Medical Treatments for Osteoarthritis Pain
Primary care doctors, physical therapists and orthopaedists can play an important role in treating osteoarthritis. Here’s the latest evidence on a growing range of options for treating OA pain, including topicals, pills, injectables, physical therapy, orthotic, brace care and more.
Therapeutic Interventions
Physical Therapy (PT)
A physical therapist can create an individualized exercise program that will improve balance, strength and joint alignment and increase overall physical function and reduce pain.
Exercise
The OA management guidelines from the European League Against Rheumatism (EULAR, 2013), the American College of Rheumatology (ACR, 2012) and the American Academy of Orthopaedic Surgeons (AAOS, 2013) all recommend exercise supervised by a physical therapist.
Joint Alignment Devices
Problems with biomechanics – how the spine, hips, knees and feet work together – can worsen the pain of OA and damage affected joints. Evidence for the effects of custom and off-the-shelf braces and insoles on OA pain is mixed.
Guidelines from ACR and OA Research Society International (OARSI, 2014) suggest considering them an option for people with lower-limb OA. They advise people to get a biomechanical evaluation from an appropriate specialist – usually a physical therapist.
Guidelines from ACR and OA Research Society International (OARSI, 2014) suggest considering them an option for people with lower-limb OA. They advise people to get a biomechanical evaluation from an appropriate specialist – usually a physical therapist.
Transcutaneous Electrical Nerve Stimulation (TENS)
Scientists think this technique, in which a weak electric current is administered through electrodes on the skin, stops pain messages from reaching the brain. The 2017 AHRQ update found moderate-quality evidence TENS relives knee OA pain for up to 3 months compared with a sham treatment.
Pills and Topicals
Acetaminophen (Tylenol)
Several guidelines recommend acetaminophen as a treatment of mild-to-moderate pain from knee and hip OA. However, because of risks of liver damage, current guidelines recommend taking the lowest dose for the shortest time possible. Studies generally show acetaminophen works better than placebos for pain, but not as well as other drugs.
Nonsteroidal anti-inflammatory drugs (NSAIDs).
These medications (aspirin, ibuprofen, naproxen sodium, others) provide OA pain relief. They do come with risks of gastrointestinal (GI) side effects such as ulcers and bleeding, cardiovascular problems, and kidney damage. The 2016 EULAR guidelines note they should be used only at the lowest effective dose for the shortest time possible.
Topical NSAIDs
These rub-on products are about as effective as oral NSAIDs but pose fewer GI risks. Although these topicals can cause skin irritation, they’re considered safer than oral drugs (though they’re often more expensive).
Capsaicin cream, gel or patch
Capsaicin, derived from chili peppers, depletes a pain-causing substance in nerve endings and lessens OA pain by about 30 percent in some users. Common side effects are a burning sensation or skin redness where capsaicin is applied.
Duloxetine (Cymbalta)
This antidepressant may help with chronic pain from a variety of sources, especially centralized pain. However, side effects like nausea, dry mouth, fatigue, constipation and increased sweating may keep some people from taking it.
Opioid and narcotic analgesics
Opioids relieve OA pain, but have many side effects and a high potential for addiction. Overall, about a quarter of patients treated with opioids dropped out of studies because of side effects. The ACR recommends them only for people who haven’t gotten relief from other treatments.
Injectables
Corticosteroids
Injecting corticosteroids directly into affected joints can decrease OA pain in the short term, according to 2013 EULAR guidelines. Pain relief typically wears off after a few weeks, with little effect found by 4 weeks. You may need repeat injections.
Hyaluronic acid
Hyaluronic acid supplements a natural substance that gives joint fluid its viscosity. Studies of its pain-relieving ability in OA have produced conflicting results. Although some people report relief, most guidelines classify these injections as of uncertain effectiveness and note they should be considered for knee pain alone, and not for injection into other joints.
Platelet-rich plasma (PRP)
Recent study data look promising for PRP injections’ ability to relieve knee OA pain, though there are still many questions. It involves drawing patients’ blood, spinning it down to concentrate the plasma and growth factors – which are believed to reduce inflammation and stimulate healing. The concentrate is then injected into the affected joint. The 2017 AHRQ review found some evidence PRP relieves OA pain for 4–8 months after injection.
Joint Surgery
Usually considered a last resort, surgery may be an option for OA pain relief. For young, active people with hip or knee osteoarthritis, osteotomy (a procedure in which bones are cut and realigned to improve joint alignment) may delay the need for joint replacement. When needed, a damaged joint may be replaced with a a prosthesis made from ceramic, metal or plastic. An unicompartmental knee replacement (also called partial knee replacement) may offer the same improvement and function as total knee replacement but with less trauma and better range of motion.
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