Pillar 2: Control the Pain
Conservative Pharmaceutical and Other Measures from Your Physician
The treatments covered in this section are prescription medications commonly prescribed by family physicians or specialists for Knee OA. As this section is primarily the expertise of your doctors, we will keep the information here short and mostly in list form. As this Knee OA course focusses on conservative (non invasive) measures, we do not touch on injections or surgery here - those are further up the pyramid and best discussed with your physician.
Further discussion on whether these medications are appropriate for you and your health status will also need to be discussed with your physician.
Topical Non-Steroidal Anti-inflammatory Drugs ★★★★
This recommendation is at the top of the list in the AAOS recommendations. Topical Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) are applied directly to the skin over the painful / affect part of the knee, many people find short term relief with these medications. Topicals are often prescribed so that you don’t have to expose yourself to the stomach issues or cardiovascular risks of oral inflammatories. Although it does not work for everyone, it is often recommended as a first treatment for OA of the knee due to its low risk profile. The most common topical prescribed is Diclofenac. Diclofenac is available as an over the counter as Voltaren, and other forms are available from your family physician. Excellent further information on topical NSAIDs is available from The Arthritis Foundation.
It should be noted that while these are highly recommended by the AAOS, they are still medications and have potential side effects on your body’s organs and systems. If at all possible, if you can get pain control through the non-pharmaceutical means recommended in the previous chapters, most healthcare professionals would recommend you do that over taking medications.
Oral Non-Steroidal Anti-inflammatory Drugs ★★★★
If topical treatments fail, your family doctor may recommend an Oral NSAID drug. NSAIDs are the most effective oral medicines for OA. The most well known NSAIDs are ibuprofen (Motrin, Advil) naproxen (Aleve). All work by blocking enzymes that cause pain and swelling.
There are some risks to Oral NSAIDs though, and you will want to discuss their use with your doctor. While you may need NSAIDs to manage your arthritis, make sure you try some of the other non-pharmacological strategies in the other chapters to reduce your pain (exercise, weight loss, thermal agents, bracing, etc). You may very well be able to reduce or eliminate medication use with these options.
The Arthritis Society offers some excellent information on oral NSAIDs here.
It should be noted that while these are highly recommended by the AAOS for their effectiveness, they are still medications and have potential side effects on your body’s organs and systems. If at all possible, if you can get pain control through the non-pharmaceutical means recommended in the previous chapters, most healthcare professionals would recommend you do that over taking medications.
Patient Education ★★★★
Patient education is highly recommended as a pain management strategy for all Knee Osteoarthritis. Patient education encourages positive changes in attitude, knowledge, health behaviors, and beliefs about pain. Learning new skills and strategies to manage your arthritis can help you carry out daily activities, communicate better with healthcare professionals, and feel in control of your condition. It can also boost your sense of confidence and self-efficacy, which are important for taking charge of your health. Patient education is a unique approach to pain management because it is entirely individualized. You decide when and how to explore factors beyond the immediate causes and consequences of your arthritis, such as the role of proper sleep, healthy eating and more.
Your family physician / general practitioner is usually your first instructor in your continuing Knee OA education journey. Although their time may be limited, they may direct you to resources to help you learn how to manage Knee OA. Your family physician may help you to:
Get an accurate diagnosis and explain the nature of the condition
Take a course such as this, as a companion to in-clinic care
Use online resources such as from the Arthritis Society (www.arthritis.ca) to learn more about your condition
Join a self-management education workshop, which can help you learn the skills to manage your arthritis and make good decisions about your health.
Meet others in the arthritis community. Sharing your experiences, coping mechanisms, and personal tips and tricks with others can help you relieve the burden of pain.