Joint pain and osteoarthritis: Management

Man holding knee

Joint pain can impinge on all areas of a person’s life, particularly in older individuals.

Together with education, a range of pharmacological and non-pharmacological techniques is available to help manage pain and flare-ups1,2 and help keep patients moving.

Guideline recommendations for managing osteoarthritis pain

Stepwise management of osteoarthritis

Guidelines recommend a stepped approach to management2-5

Management of osteoarthritis may require a combination of non-pharmacological and pharmacological modalities.2,5

Guidelines* recommend a stepwise strategy for the pharmacological management of osteoarthritis.2-5

*From the National Institute for Health and Care Excellence (NICE), European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR).

OARSI Guidelines and topical steroids

Guidelines support the use of topical NSAIDs6

For knee osteoarthritis in patients with no comorbidities, the Osteoarthritis Research Society International(OARSI) Guidelines ‘strongly recommend’ topical NSAIDs.6

NICE Guidelines recommendation is to consider topical NSAIDs for pain relief in addition to core treatments for people with knee or hand osteoarthritis and to consider topical NSAIDs and/or paracetamol ahead of oral NSAIDs, COX-2 inhibitors or opioids.4

More than one pain treatment might be needed

Image of lady holding her knee

Additional support might be needed for flare-up pain

Chronic joint pain is often accompanied by acute inflammatory flare-up pain.7

During this flare-up pain, patients may require additional short-term pain relief.7

  • Patient education and lifestyle changes

    Patient education around disease progression and management issues is helpful to encourage proactive self-management.2,4,8–11

    Lifestyle changes for patients with osteoarthritis may include:10

    • Weight management
    • Managing depression and sleep disturbances
    • Vocational rehabilitation
    • Adaptations to the home and working environments

    Patient support groups specifically for patients with osteoarthritis can provide practical and emotional advice and support, enabling patients to cope with their condition, feel more positive and live life more fully on a daily basis.12,13

  • Exercise

    Exercise is a key part of maintaining healthy joints and should be a core recommendation as part of the holistic management of osteoarthritis.14 It builds stamina, strengthens muscles that support the joint, and helps to reduce fatigue.15 It can also help patients to maintain a healthy weight, which reduces the burden on weight-bearing joints.15

    However, the type and amount of exercise must be tailored to each individual patient's capabilities and needs; putting excess strain on a joint or doing too much exercise can worsen symptoms.15 Contact sports are not advisable, but swimming, cycling and low-resistance strengthening exercises may be appropriate.15

  • Physical therapy

    Physical therapy is used in osteoarthritis management approaches and includes strengthening and aerobic exercises, the use of supports and orthotics and heat/cold therapy.4,5,8-11

  • Pharmacological treatment

    Pharmacological treatment

    Guidelines support the use of topical NSAIDs4,6

    2019 OARSI Guidelines recommend initial options for knee OA6

    For knee osteoarthritis in patients with no comorbidities, the Osteoarthritis Research Society International(OARSI) Guidelines ‘strongly recommend’ topical NSAIDs.6

    Other Guidelines (EULAR, American College of Rheumatology, NICE) recommend a stepwise approach to intervention for osteoarthritis, using oral paracetamol and/or topical NSAIDs such as diclofenac as first-line pharmacological treatment options.3-5,16

    Long-term use of paracetamol may be required, and topical NSAIDs are appropriate for further pain relief or for treatment of pain flares.4,5,17 However, the risk–benefit ratio should be considered when using paracetamol for osteoarthritis.18

    Oral NSAIDs can be considered as the next step in therapy, but should be restricted to short-term use.2,4,5,8

    Opioids should be reserved for refractory or severe osteoarthritis only.2,4,5,8

    Recent guidelines from the Royal Australian College of General Practitioners do not recommend nutraceuticals such as glucosamine and chondroitin for the management of knee and/or hip osteoarthritis.19

  • Surgery

    Surgical interventions for severe joint pain and osteoarthritis include partial or total joint replacements.2,4,5,8,9

How can Nora and Wendy be helped?



Nora wakes with joint pain and stiffness each morning.

She wants sustained relief from her pain so she can return to the activities she enjoys, like walking and spending time with her grandchildren. However, she is concerned about treatment side effects.

Nora needs to regain her mobility by easing joint pain.

Panadol Osteo delivers effective pain relief of persistent osteoarthritis pain for up to 8 hours.20 Paracetamol is one of the most used analgesic and antipyretic over-the-counter medicines.21


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Wendy is a 50-year-old who has experienced intermittent osteoarthritis knee pain for 5 years. The flare-up pain disrupts her sleep and limits her previously active lifestyle and social life, making her feel anxious and depressed.

She wants effective relief from her pain so she can return to the activities she used to enjoy, like going to yoga classes with her friends and taking long walks with her dog.

Her doctor recommended weight loss and exercise as a remedy, but she feels her pain prevents her from exercising.

Wendy is frustrated and is looking for a solution that does not involve yet another pill.

Voltaren Osteo Gel 12 Hourly provides relief from mild osteoarthritis flare-up pain, for up to 12 hours.22  With an easy-open cap it offers convenient, twice-daily topical treatment.

Topical diclofenac has low systemic absorption, for a lower risk of systemic side effects than oral NSAIDs.23-25

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Understanding joint pain and osteoarthritis

Causes icon


Find out about the causes of joint pain and osteoarthritis.

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Signs and symptoms icon

Signs and symptoms

Find out how to recognise joint pain and osteoarthritis and know when to refer patients.

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Overview of sprains and strains

Overview of sprains and strains

Learn more about sprains and strains, and meet two patients with these conditions.

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Voltaren Osteo Gel 12 Hourly

Voltaren Osteo Gel 12 Hourly with easy open cap

Up to 12 hours of relief from mild osteoarthritis flare-up pain.22

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Panadol Osteo

Panadol Osteo

Provides relief of osteoarthritis pain for up to 8 hours.20,26

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Voltaren Emulgel

Voltaren Emulgel with No-Mess Applicator

Relieves muscle pain and reduces inflammation.23,25,27

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