Knee pain treatments

In this article we will look at new and recent research for the non-surgical treatment options for knee pain.

Non-steroidal anti-inflammatory drugs (NSAIDs), analgesics, intra-articular corticosteroid injections are of little value in the long term, and opioids may have ominous consequences.

A study from 2022 (1) writes about the need for new knee pain treatments: “Non-steroidal anti-inflammatory drugs (NSAIDs), analgesics, intra-articular corticosteroid injections are of little value in the long term, and opioids may have ominous consequences. Radiotherapy of knee osteoarthritis has no added value. Physical therapy, exercises, weight loss, and lifestyle modifications may give pain relief, improve physical functioning and quality of life. However, none of them has articular cartilage regenerating potential. . .(in this paper the researchers) focus on emerging osteoarthritis knee treatments, relieving symptoms, and regenerating damaged articular cartilage that includes intra-articular human serum albumin, conventional disease-modifying anti-rheumatic drugs (DMARDs), metformin, lipid-lowering agents (statin), nerve growth factors antagonists, bone morphogenetic protein, fibroblast growth factors, Platelet-Rich Plasma (PRP), Mesenchymal Stem Cells (MSC),” and other treatments. We will be discussing some of these treatments in this article and the research published by other investigators.

Ultrasound-guided genicular nerve blocks

July 2022 study: (2) “Ultrasound-guided genicular nerve blocks using pharmacological agents for pain control in chronic knee osteoarthritis are gaining in popularity. There is fair evidence to at least target the superior medial genicular nerve, inferior medial genicular nerve, and Inferior medial genicular nerve using local anesthetics, corticosteroids, or alcohol to reduce pain and to improve knee function in patients with chronic knee osteoarthritis under ultrasound guidance. The procedure is safe but more research is needed to determine the optimal interventional approach.”

Placebos can improve symptoms in various medical conditions including knee pain

May 2022 study (3) Recent studies indicate that the administration of open-label placebos  can improve symptoms in various medical conditions. The primary aim of this 3-week randomized controlled trial was to examine the effects of open-label placebos  treatments on pain, functional disability, and mobility in patients with arthritic knee pain. Evaluation of daily pain ratings indicated significant pain decrease in the open-label placebos  groups compared to no treatment group.  open-label placebos treatment improved knee pain in elderly patients with symptomatic knee osteoarthritis (OA), while functional disability and mobility of the knee did not change. The content of the verbal suggestion was of minor importance. open-label placebos administration may be considered as supportive analgesic treatment in elderly patients with symptomatic knee osteoarthritis.

Irenka and Cymbalta

A May 2022 paper (4)  Irenka and Cymbalta

Assessed the effectiveness of duloxetine (Irenka and Cymbalta) in addition to usual care in patients with chronic osteoarthritis pain. Patients with chronic hip or knee osteoarthritis pain who had an insufficient response to acetaminophen and nonsteroidal antiinflammatory drugs were included. Patients received duloxetine (60 mg/day) in addition to usual care or usual care alone.

  • A total of 66 patients were randomized to receive duloxetine in addition to usual care, and 66 patients were randomized to receive usual care alone.
  • No difference in pain scores between the groups at 3 months or at 12 months.
  • Conclusion: Researchers found no effect of duloxetine added to usual care compared to usual care alone in patients with chronic knee or hip osteoarthritis pain.

Do non-surgical treatment options work for knee pain? A look at weight loss plus exercise.

A July 2022 study (7) examined the recommended non-surgical interventions for osteoarthritis

  • Nine knee osteoarthritis studies, evaluating diet plus exercise, exercise, unloading shoes, high-expectation communication during acupuncture and telephone-based weight loss plus exercise were identified.
  • In knee osteoarthritis, some evidence suggests that the benefits of i) diet and exercise are mediated through changes in body weight, systemic inflammation and self-efficacy; ii) exercise is mediated through changes in knee muscle strength and self-efficacy; and iii) high-expectation communication style is mediated through changes in self-efficacy.

Virtual reality as a clinical treatment for older adults with chronic osteoarthritis knee pain

A June 2022 study (5) “There is an urgent need for safe and effective nonpharmacologic approaches to treat chronic knee pain in older adults. Although virtual reality (VR) has shown some effectiveness for acute pain, there is limited evidence on the effects of virtual reality on chronic pain particularly with older adult populations. This study evaluated the feasibility and effectiveness of virtual reality as a clinical treatment for older adults with chronic osteoarthritis knee pain.

  • Nineteen participants aged 60+ years old participated in a 10-min virtual reality meditation program. Results suggest that virtual reality meditation had significant moderate to large analgesic effects on knee pain intensity, primarily during virtual reality and post virtual reality, with some lasting effects into next day. The findings also suggest virtual reality meditation intervention had a positive effect on affect, with a significant large decrease in negative affect scores pre- to post-virtual reality. The significant moderate to large decreases in pain interference for normal work, mood, sleep, and enjoyment of life suggest that older adults may have a higher ability to participate in meaningful daily activities up to 24-48 hours after virtual reality meditation. VR appears to be a feasible and effective nonpharmacological tool for older adults to treat chronic overall and knee-specific pain.

In a June 2022 study (6) Doctors investigated the incidence and risk of knee and hip replacement in patients with osteoarthritis treated with different medications. Compared to non-users, bisphosphonate users had a reduced risk of knee replacement.

A September 2022 (8) paper describes Genicular nerve ablation (GNA)as a percutaneous, needle-based therapy option designed to palliatively treat knee pain. Analogous to an intra-articular injection with corticosteroid, GNA is not intended to remedy the root cause of pain or structurally alter the joint in any way; rather, the goal is to block/interrupt the transmission of pain signals from the knee, itself, thus eliminating the perception of pain by the brain. 

1 Cao X, Cui Z, Ding Z, Chen Y, Wu S, Wang X, Huang J. An osteoarthritis subtype characterized by synovial lipid metabolism disorder and fibroblast-like synoviocyte dysfunction. Journal of orthopaedic translation. 2022 Mar 1;33:142-52.
2 Tan YL, Neo EJ, Wee TC. Ultrasound-guided Genicular Nerve Blockade With Pharmacological Agents for Chronic Knee Osteoarthritis: A Systematic Review. Pain Physician. 2022 Jul;25:E489-502.
3 Olliges E, Stroppe S, Haile A, Reiß F, Malhis M, Funke SA, Meissner K. Open-Label Placebo Administration Decreases Pain in Elderly Patients With Symptomatic Knee Osteoarthritis–A Randomized Controlled Trial. Frontiers in psychiatry. 2022;13.
4 van den Driest JJ, Schiphof D, Koffeman AR, Koopmanschap MA, Bindels PJ, Bierma‐Zeinstra SM. No Added Value of Duloxetine in Patients With Chronic Pain due to Hip or Knee Osteoarthritis: A Cluster‐Randomized Trial. Arthritis & Rheumatology. 2022 May;74(5):818-28.
5 Sarkar TD, Edwards R, Baker N. The Feasibility and Effectiveness of Virtual Reality Meditation on Reducing Chronic Pain for Older Adults with Knee Osteoarthritis. Pain practice: the official journal of World Institute of Pain.
6 Cui B, Chen Y, Tian Y, Liu H, Huang Y, Yin G, Xie Q. Effects of medications on incidence and risk of knee and hip joint replacement in patients with osteoarthritis: a systematic review and meta-analysis. Advances in Rheumatology. 2022 Dec;62(1):1-1.
7 Lima YL, Lee H, Klyne DM, Dobson FL, Hinman RS, Bennell KL, Hall M. How do non-surgical interventions improve pain and physical function in people with osteoarthritis? A scoping review of mediation analysis studies. Arthritis Care Res (Hoboken). 2022 Jul 22. doi: 10.1002/acr.24983. Epub ahead of print. PMID: 35866717.
8 Hunter CW, Deer TR, Jones MR, Chien GC, D’Souza RS, Davis T, Eldon ER, Esposito MF, Goree JH, Hewan-Lowe L, Maloney JA. Consensus Guidelines on Interventional Therapies for Knee Pain (STEP Guidelines) from the American Society of Pain and Neuroscience. Journal of Pain Research. 2022;15:2683.


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