Knee Pain

What is knee pain?

Knee pain is a common. Sometimes, it occurs acutely, such as when someone falls and tears a ligament. Other times, its onset is slow, due to strain on muscles or ligaments from repetitive motion. It can also come and go, such as when people have bursitis. Sometimes, however, it lasts longer and can become chronic. In most cases of chronic knee pain, it is due to osteoarthritis.

The most common cause of chronic knee pain is osteoarthritis. Osteoarthritis is a common form of arthritis. It is a pain condition marked by inflammation of the joints. The inflammation causes pain, swelling, and stiffness.

Osteoarthritis might best be considered the result of general wear and tear. It can occur from injuries, overuse, and age. It results from a loss of cartilage, which ordinarily provides cushioning for the bones in the joints. With the loss of cartilage, inflammation can occur when the joint is used. In turn, the inflammation leads to pain, swelling, and stiffness.

Patients often mistake osteoarthritis for rheumatoid arthritis. While each condition causes inflammation and pain in the joints, the two types of arthritis are different. Rheumatoid arthritis occurs when the immune system mistakes healthy cartilage for being diseased, and consequently attacks the cartilage of the joints. Over time, the immune system erodes the cartilage. This loss of cartilage causes inflammation and subsequently pain, swelling, and stiffness. In osteoarthritis, the immune system has no such role. Indeed, there is no disease process at all which erodes the cartilage in osteoarthritis. The loss of cartilage in osteoarthritis comes simply from the wear and tear of injuries, use, and age over time.

Is there a cure for knee pain?

Knee pain that is due to osteoarthritis is a chronic condition. Chronic health conditions are conditions that have no cure. As such, chronic conditions typically last indefinitely.

Therapies & procedures for knee pain

In the absence of a cure, patients and their healthcare providers typically pursue therapies with the goal of reducing pain and increasing the ability to do more things in life. In our healthcare system, patients can commonly get many different therapies and procedures for osteoarthritic knee pain. Common treatments for such knee pain are anti-inflammatory medications, physical therapy, injection therapies, arthroscopic and joint replacement surgeries, and chronic pain rehabilitation programs.

Some of these therapies and procedures have been shown in research to be helpful in reducing pain and increasing functioning. Others have been shown to be unhelpful, even though they are done quite a bit in our healthcare system.

Anti-inflammatory medications

Anti-inflammatory medications are likely the most commonly used medication for knee pain. Anti-inflammatory medications (as well as acetaminophen) have been shown to be mildly effective in reducing pain.1, 2 

Physical therapy

Physical therapy is also commonly used to treat osteoarthritic knee pain. Physical therapy is proven to be beneficial.3 

Injection therapies

Many patients also try cortisone injections for osteoarthritic knee pain. Research shows that cortisone injections are mildly helpful in reducing pain for one to two weeks.4, 5 

Hyaluronan injections are also sometimes used to treat osteoarthritic knee pain. The outcome research for hyaluronan injections is mixed. Many studies show no benefit.6, 7 Other studies show a small benefit.8, 9

Arthroscopic and joint replacement surgeries

Arthroscopic surgeries are commonly performed for osteoarthritic knee pain. Surprisingly, however, arthroscopic knee surgeries have consistently been shown to be ineffective.10, 11 

Total knee replacement surgeries are often pursued for patients with advanced forms of osteoarthritis of the knee. These surgeries are largely effective in reducing pain and increasing quality of life.12, 13 

Chronic pain rehabilitation programs

Chronic pain rehabilitation programs are also a common therapy for patients with osteoarthritic knee pain, among other types of chronic pain. They are not a cure, but rather help patients to live well despite having chronic pain. Chronic pain rehabilitation programs focus on reducing pain, returning to work or other life activities, reducing the use of pain medications, and reducing the need for obtaining healthcare services. It is an intensive, interdisciplinary approach that combines lifestyle changes, coping skills training, and medication management. Research consistently shows that for the goals of reducing pain, returning to work, and reducing the need for pain medications, these programs are highly effective.14, 15, 16 

References

1. Bradley, J. D., Brandt, K. D., Katz, B. P., Kalasinski, L. A., & Ryan, S. I. (1991). Comparison of anti-inflammatory dose of ibuprofen, an analgesic dose of ibuprofen, and acetaminophen in the treatment of patients with osteoarthritis of the knee. New England Journal of Medicine, 325, 87-91.

2. Bjordal, J. M., Ljunggren, A. E., Klovning, A., & Slordal, L. (2004). Non-steroidal anti-inflammatory drugs, including cyclo-oxygenase-2 inhibitors, in osteoarthritic knee pain: Meta-analysis of randomized, placebo-controlled trials. British Medical Journal, 329, 1317-1323.

3. Jamtvedt, G., Dahm, K. T., Christie, A., Moe, R. H., Haavardholms, E., Holm, I., & Hagen, K. B. (2008). Physical therapy interventions for patients with osteoarthritis of the knee: An overview of systematic reviews. Physical Therapy, 88, 123-136.

4. Arroll, B., & Goodyear-Smith, F. (2004). Corticosteroid injections for osteoarthritis of the knee: Meta-analysis. British Medical Journal, 328, 869-874.

5. Bellamy N., Campbell, J., Welch, V., Gee, T. L., Bourne, R., & Wells, G. A. (2006). Intraarticular corticosteroid for treatment of osteoarthritis of the knee. [Cochrane Review]. In Cochrane Database of Systematic Reviews, 2006 (2). Retrieved April 13, 2012, from The Cochrane Library, Wiley Interscience.

6. Arrich, J, Piribauer, F., Mad, P., Schmid, D., Klaushofer, K., & Mullner, M. (2005). Intra-articular hyaluronic acid for the treatment of osteoarthritis of the knee: Systematic review and meta-analysis. Canadian Medical Association Journal, 172, 1039-1043.

7. Karlsson, J., Sjogren, L. S., & Lohmander, L. S. (2002). Comparison of two hyaluronan drugs and placebo in patients with knee osteoarthritis: A controlled, randomized, double-blind, parallel-design multicentre study. Rheumatology, 41, 1240-1248.

8. Lo, G. H., LaValley, M., McAlindon, T., & Felson, D. T. (2003). Intra-articular hyaluronic acid in treatment of knee osteoarthritis: A meta-analysis. Journal of the American Medical Association, 290, 3115-3121.

9. Bannuru, R. R., Natov, N. S., Obadan, I. E., Price, L. L., Schmid, C. H., & McAlindon, T. E. (2009). Therapeutic trajectory of hyaluronic acid versus corticosteroids in the treatment of knee osteoarthritis: A systematic review and meta-analysis. Arthritis Care & Research, 61, 1704-1711.

10. Kirkley, A., Birmingham, T. B., Litchfield, R. B., Giffin, R., Willits, K. R., Wong, C. J., Feagan, B. G., Donner, A., Griffin, S. H., D’Ascanio, L. M., Pope, J. E., & Fowler, P. J. (2008). A randomized trial of arthroscopic surgery for osteoarthritis of the knee. New England Journal of Medicine, 359, 1097-1107.

11. Moseley, J. B., O’Malley, K., Petersen, N. J., Menke, T. J., Brody, B. A., Kuykendall, D. H., Hollingsworth, J. C., Ashton, C. M., & Wray, N. P. (2002). A controlled trial of arthroscopic surgery for osteoarthritis of the knee. New England Journal of Medicine, 347, 81-88.

12. Agency for Healthcare Research and Quality. (December, 2003). Total knee replacement. AHRQ Publication No. 04-E006-2. Washington DC: Government Printing Office. Retrieved from http://www.ahrq.gov/downloads/pub/evidence/pdf/knee/knee.pdf

13. Rasanen, P., Paavolainen, P., Sintonen, H., Koivisto, A. M., Blom, M., Ryynanen, O. P., & Roine, R. P. (2007). Effectiveness of hip or knee replacement surgery in terms of quality-adjusted life years and costs. Acta Orthopaedica, 78, 108-115.

14. Gatchel, R., J., & Okifuji, A. (2006). Evidence-based scientific data documenting the treatment and cost-effectiveness of comprehensive pain programs for chronic non-malignant pain. Journal of Pain, 7, 779-793.

15. Hurley, M. V., Walsh, N. E., Mitchell, H., & Patel, A. (2012). Long-term outcomes and costs of an integrated rehabilitation program for chronic knee pain: A pragmatic, cluster randomized, controlled trial. Arthritis Care and Research, 64, 238-247.

16. Turk, D. C. (2002). Clinical effectiveness and cost-effectiveness of treatments for patients with chronic pain. Clinical Journal of Pain, 18, 355-365.

 

Date of publication: April 27, 2012

Date of last modification: October 23, 2015

Murray J. McAllister, PsyD, is the executive director of the Institute for Chronic Pain (ICP). The ICP is an educational and public policy think tank. Its mission is to lead the field in making pain management more empirically supported. Additionally, the ICP provides Academic quality information on chronic pain that is approachable to patients and their families. Dr. McAllister is also the clinical director of pain services for Courage Kenny Rehabilitation Institute (CKRI), part of Allina Health, in Minneapolis, MN. Among other services, CKRI provides chronic pain rehabilitation services on a residential and outpatient basis.

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