Nonsurgical Therapies for Knee OA Pain: From Medications to Bracing to Exercise, What Works & What Doesn’t

Injections & Other Drugs
In a 2015 Cochrane review, intra-articular corticosteroids compared with placebo for knee OA pain had a small effect size of 0.3.¹² Repeat injections significantly reduced cartilage thickness, according to a 2017 study, possibly because patients “felt so much better.¹³ They were much more active and they damaged their cartilage,” he said. “This doesn’t have anything to do with the effects of the steroid on cartilage. It has to do with the effect of activity on these knees.” Dr. Felson injects 80 mg of corticosteroids into the knees of his OA patients or 40 mg for diabetic patients, he said.

Intra-articular hyaluronic acid injections are ineffective for knee OA, although some patients may feel relief due to the placebo effect, he said.¹⁴ Glucosamine and chondroitin sulfate, although popular, also do not relieve OA knee pain.¹⁵ Opioids also do not work well for knee OA pain relief; a recent meta-analysis shows that opioids’ effect size is 0.36.¹⁶

Tanezumab, a humanized monoclonal antibody to nerve growth factor that targets the peripheral nerves, had an effect size of 0.8 in a 2010 randomized controlled trial, but the trial was stopped when patients in the active treatment group had rapid disease progression, likely due to overdoing physical activity when their pain subsided.¹⁷

Nondrug Strategies
Braces are effective treatments for malaligned joints, and in a 2015 meta-analysis, their effect size was 0.33.¹⁸ “Why are braces not the most popular treatment? The answer is that many patients won’t wear them or wear them for three hours a day or less,” he said. Suggest an over-the-counter knee brace before referring a patient to an orthotics specialist for a fitted brace due to the high cost, he suggested.

Exercise is also effective for knee pain, and if a patient is overweight, exercise with diet modification is even more effective, he said.¹⁹ He encourages his patients to do gentle squats at increasing depth as long as they are not in pain. “Exercise needs to be progressive,” he said. “You need to reinforce that with your patients.”

Susan Bernstein is a freelance medical journalist based in Atlanta.

References

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