Pillar 2: Control the Pain
Using the Treatment Pyramid To Guide Short-Term Pain Relief Recommendations
Time to get some control of the pain right now. To choose the right treatments for you, let’s briefly look at how to know what to try and where to get what you need.
Remember the Treatment Pyramid?
If you recall back to the Introduction chapter of this course, you will recall that the treatment pyramid is a great visual representation of guidelines developed from Knee OA research. Remember, this course is offering help with conservative knee OA treatment, so we are only dealing with the bottom half of the pyramid (so we will fade out the top). These treatments are applicable to all people with Knee OA, and will be the only treatments that most people with mild to moderate knee OA will ever need.
You will further recall that the purpose of this course is to ‘meat on the bones’ of the pyramid. For the pain control, we are going to present the meat in 3 lessons that reflect how we treat things in real life. They will be:
Pain Relief at Home
Pain Relief from your Physiotherapist
Pain Relief from your Doctor
Image Credit: Gillian Hatfield, University of the Fraser Valley
Strength of Recommendations Ratings
In developing this course, I wanted to give you not only the recommended treatments, but some sense of which ones are most recommended. The interventions suggested are given a rating based on a 4-star system. This similar to and largely based on the Management of Osteoarthritis of the Knee Guidelines from the American Association of Orthopaedic Surgeons, but leans on other guidelines / sources where the AAOS recommendations do not speak to the topic, or more detail is required for practical advice. I also input our my opinion at times based on our extensive clinical experience, in much the same way as you would get our opinion if you attended for a clinic appointment. . You can click on each level of the rating system below to open up the criteria I have used to make each recommendation.
-
4 stars indicates we have evidence consistent evidence from high quality studies in the guidelines, and our clinical experience agrees with these findings. Nearly all patients should do these treatments. These recommendations have been established for some time and are very unlikely to change with further research.
-
3 stars indicates we have moderate to high quality evidence in the AAOS or other guidelines. Unless otherwise stated, our clinical experience agrees with this opinion. These are good treatments to try with most clients, while monitoring individual reaction. While it is possible, future research is still unlikely to change these recommendations.
-
2 stars low to moderate evidence for these treatments. Our clinical experience typically work for some people and not for others. It is difficult to predict who will get benefit from these treatments. They are generally safe and can be used on a ‘see how it goes’ basis. It is possible that future research will change the recommendation.
-
1 star indicates there is an absence of any reliable evidence for this intervention. This does not mean that the intervention is completely without merit.. It may still work for some people, but we do not have evidence for it at meaningful evidence at this time. This star level generally applies to newer treatments that have some testimonial or speculated merit. They may be safe to try, but it is not recommended that patients spend their primary resources on these treatments. We may still include them here for educational purposes.
Some Final Words on the Treatment Recommendations
Just a few more things to consider:
These recommendations are to help you get control of your pain in the short term. In the long term, you will need to give attention to Pillars 3 and 4 (REDUCE THE LOAD and MAKE IT STRONG)
Combinations of treatments are generally more effective than treatments in isolation. So for example, you may wish to heat your knee and then exercise it. The treatments are all safe to try. Where you should check with your physiotherapist or doctor first, we have specified this
Where applicable, we give you some tips and links to products that you should find useful based on our decades of experience in treating osteoarthritis
For further information and tips, we link to videos and other useful information on the topic