You don’t have to be a baby boomer to suffer from knee pain. Plenty of younger people have pain that they can trace to overuse or to a specific injury. Older people also may be afflicted with arthritis that can cause knee or hip pain. But as increasing numbers of boomers move into their 60s and 70s, knee arthritis is becoming a common complaint. Moreover, the pain it produces can interfere with patients being able to run or even walk as they would wish. Understandably, many people are looking for the best medication to ease the pain. Here, the research has failed us all.
No Clarity on Long-Term Pain Control for Knee Arthritis:
A recent article in JAMA (Dec. 25, 2018) reviewed 47 randomized controlled trials of medications or supplements for knee pain. In all of them, the pharmacological intervention was compared to placebo or to another treatment. Importantly, all of the studies lasted for at least a year. (Short-term pain relief studies may not tell us enough about how well the treatment works in the long run.) This is exactly the type of study that should reveal how well medications work over the long term for controlling knee pain.
The Envelope Is Nearly Empty:
As a result, we are disappointed that this meta-analysis that included more than 22,000 patients did not demonstrate a clear winner. Two of the interventions did show a decrease in pain attributed to knee arthritis. They were celecoxib (Celebrex), a specialized COX-2 inhibitor in the NSAID category and crystalline glucosamine sulfate. (This product is available by prescription in Europe, where the authors are based, but not in the US.) Glucosamine sulfate had the best showing but the effect was small to moderate.
As the investigators state:
“Among the high-quality trials, glucosamine sulfate had the highest probability of being the best long-term treatment…”
In addition, the scientists found that glucosamine sulfate was most likely to be associated with improvements in joint structure. However, the authors noted significant uncertainty regarding how much this product is likely to help. Importantly, they found even more uncertainty with respect to celecoxib, the only NSAID (nonsteroidal anti-inflammatory drug) to do well in this set of long-term clinical trials. NSAIDs like ibuprofen and naproxen are far and away the most popular medications used to treat knee arthritis despite a lack of evidence that they help over the long term.
Consequently, the researchers conclude:
“Larger RCTs are needed to resolve the uncertainty around efficacy of medications for knee osteoarthritis.”
What Can You Do About Knee Arthritis?
Given this research, a person suffering the pain of osteoarthritis of the knee might well decide to explore glucosamine sulfate as a treatment option. People in the US might have trouble finding crystalline glucosamine sulfate, however, and other forms of glucosamine do not appear to be useful.
Will home remedies help? Few scientists have studied home remedies or dietary supplements for knee arthritis. If you would like to learn more about them, you may be interested in our Guide to Alternatives for Arthritis. It is available as a printed book or as an online resource (not a pdf). In addition, you may wish to listen to our recent interview with Dr. Beth Jonas. It is Show 1140: How Can You Manage Arthritis Pain?