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What You Can Do To Make Your Knee Pain Disappear Without Taking Drugs Or Injections

Nov 8, 2007
Knee pain is one of the most common maladies that brings patients into an arthritis specialist's office. While there are many causes, the most common in people over the age of 35 is osteoarthritis (OA) of the knee.

The treatment for osteoarthritis involves a comprehensive approach employing patient education, maintenance of ideal weight, strengthening exercises for the quadriceps muscles (muscles in the front of the thigh) as well as the hamstring muscles (muscles in the back of the thigh.

Avoidance or reduction of activities that aggravate knee pain may also be required. For example, an auto mechanic who spends a lot of time in a crouched position or a carpet layer who kneels a lot may need to modify what they do. Another example may be to have a person who enjoys long distance running reduce the amount of training they do or cross train using other activities such as cycling or using an elliptical trainer.

While anti-inflammatory medications can help, many people are either sensitive to these drugs or simply don't want to take them. So what else can be done?

Many people aren't aware that something as simple as an ice pack applied to the knee for 10-15 minutes twice a day can dramatically reduce pain and inflammation due to OA. This should be done routinely, not just occasionally.

Also there are topical agents that can be used. For example, rubs, ointments, and creams that contain capsaicin often can relieve discomfort. Capsaicin works by irritating nerve endings and possibly by altering the production and effects of Substance P, a chemical messenger responsible for the perception of pain.

A preparation called Myorx, which contains Omega-3 fatty acids and menthol along with capsaicin may also be every effective in providing soothing relief. We use this preparation for our patients and get rave reviews.

The FDA recently approved Novartis's Voltaren (diclofenac) topical 1% gel as a non-steroidal anti-inflammatory drug (NSAID) prescription treatment for pain associated with osteoarthritis. It is the first prescription NSAID that can be applied directly to the site of OA pain. It is the first topical treatment for OA that has demonstrated effectiveness in the hands and knees in clinical trials.

The gel was studied among more than 900 patients with OA of the hand or knee. FDA approval was supported by the results of 2 randomized controlled studies. In one six-week trial, the gel led to a 46% reduction in pain levels in patients with hand OA. In a 12 week study, the gel reduced OA-related knee pain by 51%. Systemic absorption of Voltaren gel is 94% lower than that of oral diclofenac.

Another treatment that can be used with some effectiveness are patches. One example is the Thermocare heat wrap designed to help manage arthritis flare-ups with 12 hours of heat. Heat discs in the Thermocare contain a mixture of iron, charcoal, salt, and water, which when exposed to air, gives off consistent heat for 12 hours. The heat increases local blood circulation delivering oxygen and nutrients to the knee and promotes healing. These wraps have been compared with ibuprofen and acetaminophen in clinical trials. Thermocare provided 38% more pain relief than acetaminophen and significantly improved ranged of motion (68%) compared to ibuprofen.

Some patients also report that the use of patches containing lidocaine (Lidoderm) are effective in controlling OA pain. These patches can be worn for 12 hours followed by a 12 hour break. While Lidoderm for OA of the knee associated pain is not an FDA approved indication, it appears to be effective for many patients. Since there is the chance of systemic absorption, patients with a cardiac history should use this only under direct medical supervision.

Various braces can be used to good effect and that topic has been discussed by me in another article.
About the Author
Nathan Wei, MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine. For more info: Arthritis Treatment.
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