Joint pain and osteoarthritis: Management
Managing joint pain and osteoarthritis
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 treating joint pain and osteoarthritis
Guidelines recommend a stepped approach to management2,4–6
Management of osteoarthritis may require a combination of non-pharmacological and pharmacological modalities.2,6
Guidelines* recommend a stepwise strategy for the pharmacological management of osteoarthritis.2,4–6
*From the National Institute for Health and Care Excellence (NICE), European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR).
More than one pain treatment might be needed
Additional support might be needed to cover pain flares
Chronic joint pain is often accompanied by acute inflammatory flares.7
During this flare-up pain, patients may require additional short-term pain relief.7
Patient education around disease progression and management issues is helpful to encourage proactive self-management.2,5,8–11
Lifestyle changes for patients with osteoarthritis may include:10
- Weight management
- Tackling 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 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 are may be appropriate.15
Physical therapy is used in osteoarthritis management approaches and includes strengthening and aerobic exercises, supports and orthotics and heat/cold therapy.5,6,8–11
First-line pharmacological treatment is with oral paracetamol and/or topical non-steroidal anti-inflammatory drugs (NSAIDs)
Following a stepwise approach to intervention for osteoarthritis, oral paracetamol and/or topical NSAIDs such as diclofenac should be used as first-line pharmacological treatment options.4–6,17
Long-term use of paracetamol may be required, and topical NSAIDs are appropriate for further pain relief or for treatment of pain flares.4,5,18 However, the risk–benefit ratio should be considered when using paracetamol for osteoarthritis.19
Oral NSAIDs can be considered as the next step in therapy, but should be restricted to short-term use.2,5,6,8
Opioids should be reserved for refractory or severe osteoarthritis only.2,5,6,8
There is mixed evidence and guidance on whether topical capsaicin and nutraceuticals such as glucosamine and chondroitin may also offer some benefits as adjunctive treatments.2,5,6,8,9,11,20,21 Recent guidelines from the Royal Australian College of General Practitioners do not recommend these nutraceuticals for the management of knee and/or hip osteoarthritis.16
Surgical interventions for severe joint pain and osteoarthritis include partial or total joint replacements.2,5,6,8,9
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.
Wendy has experienced intermittent knee pain for 5 years. The pain disrupts her sleep and limits her previously active lifestyle and social life making her feel anxious and depressed.
Her doctor recommended weight loss and exercise as a remedy. But chronic pain creates a lack of motivation and she feels her pain prevents her from exercising.
Wendy wants a drug-free, yet effective method of pain relief so she can return to the activities she used to enjoy.