Non-surgical Treatments for Arthritis

By Richard P. Driessnack, MD

Ok, I know I have arthritis of the knee, but I really do not want surgery for it. What can I do to decrease the pain and help me function better?”  

This is a common scenario in my office. Here are some things that can help before considering surgical treatment:

1. Get enough sleep. Seven to eight hours per night. Tired muscles cannot support joints that hurt.
2. Eat low-inflammatory foods. The anti-inflammatory diet described by the Arthritis Foundation can help. Check out Arthritis.org.
3. Control your weight. If this sounds familiar, it’s because it is so important. Too often, we let our weight get out of control. A smart combination of diet and regular exercise can lead to healthier joints and better physical quality of life.
4. Strengthen your muscles. I very often prescribe physical therapy consultations for my patients. An assessment of strength and flexibility is done, followed by a program of stretching and strengthening that will support and protect painful joints. Many of my patients are skeptical, at first, about the potential benefit of therapy, but are pleasantly surprised after giving it a try.
5. Medication. Pain medicine can take the edge off the pain and help you to function better. The first thing to try is Tylenol. It is relatively safe, and the foundation of a medication program. The second would be NSAIDs: non-steroidal anti-inflammatory drugs.

   These include ibuprofen, naproxen sodium (both available over-the-counter without a prescription), along with some oral and topical prescription NSAIDs.

   All of these have potential side effects, so check with your primary care doctor to make sure they are safe for you. Stronger pain medicine like Tramadol, or even stronger opioids like hydrocodone or oxycodone, should rarely be used for arthritis pain. We know that developing a pattern of dependence or tolerance to opioids can be counter-productive in managing arthritis pain, so if the pain cannot be controlled with non-opioid medication, it may be appropriate to consider surgical treatment. Patients who are dependent upon opioids before joint replacement surgery often do worse with pain management after surgery.

6. Injections: Primary options for injections are steroids (“cortisone”), viscosupplementation (“gels”), or NSAIDs such as Toradol. Steroid injections should not be given unless there is clear evidence of cartilage deterioration from arthritis. If they relieve your pain, they can be repeated every three months. Visco injections work best in mild to moderate arthritis, and can be given in either a single injection, or three injections over three weeks, or five injections over five weeks. A recent review by the American Academy of Orthopaedic Surgeons suggested that, perhaps, this was not as effective as previously thought, but most orthopaedic surgeons would not object to this as one option to try prior to surgery. In patients with diabetes, steroids can sometimes cause a marked elevation of the blood glucose. If that occurs, yet the steroid provides some relief from the arthritis pain, I frequently will recommend the use of Toradol injections. This is like a “liquid ibuprofen,” and acts to fight inflammation without elevating the blood sugar. These can also be repeated every three months. In the future, there will likely be newer formulations of extended-life steroids that can last for a longer time than those currently approved for injections.
7. Knee braces. A simple elastic knee sleeve or wrap can help support the knee. More sturdy knee braces with hinges on the sides offer greater support and can be helpful for slender knees which might feel weak or unstable. Sometimes an “unloader brace” is helpful, which applies a force to the knee and helps take pressure off the worn-out portion of the knee to relieve your pain. Your orthopaedic surgeon is the best person to make this recommendation.
8. “Alternative injections.” I am starting to get this question a lot from patients, as the marketplace is becoming saturated with treatments which, in theory, might help arthritis pain or even claim to “rebuild” cartilage. This includes PRP (platelet rich plasma) and stem-cell injections. Unfortunately, these treatments can be very expensive, not covered by insurance, but most importantly, have not shown, in controlled studies, to be consistently better than existing treatments such as steroid injections, and their longevity is unproven. They are very profitable for those who give these injections. Before you pay for this, check out the existing evidence for their efficacy at the Arthritis Foundation website under “Stem Cell Injections.”
9. Natural supplements: Many patients have found relief from supplements such as Glucosamine sulfate, Chondroitin Sulfate, MSM, SAM-e, Curcumin, and many others. The FDA does not regulate these substances, as they are marketed as food additives or nutritional supplements. Again, additional information is available on the Arthritis Foundation website. Be sure to check with your family physician prior to starting these, as some may interfere with important medications you are taking for other reasons.

These treatments can provide significant relief from knee arthritis pain and are among the most-prescribed non-surgical treatments by orthopaedic surgeons. A balanced approach to treatment should be employed. Contact your orthopaedic surgeon and discuss your symptoms with him or her.

For more information, contact OSF Orthopedics at 309-676-5546 or on the web at www.PeoriaJointReplacement.com. They have two locations: OSF Orthopedics — Downtown Peoria, 303 North William Kumpf Boulevard, Peoria; and OSF Orthopedics — North Peoria, 7800 N. Sommer St., Peoria.