The Best Treatment Options for Painful Knees

You may not be able to totally eliminate knee pain, but you have plenty of weapons to reduce the discomfort enough to carry on normal daily activities.

“Today, a variety of effective interventions are available for persistent knee problems, and many of these can greatly improve pain, mobility, and quality of life,” says Bruce Ferrell, MD, professor of Medicine and Geriatrics at UCLA David Geffen School of Medicine and Editor-in-Chief of Healthy Years. Talk with your doctor about which of the following strategies will work best for you:

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Over-the-counter NSAIDs such as aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve) can be used independently or combined with other treatments. NSAIDs are effective for mild and moderate pain, but there is a limit to how much discomfort they can control. Side effects, even with normally recommended doses, can include stomach pain, nausea, bleeding, or ulcers. Large doses and long-term use can lead to gastric bleeding or kidney problems.

Other analgesics. Acetaminophen (Tylenol) has been shown to be just as effective for pain as NSAIDs, but without the risk of gastric bleeding or kidney problems. For this reason, acetaminophen has become the drug of choice for most patients with persistent knee pain that is mild or moderate in severity. For more severe pain, the alternative is usually narcotics, such as codeine, synthetic codeines, or derivatives of morphine.

Because of well-known side effects, these drugs are not for everyone and should be carefully limited.

Topical analgesics

Almost all pain-relief medications that you rub into the skin are available without pre-scription. They act on local nerve endings and are best for temporary, localized knee pain relief. Some of the products distract you from the underlying pain, while others actually help block the transmission of pain sig-nals. Many contain an active ingredient called capsaicin (a compound that causes the “heat” in chili peppers), which can cause an irritating, burning sensation if not used correctly. Topical analgesics are not a cure, but a promising source of short-term relief.

Among older patients with osteoarthritis, a Yale University survey found that capsaicin creams were pre-ferred over NSAIDs and other treatments for knee pain—not because they are more effective, but be-cause they do not carry the risk of gastrointestinal side effects.

Weight loss

If you are among the 60 percent of Americans who are either overweight or obese, losing weight might be the best pain-relief strategy of all. Research has found that every pound lost results in a four-pound reduction in pressure exerted on knee joints. With every step taken, the cumulative amount of pressure becomes significant. Less pressure equals less wear and tear, and consequently, less pain. The study implies that weight loss could be used as a treatment.

Exercise

Among conservative treatments for knee pain, exercise—in or out of a supervised physical therapy program—should be high on your list. Research supports the pain-relieving benefits of exercise for older adults. The data suggest that “at least 20 minutes of exercise once a week that is sufficient enough to result in sweating or some shortness of breath might be adequate for pain relief.”

According to The American Geriatrics Society, randomized, controlled trials clearly show that regular mod-erate-level exercise does not make OA pain worse, nor does it accelerate the disease process. These studies also “strongly indicate” that increasing the level of physical activity in OA patients reduces pain and morbidity.

 Viscosupplementation

Another alternative to treat knee pain caused by OA is viscosupplementation, which involves the injection of a thick lubricating substance called hyaluronate. It is a natural component of healthy joints, but people with OA have it in low concentrations.

“The best candidates for viscosupplementation are people who have mild to moderate OA, but the treatment can also be effective in severe cases,” says David Fish, MD, a pain management specialist at UCLA Health System. “These people may not be ready for surgery and they want to maximize all of their conservative options.”

Knee injections are a temporary solution to a long-term problem. They won’t work for everyone, but the treatment is worth discussing with your doctor. Studies endorsed by the U.S. Food and Drug Administration found that hyaluronate provides pain relief for up to six months.

Infection at the injection site is rare. Commonly reported side effects include pain at the injection site, swelling, heat, redness, itching, and bruising. Reactions are usually mild and temporary, and applying an ice pack will ease the discomfort.

Cartilage transplant

It is now possible to transplant cartilage from a healthy, non-weight-bearing area of the knee to a damaged area. This technique works best when it is performed on a person with an otherwise healthy knee, but it is not a good option for advanced cases of rheumatoid arthritis and OA. Rehabilitation after carti-lage transplant usually includes the use of crutches and limited weight-bearing activity for three to six weeks, depending on the size of the area affected. Total recovery could take at least four months, possibly longer. The results of cartilage transplant vary widely, depending on the patient. Success is best measured by how well the person functions based on pre-surgery expectations.

Knee replacement

For people who have suffered significant damage but still have some degree of healthy knee cartilage, partial knee replacement may be an option. The surgeon replaces only the damaged areas of the knee. Healing usually takes a couple of months, but long-term results are not as good as with total knee re-placement (TKR).

In TKR, an orthopaedic surgeon removes damaged bone and cartilage and replaces them with artificial components made of metals, plastics, and polymers. You may be a candidate for TKR if your knee is severely damaged, if your mobility and function are diminished, and if you are older than 55.

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