Treatments for Osteoarthritis

By Mary Anne Dunkin | June 15, 2022

Managing osteoarthritis (OA) pain and maintaining your ability to do daily activities involves physical activity and exercise, weight loss, healthy lifestyle changes and over-the-counter (OTC) or prescription medications. When these don’t sufficiently relieve pain, surgery may be an option. Work closely with your doctor to determine the best treatment plan for you.

The goal of osteoarthritis treatment is to

• relieve pain and stiffness
• help you to maintain normal activities

Physical Therapy and Exercise

Regular physical activity may be the most important piece of your overall treatment plan. Being active can help you stay mobile, relieve pain, lose weight and reduce your risk of other health problems. Activities such as walking, biking, swimming, yoga and water aerobics are all helpful for your OA symptoms and overall health. If joint pain or stiffness makes activity difficulty, work with a physical therapist to develop an exercise plan and find modifications that work for you.

Weight Loss

If you are overweight or obese, losing weight is one of the kindest things you can do for your joints. Not only do fat cells contribute to inflammation, research has shown that every one pound lost results in four pounds less pressure on knees and other weight-bearing joints. One study found that losing 10% to 20% of body weight improved pain, function and quality of life for older adults with obesity and OA.

Medications

Although there are no medications that can slow or stop the progression of osteoarthritis, some can minimize or relieve pain so you can be more comfortable and active, and more activity can further reduce pain and improve fitness. Most medications used to ease osteoarthritis pain are taken by mouth. They include the following:

• Acetaminophen ( Tylenol ). Available over the counter, acetaminophen is an analgesic medication. Acetaminophen alone may be sufficient for mild to moderate OA pain.
• Nonsteroidal anti-inflammatory drugs (NSAIDs). At over-the-counter doses, NSAIDs such as ibuprofen ( Advil , Motrin IB ) and naproxen sodium ( Aleve ), can ease pain to make physical activity easier. At higher, prescription doses, NSAIDs also relieve inflammation.
• Duloxetine ( Cymbalta ). Although it was developed as an antidepressant, duloxetine is also approved for treating chronic pain, including pain related to OA.
• Tramadol ( Ultram ). Available only by prescription, tramadol is a pain-relief option for OA pain that is not relieved by other medication. Tramadol is an opioid and carries a risk of addiction and abuse. Its use is tightly regulated.

Because medications taken orally to relieve pain may have harmful side effects, your doctor may recommend other options that target only the affected joint(s). If oral medications alone don’t sufficiently relieve your pain, adding one or more of these topical and injectible medications may help.

Topical analgesics are rubbed into, sprayed on or applied as patches to the skin directly over the painful joint(s). They are most effective for joints that are close to the skin’s surface, such as the knees or joints of the hands. Active ingredients in topical analgesics include one or a combination of the following ingredients:

• Capsaicin. A chemical compound in hot chili peppers. When applied to the skin, capsaicin depletes the nerve cells of substance P, a chemical important for transmitting pain messages.
• Salicylates. The same pain-relieving ingredients in aspirin and aspirin-like drugs.
• Counterirritants. Substances such as menthol and camphor, which create a burning or cooling sensation that distracts your mind from your pain.
• Diclofenac. A prescription NSAID that may act similarly to oral NSAIDs to relieve pain.

Different types of injections may also be a part of your OA treatment plan. You may hear about “stem cells” as an alternative, but these have not been proven effective and safe and have not been approved by the Food and Drug Administration.

• Corticosteroids. A strong anti-inflammatory drug similar to the hormone cortisol made by our bodies. When injected into the knee, a corticosteroid can provide quick relief of pain and inflammation.
• Hyaluronic acid. A substance that bolsters joint fluid viscosity and cushioning. Injections of hyaluronic acid, which mimics the natural fluid in joints, are given a week apart in a series of three or four injections.

Other Pain-Relieving Therapies

Beyond medications and exercise, a number of different therapies are available that may help relieve your OA pain.

• Hot and cold. Heat, in the form of a heating pad, warm bath or paraffin wax bath (for hands or feet), can improve blood flow and ease joint stiffness. Using cold packs (such as bag of frozen vegetables placed on the painful joint,) reduces pain and swelling.
• Relaxation techniques. Techniques such as deep breathing, guided imagery and visualization can calm your mind, relax tight muscles and relieve pain.
• Acupuncture. An ancient Chinese medical technique that involves inserting needles into certain points in the body, acupuncture has been shown to help relieve OA pain.
• Massage. Rubbing and kneading of muscles and joints — including self-massage — can help reduce OA pain, improve joint function and ease stress.
• Braces, splints and orthotic devices . Devices such as braces and splints may be helpful for relieving joint pain by shifting weight away from the damaged area of the joint, reducing pressure on the joint and relieving swelling by compression. If you are interested in trying one, consult a physical or occupational therapist to ensure the right fit and proper use.
• Radiofrequency ablation. RFA is a procedure in which a doctor inserts a needle guided by X-ray into the painful area of an arthritic joint, and then passes a current through the needles to ablate or burn the nerve ending to relieve pain. RFA is reserved for people for whom less invasive treatments have failed to relieve pain.

A Healthy Lifestyle

Along with medications, physical activity and weight loss, healthy lifestyle changes can help you better manage osteoarthritis and reduce your risk of health problems that can go along with it.

• Stop Smoking. If you smoke, stop. Some research suggests that people who smoke may have more cartilage loss and pain than those who don’t. If you need joint surgery, smoking can interfere with healing. Of course, it also increases your risk of other health problems.
• Use Self-Help Devices. If arthritis makes it difficult to bend, reach, grasp, stand up or other daily activities, ask an occupational therapist about self-help devices that can make daily tasks easier.
• Seek Emotional Wellness. Pain and limited mobility can lead to anxiety and sadness. But you can learn to cope with arthritis, improve your mood and ease worries.
• Communicate with Your Partner. Arthritis symptoms can affect daily activities — and relationships. Ask for help when you need it and let people in your life know when you aren’t able to do activities you used to. The same is true of sex. Discussing your needs with your partner and finding modifications will help you overcome almost any difficulty.
• Consider Workplace Accommodations. Having osteoarthritis doesn’t have to affect your productivity at work but, depending on the demands of you job and the specific joint(s) involved, certain accommodations may make your job easier. Those may be as simple as adjusting the height of your desk or computer screen, taking breaks to get up and walk around or alternate sitting and standing while you work.
• Eat Well. There is no specific diet for OA . However, eating a diet rich in vegetables, fruit, fish and healthy fats like olive oil will help support an overall healthful lifestyle. A healthy diet can also help you lose weight if needed or maintain a healthy weight. Studies have shown that for people who are overweight, even modest weight loss can reduce OA pain.
• Nutritional supplements. Glucosamine and chondroitin sulfate nutritional supplements — both components of natural cartilage — have been widely promoted and used to treat OA pain. Studies in test tubes and laboratory animals have shown the two compounds may stimulate the production of new cartilage components, but whether that translates to stronger joint cartilage in people is unclear. However, the two supplements, which are available at pharmacies and health-food stores without a prescription — may be effective pain relievers for some people.

Surgery

When medications and other treatment no longer ease pain, joint surgery is often an option. Hip and knee replacements are the most common surgical procedures for OA and can relieve pain and help restore function.