Proliance Orthopedic Associates

How do you treat arthritis pain without surgery?

Written by Dr. Prash Bremjit

Here you can find a list I created of the most commonly used treatments for managing joint pain and discomfort without surgery, and the evidence behind them as demonstrated through decades of research by the American Association of Orthopedic Surgeons (AAOS).

Medications

Pain relievers are usually the first choice of therapy for osteoarthritis of the hip and knee.

  • The best types of pain medications are anti-inflammatory medications such as over-the-counter medications like aspirin, ibuprofen (Motrin or Advil), naproxen (Aleve), meloxicam/mobic (prescription), Voltaren (diclofenac, topical ointment), to help reduce pain and swelling in the joint. The pain in your joint is often due to inflammation, so the anti-inflammatory medications actually help your pain by helping the problem. Like all medications, these can have side effects - so take them with food to avoid irritating your stomach, and patients with a history of gastrointestinal, kidney, or heart issues should avoid taking them. AAOS Recommendation: STRONG EVIDENCE

  • Many patients try to incorporate anti-inflammatory foods and spices into their diet. A list of these supplements can easily be found on the internet. A commonly used one is turmeric.

  • Other simple pain relievers, such as acetaminophen (Tylenol), are available without a prescription and can be effective in reducing pain. AAOS Recommendation: STRONG EVIDENCE

  • We recommend AGAINST narcotics (Norco, Vicodin, Oxycodone, Dilaudid) for treatment of arthritis. These are not effective at treating arthritis pain, and if you eventually do undergo surgery, lead to a more challenging recovery and a worse outcome.

Injections

There are several types of injections that are commonly used to provide temporary relief from a flare-up of arthritis pain.

  • Cortisone injections can provide you with pain relief and reduce inflammation. They act like putting an Advil right inside your knee joint. However, it is important to know that they are temporary and do not treat the underlying problem. How long the injection works before it wears off is variable, and there is a limit to how many your doctor can give you per year. For some lucky people, these injections last 6 months and for others, they last 6 hours. In general, most patients get some relief for about 2 months. AAOS EVIDENCE: HELPFUL, short-term pain relief

  • Other injections include "gel" injections such as hyaluronic acid (HA) is injected into the joint. It can help joints to work properly by acting like a lubricant. It isn't clear how helpful these injections are, but some patients do get a significant amount of relief from them. These are not typically utilized for hip joints. Examples of such medications include Synvisc, Orthovisc, Supartz, Hyalgan, etc. EVIDENCE: NOT recommended routinely, but may be helpful if trying to put off surgery

Weight Loss

Many people with osteoarthritis carry some extra weight on their body. Simple weight loss can reduce stress on your weight-bearing joints, such as the hip or knee. Based upon the physics of the hip and knee joints, you put three to five times your body weight across these joints throughout the day - especially during stair climbing and getting in and out of a chair. Every pound you carry puts a force of 5 lbs on the hip and knee. So even losing 5 lbs results in 25 less pounds that your hip or your knee is feeling!! Losing weight can result in reduced pain and increased function, and also decrease your risk of complications after surgery.

AAOS EVIDENCE: Proven to be helpful

Exercise

An exercise routine can help increase your range of motion and flexibility as well as help strengthen the muscles in your legs. Exercise is often effective in reducing pain and improving function. Unfortunately, in the setting of advanced arthritis (bone-on-bone), exercise can sometimes increase pain in your hip and knee joints. Your physical therapist can help develop an individualized exercise program that meets your needs and lifestyle. Consider daily protein supplements/shakes to help build muscle. EVIDENCE: Proven to be helpful

Physical Therapy

Physical therapy to strengthen the muscles around your joint may help absorb some of the shock imparted to the joint. Physical therapy can help to reduce the pain, swelling, and stiffness of osteoarthritis, and it can help improve joint function. It can also make it easier for you to walk, bend, kneel, squat, and sit. Again, like exercise, for some people with bad arthritis already, physical therapy can often cause more pain than it relieves. EVIDENCE: Proven to be helpful

Braces and Splints

Braces have moderate evidence to support some improvement in pain for knee arthritis. The challenge is that many braces are difficult or uncomfortable to wear. However, in some patients who do not want surgery or are not good candidates for knee replacement, they may be helpful in relieving some of the symptoms.

Alternative Therapies

There has not been high-quality evidence to suggest the following are helpful, but as long as these therapies are not dangerous, there is usually no harm to try them and some patients have benefited from them. These include:

  • Acupuncture
  • Chiropractic Medicine
  • Massage Therapy
  • Stem Cell Injections
  • PRP Injections
  • Laser Treatment
  • Foot/Shoe Insoles

List of Useful Exercises:

**The above information was obtained and edited from the American Association of Hip and Knee Surgeons (AAHKS) website. For more education from this very useful website, go to www.aahks.org and click on the link at the top "For Patients".