Knee pain is a prevalent issue affecting many, second only to back pain. Navigating the maze of treatment options can be daunting. This article outlines the array of painkillers available, from opioid medications to steroid injections, shedding light on their efficacy and safety for managing knee pain.
Non-steroidal anti-inflammatory drugs (NSAIDs), which come in pills or a gel, are the primary medication experts recommend for knee pain. Using them for the long term can cause other health issues.
Corticosteroid injections work similarly to NSAIDs and are injected directly into the knee to relieve swelling and pain. They are only used for immediate, short-term pain relief and are not safe for chronic use.
Opioids, the strongest painkiller available, are generally reserved for short-term use after injury or surgery due to the high risk of misuse, abuse, overdose, and death when used for 8 days or longer.
For knee pain from nerve damage, using an antidepressant called duloxetine is recommended by experts, but side effects may limit its usage.
The latest in knee pain relief
Knee pain is a common issue that requires a doctor's attention, and it's the second most common type of pain after back pain. Almost half of people will experience knee pain at some point. This type of pain can make it hard to do your daily tasks and be quite expensive to treat.
There are many ways to ease knee pain. Doctors and therapists have many treatments to choose from. These can range from exercises and medicine to surgeries and other medical procedures. It's tough to decide which method is the best and in what order to try them.
The most common causes of knee pain include osteoarthritis, knee surgery, soft tissue injuries, and a severe pain called complex regional pain syndrome (CRPS) that can affect the knee area.
Usually, the most accessible treatments, such as medications, are tried before moving on to more complicated ones, such as surgery. However, experts don't always agree on which medicines to start with because underlying causes may be complicated.
To help doctors and patients choose the best treatments, the American Society for Pain and Neuroscience has created a detailed guide based on a review of past research. This article will summarize research on different painkiller options and suggest which ones might be the safest and most helpful for different types of knee pain.
Non-steroidal anti-inflammatory drugs (NSAIDs)
NSAIDs are the primary treatment for knee osteoarthritis, the most common reason for knee pain. They treat pain by reducing swelling and inflammation at the site of injury. Besides osteoarthritis, NSAIDs may also be used to treat other kinds of knee pain, such as:
- Knee sprains. When you stretch your knee too much.
- Cartilage or meniscus damage. When your knee cushioning gets hurt.
- Tendon strains. When tissues connecting muscles to bones in your knee are pulled.
- Bursitis. When the small bags filled with fluid in your knee get swollen.
- Swelling. If that happens after knee surgery.
Two common forms of NSAIDs can relieve knee pain: oral pills or a skin-applied gel. Topical diclofenac gel is often the first suggested treatment for knee pain. Research shows it can help lessen pain quite well and usually doesn't cause many side effects. Skin irritation is the main problem you may have with diclofenac gel. You can get this medicine over the counter (OTC) or with a prescription from a doctor.
If you prefer the ease of a pill, oral NSAIDs are also an effective treatment for knee pain. Looking closely at past research, experts have determined that several NSAIDs, like celexecob, diclofenac, naproxen, and piroxicam, were just as good at treating osteoarthritis knee pain as opioid painkillers. The opioids in the research included tramadol, hydromorphone, and oxycodone. The good news is you can get oral NSAIDs, like naproxen and ibuprofen, either OTC or with a prescription.
Although NSAIDs are commonly used, the FDA warns that they may cause problems with your heart, stomach, or kidneys. Because of this, doctors advise that people with specific health issues, such as stomach ulcers, kidney disease, or high blood pressure, should avoid these medicines.
Also, it's best not to use NSAIDs for more than three months. Experts suggest that instead of taking NSAIDs routinely every day, just take them when the pain is bothering you. Doing this may help avoid side effects from using them all the time.
Talk to your doctor or pharmacist before using NSAIDs for knee pain to reduce the risk of side effects or drug interactions. Your pharmacist can recommend safe dosing and help you monitor for problems. Your doctor may take lab tests for liver, kidney, and red blood cell levels when you use NSAIDs routinely for periods longer than 3–7 days.
Corticosteroid injections are a common treatment for knee osteoarthritis. They work similarly to NSAIDs by blocking the action of inflammatory substances that cause joint soreness, tenderness, and swelling.
Experts say that a corticosteroid injection into the knee joint provides immediate, short-term, mild-to-moderate pain relief if you have osteoarthritis. Also, corticosteroid injections are effective for knee tendonitis, arthritis, and bursitis.
This class of medication, also known as steroids, is not intended for routine or long-term use.
Using steroids for the long term may cause your body to stop making its own natural steroids in your adrenal glands. Because your adrenal steroids help your body regulate blood pressure and metabolism and combat physical stress and infections, losing your natural steroid production can be life-threatening.
Other drawbacks of corticosteroid injections include the loss of cartilage in the joint, temporary fluid retention, infection, and increased blood sugar.
Now that we've learned how NSAIDs and steroids can help with knee pain, let's talk about opioids and why they are not usually a first choice for treating long-term knee pain.
The CDC advises that opioids are best used for only 3–7 days after knee surgery or injury. Some patients may need more extended therapy depending on the extent of their injuries or surgery.
However, research has shown that when routine opioid use exceeds 8 days, the risk of misuse, abuse, overdose, and death increases. Also, there is little evidence to suggest that opioids provide significant pain relief over the long term.
The overuse of opioids may lead to a condition called hyperalgesia. In this condition, the body's response to pain signals is exaggerated, increasing pain sensitivity.
For these reasons, experts advise against opioid painkillers such as tramadol, oxycodone, hydrocodone, or hydromorphone for long-term knee pain. Instead, after completing short-term opioid therapy, they recommend other treatments like non-opioid pain medications and physical therapy.
Now that we've looked at treating knee pain with opioids, let's review the use of antidepressants, which may help with a different kind of knee pain.
Complex regional pain syndrome (CRPS) is a chronic pain condition due to an injury or surgery. This condition used to be called causalgia or reflex sympathetic dystrophy. It affects the nerves in your body and can cause different problems like changes in skin temperature or feeling pain more intensely.
Another difficult knee pain to treat is post-surgical knee pain (PSKP). It can arise after knee surgery and may persist for 3–6 months. Researchers think this condition results when the body does not correctly reset its pain perceptions after surgery.
Typical pain medications, such as NSAIDs or opioids, are ineffective for CRPS and PSKP because these conditions involve nerve problems and damage.
Researchers instead suggest a trial of duloxetine, an antidepressant, to help manage post-surgery pain by blocking pain signals in the brain and spinal cord.
However, duloxetine, like all antidepressants, carries an FDA warning of increased suicidal thoughts or actions, especially if used in children, teens, or young adults. It is important to monitor for changes in your thoughts and mood when using duloxetine.
Other side effects of duloxetine may include:
- Dry mouth
- Low energy
- Increased blood pressure
Other antidepressants, such as amitriptyline and nortriptyline, are mentioned by researchers as possible treatments for nerve pain. Still, because the evidence is mixed, the experts agree that more research is needed to evaluate their effectiveness.
Wrapping up knee pain
Selecting the proper medication for knee pain depends on various factors, including the root cause, how severe the pain is, and individual characteristics such as age or medical history.
Alternatives to medication, such as physical therapy, exercise, and lifestyle changes are also proven to manage knee pain well and are worth considering.
Talking to your doctor or pharmacist is a great start to determining the best treatment for you.
Will medication use prevent me from needing surgery for knee pain?
Osteoarthritis, caused by "wear and tear" on your joint, is the most common reason for knee pain. Medications may provide temporary relief, but most experts agree that surgical repair or other non-medicine therapies may be needed eventually.
Are steroid injections safe for use in the knee joint?
Steroid injections can be used to help safely reduce knee pain. The effect is temporary, and experts do not recommend chronic use because joint cartilage can be weakened. There is also a risk of increased blood sugar and infection.
What is the best painkiller for knee pain?
The best painkiller for knee pain depends on the person and their kind of pain. Usually, doctors suggest starting with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as topical diclofenac gel, oral ibuprofen, or oral naproxen to help with pain and swelling. For long-term use of NSAIDs in knee pain, consult your doctor or pharmacist for details.
- Journal of Pain Research. Consensus guidelines on interventional therapies for knee pain (STEP Guidelines) from the American Society of Pain and Neuroscience.
- Osteoarthritis Research Society. Comparative pain reduction of oral non-steroidal anti-inflammatory drugs and opioids for knee osteoarthritis: systematic analytic review.
- Food and Drug Administration. Medication guide for non-steroidal anti-inflammatory drugs (NSAIDs).
- Centers for Disease Control and Prevention. Opioids: patients’ frequently asked questions.
- National Institute of Neurologic Disorders and Stroke. What is pain?
Show all references
- National Institute of Neurologic Disorders and Stroke. Complex regional pain syndrome (CRPS).
- The Journal of Bone and Joint Surgery. Duloxetine reduces pain and improves quality of recovery following total knee arthroplasty in centrally sensitized patients.
- Food and Drug Administration. Medication guide for antidepressants.