Wear comfortable shoes

Clothing and footwear play an important role in preventing knee pain. Wear comfortable shoes with good cushioning to reduce pressure on your knee joints.

4. Warm up and stretch before exercise

Warming up and stretching help prepare your muscles for physical activity. This can reduce the risk of injury and knee pain. It is recommended to spend 5-10 minutes warming up and stretching before playing sports.

5. Consult a doctor at the first symptoms of knee pain

At the first symptoms of knee pain, it is recommended to immediately consult a doctor. This can prevent the condition from worsening and help with treatment, which may include physical therapy, medication, or surgery.

Consequences of ignoring knee pain

Although knee pain can occur for many reasons, ignoring it can lead to serious consequences. First of all, this can lead to the accelerated development of joint diseases that cause significant damage to health.

Persistent knee pain can lead to reduced quality of life, reduced physical ability and the development of arthrosis. There may also be problems with bone tissue and injuries of all kinds.

Therefore, if you experience knee pain, you should not delay your visit to the doctor and ignore these symptoms. Early identification of the cause of pain and timely treatment will help maintain health and quality of life for many years to come.

Sports and knee pain: how to minimize the risk of injury

Sport is an integral part of a healthy lifestyle, but if you do not exercise properly, you can get a serious injury that causes knee pain.

To minimize the risk of injury to this important joint, it is necessary to take a number of measures:

• Choose the right sport based on physical capabilities and characteristics of the body;
• Wear special equipment that includes knee protection;
• Observe the technique of performing exercises, do not overload the knee and do not exceed the permissible load;
• Regularly develop the flexibility of the knee joint with special exercises;
• Monitor your physical fitness and maintain it at the right level;
• After training, it is imperative to take measures to restore the body.

When knee pain occurs, consultation with a specialist and proper treatment are necessary, otherwise it will not be possible to avoid the consequences of the injury. Constant monitoring of your health and the right approach to sports will help keep your joints healthy and avoid knee pain.

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Q&A:

What is knee pain?

Knee pain is a feeling of discomfort, pressure, pain, or stiffness in the area of ​​the knee joint that a person may experience with or without movement. It can be caused by a variety of factors such as injury, wear and tear on the joints, or diseases such as arthritis.

What causes knee pain?

Knee pain can be caused by a variety of causes, including trauma, wear and tear, arthritis, bursitis, osteochondrosis, various bone and joint infections, and more.

What are the consequences of ignoring knee pain?

Ignoring knee pain can lead to serious consequences such as deterioration of the joints, deformity of the knee, impaired walking and movement, forced processing of other joints and muscles, the possibility of new injuries, which will further worsen the condition of the joint.

How can you treat knee pain at home?

There are several ways to help manage knee pain at home, such as strengthening exercises, cold and hot compresses, massage, wearing a knee brace, avoiding excessive stress on the knee joint. However, before applying home treatments, a doctor’s consultation is necessary to rule out more serious diseases.

What medicines can be used to treat knee pain?

Treatment for knee pain includes a wide range of drugs such as anti-inflammatory drugs, pain relievers, muscle relaxers, cartilage regeneration stimulators, etc. Which medications the doctor prescribes depends on the cause of the pain.