NSAIDs May Not Be As Useful for Chronic Knee Pain As Previously Thought
Osteoarthritis of the knee is the most prevalent type of ]]>osteoarthritis]]> , a common condition associated with pain and inflammation of the joints. Treatment guidelines often include pain management with non-steroidal anti-inflammatory drugs, or NSAIDs, such as aspirin, ibuprofen (Motrin), and naproxen (Aleve).
Approximately 50% of people with painful osteoarthritis use NSAIDs. Some NSAIDs, when taken regularly, can cause serious gastrointestinal complications such ulcers and bleeding. And since osteoarthritis of the knee is a chronic condition, many individuals remain on NSAIDs for long periods at a time.
NSAIDs also include newer cox-2 inhibitors, such as celecoxib (Celebrex), which are associated with a lower risk of serious gastrointestinal side effects. However, one type of cox-2 inhibitor, rofecoxib (Vioxx), has recently been taken off the market due to serious cardiovascular side effects.
Thus, the widespread use of all types of NSAIDs has prompted more research on their safety and effectiveness. A new meta-analysis published in the online version of British Medical Journal on November 23, 2004 reports that NSAIDs reduce short-term knee pain due to osteoarthritis only slightly better than placebo. Because of potential long-term complications, the researchers go on to conclude that NSAIDs should not be used chronically.
About the Study
Researchers in Norway reviewed 23 randomized clinical trials, which included 10,845 people with an average age of 62.5 years. Participants in all the studies received either an NSAID at defined doses or placebo (sugar pill). Each study used one of two well-defined scales to measure the change in overall intensity of knee pain among the participants.
The researchers pooled the results from all 23 studies and reanalyzed them together to determine if NSAIDs reduced knee pain due to osteoarthritis.
Overall, pain was reduced by about 15% in people taking NSAIDs as compared to those taking placebo after 2-13 weeks. The researchers consider this difference to be relatively small. Given the potential negative side effects of NSAIDs, the researchers concluded that “[NSAIDs] can only be recommended for limited use in osteoarthritis of the knee.”
Although this review includes a large number of participants taken from multiple studies, it has its limitations. For example, in nine of the 23 trials, pain wasn’t measured according to the same scale, which makes it difficult to compare their results with those of the other studies. In addition, the researchers included some studies that excluded people who were known not to respond to NSAIDs. This may make it appear that NSAIDs are more effective over placebo than they actually are.
Another limitation is that the average age of the participants was relatively low (about 62 years) for people with osteoarthritis of the knee. This was because some of the studies excluded patients younger than 75 years. NSAIDS may affect older people with knee osteoarthritis differently than younger people.
How Does This Affect You?
As always, check with your doctor before deciding how best to treat your arthritic knee pain. If you have been taking NSAIDs for a while, are tolerating them well, and feel they are helping, nothing in this study indicates you should stop. However, all medications have potential side effects, and in many cases, your doctor will be able to determine your risk of harm.
Generally speaking, it is best not to take NSAIDs for periods longer than 1-2 weeks without consulting your doctor, and to take the lowest dosage necessary to control your pain. Serious risks of gastrointestinal bleeding are increased in older people and those taking other blood-thinning medications, such as coumadin. Some potentially useful alternatives to NSAID for osteoarthitis include:
- Acetaminophen (e.g., Tylenol®)
- Glucosamine sulfate (a dietary supplement)
- Non-weight bearing exercises
American Chronic Pain Association
Bjordal JM, Ljunggren AE, Klovning A, Slordal L, et al. Non-steroidal anti-inflammatory drugs, including cyclo-oxygenase-2 inhibitors, in osteoarthritic knee pain: meta-analysis of randomized placebo controlled trials. British Medical Journal , doi: 10.1136/bmj.38273.626655.63 (published 23 November 2004).
Last reviewed Dec 2, 2004 by ]]>Richard Glickman-Simon, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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