Taking medicine for osteoarthritis of the knee can be one of the fastest ways to get rid of symptoms. This is a blessing if your joint pain is flaring up, for example.
Now, there are several types of drugs that can relieve osteoarthritis symptoms – oral NSAIDs, topical capsaicin cream, hyaluronic acid injections… Each with its own pros, cons, and risks.
But don’t worry – this article will teach you all about them so you can decide which ones you’d like to try. Here’s what we’ll cover, click on any of these topics to go straight to its section:
- Oral drugs
- Topical medication
- Intraarticular injections
- What about opioids?
- Other non-surgical treatments
Oral treatments for knee osteoarthritis
These drugs usually come as pills or soft gels and you can buy them over the counter in most countries.
Now, they are absorbed through the digestive system. This means they can ease knee pain relatively fast but may have gastrointestinal side effects.
So, please consult your doctor before taking them if you suffer from stomach issues or have other health conditions.
With that said, the most common oral medications for knee OA include:
These drugs can ease pain but have little to no anti-inflammatory effect. The most common is paracetamol, also known as acetaminophen.
Doctors often recommend this medication for patients with mild to moderate pain because it’s a safe choice. It has minimal side effects, it’s widely available, and cheap. (1)
Yet, recent studies suggest that its effects on knee osteoarthritis pain are very small. This can make people prone to take excessive doses looking for quick relief, which can increase the risk of side effects. (1, 2)
However, the American College of Rheumatology recommends the following (2):
For those with limited pharmacologic options due to intolerance of or contraindications to the use of NSAIDs, acetaminophen may be appropriate for short-term and episodic use. – ACR, 2019
2) Nonsteroidal anti-inflammatory drugs (NSAIDs)
These are the most popular drugs for knee osteoarthritis, as they have a pain-relieving and anti-inflammatory effect. Common examples include ibuprofen (Advil) and celecoxib (Celebrex).
They are so effective that medical associations – like the Arthritis Foundation and the American Association of Orthopaedic Surgeons – recommend them to help reduce pain in knee OA.
However, these efficient pain relievers come with a fair share of side effects. More so if taken in large or constant doses.
They can affect the stomach, kidneys, and even cause cardiac events in predisposed patients. (1, 3)
Now, if you don’t have any previous medical condition, your doctor will likely suggest a low dose of NSAIDs. They can be extremely effective in the short term for managing severe pain or flare-ups.
And what about COX-2 inhibitors?
These are a subclass of NSAIDs believed to reduce the risk of gastrointestinal side effects. However, some studies have shown that this decrease may not be as significant as once believed. (3)
With that said, your doctor will know best which type of NSAID to recommend, according to your medical history and symptoms.
Related: What to take for knee pain?
3) Dietary supplements
There are countless supplements for knee pain, but the most popular for osteoarthritis are:
Both are natural compounds present in our bodies – they are the building blocks that create joint cartilage.
So, taking them should in theory help regenerate the lost tissue. Or at least protect it from further damage.
In reality, they can help knee pain because of their anti-inflammatory effect.
Researchers aren’t sure how this happens, though. Also, some people do feel benefits after taking these supplements while others don’t.
This lack of consistency is the reason why some major medical associations recommend them with caution. However, they do acknowledge these supplements have minimal side effects compared with NSAIDs. (1, 3)
One drawback is that nutritional supplements don’t act as fast as the drugs above. You have to take them for a few months to see whether they work for you.
Yet, they’re definitely worth a try. Particularly for people with chronic pain or that are already taking medication for other conditions, like rheumatoid arthritis.
Just check with your doctor first to ensure the supplement won’t interact with other drugs.
Learn more: Best supplements for knee osteoarthritis.
Topical treatments for knee osteoarthritis pain
Topicals usually come in the form of creams, gels, sprays, or plasters and you can also find them over the counter.
You apply them to the painful joint so the active compound is absorbed through the skin. This greatly reduces the risk of severe side effects, but the benefits won’t last as long as with oral medication.
The most popular topical treatments for knee OA are:
4) Topical NSAIDs
These are strongly recommended for knee osteoarthritis patients, as they’re a safe way to relieve pain without the side effects of oral NSAIDs. (2, 3)
In fact, the American College of Rheumatology suggests trying this before taking the same drug through the mouth. (2)
However, there’s a risk of skin irritation. This is true with any other topical treatment, though. If this happens to you, discontinue its use or try another brand.
What if you combine topical with oral NSAIDs?
This may look like a good idea at first, but it’s not. According to studies:
…combining a topical NSAID with an oral NSAID confers no additional therapeutic benefit over either agent used alone, but it does increase the number of adverse events. – Royal Australian College of General Practitioners, 2018
So, it’s best to try them alone and test which one suits you best, or in which circumstances.
5) Topical capsaicin cream
Capsaicin is a compound present in hot chili peppers. With continued use, it can desensitize the area of application and relieve pain. (1, 2)
You may feel a burning sensation in the area after applying capsaicin cream. This is to be expected, but not everyone enjoys it – keep this in mind before trying it.
The most common side effect is mild burning in the area, which improves quickly after discontinuing its use. (1)
Pro tip: If you’re going to give capsaicin cream a shot, try it in a small area first. Check how you feel and decide whether to keep using it.
6) Glucosamine cream
This form can be safer than taking glucosamine through the mouth, at least for people prone to side effects. The drawback is that it’s not as effective. (4)
And as with the oral form, you need to try it for a while first to know whether it helps you or not. Yet, it’s a very safe option with practically no side effects, other than skin irritation. (4)
Learn more: Guide on glucosamine cream for knee pain.
Injected treatments for knee osteoarthritis
Here, your doctor injects a substance into the affected joint to provide pain relief. Intra-articular injections become an option if the medications above and other conservative methods can’t provide much relief.
As such, they need a prescription and are done by a specialist.
Some compounds reduce knee pain almost immediately, while others need several injections to give results. The most common for knee OA are:
7) Cortisone (steroid) injections
Corticosteroids are a type of medication that’s very effective at reducing pain in the short term. That’s why they’re mostly recommended for people going through a flare-up. (1, 5)
Yet, they are not a good strategy for the long term. Studies show that frequent use can accelerate cartilage loss, which is what we’re trying to prevent in the first place. (3, 5)
8) Hyaluronic acid injections
Hyaluronic acid is a natural compound present in the synovial fluid and cartilage. It acts as a lubricant and shock absorber for our joints. (1)
Doctors suggest injecting it to keep the knee lubricated, which can reduce pain over time. It may have an anti-inflammatory and pain-relieving effect for some people as well. (1)
However, some patients may not feel much different after receiving a course of hyaluronic acid injections. But, they do have fewer side effects than corticosteroids, so they may be worth a try if other alternatives don’t work. (2)
9) Platelet-rich therapy (PRP) injections
In this therapy, the doctor injects your own platelets into your joint. These are cells present in the blood that stimulate tissue regeneration. So, the goal is to heal damaged cartilage and create more. (1)
One problem is that to do this, you need to first get your blood extracted. Then, the specialist puts it into a centrifugation machine to separate the platelets from the rest.
This makes it an expensive procedure that’s usually not covered by insurance. (2, 3)
The results are like those from hyaluronic acid as well. Yet, this therapy is worth trying if you’ve done other injection treatments without results and can afford it. (3)
10) Stem cell injections
Stem cells are basically the raw materials of the body. They can become any type of cell -like cartilage or synovial fluid- under laboratory conditions.
In theory, this therapy could regenerate cartilage loss from knee osteoarthritis. But there’s still a lot to learn about it, so medical associations don’t recommend doing it. (1, 2)
Yet, if you have the medical team and can afford it, you may want to give it a try as a last resort before surgery.
This therapy consists of injecting an irritant – usually hypertonic dextrose – into specific areas of the knee joint. In theory, this could stimulate healing, reduce instability by strengthening the ligaments, and decrease pain. (1)
Some patients do feel much better after undergoing this treatment, but others may not.
This, combined with the lack of research and standardization of the treatment, leaves prolotherapy as an alternative approach. (2, 6)
Wait – what about opioids?
Opioids are powerful substances that easily alleviate severe pain. However, they are not particularly effective for knee osteoarthritis. (1)
Also, they can be very addictive, which represents a huge medical risk. They’re also associated with severe side effects, like (1, 2, 3):
- Severe gastrointestinal problems.
- Cognitive dysfunction.
- Decreased bone health.
- Impaired immune system.
- Increase in chronic pain.
- Fatal overdose.
The risks outweigh the benefits by a mile. That’s why all medical associations don’t recommend taking them for knee osteoarthritis. (2, 3)
Other non-surgical treatments for knee osteoarthritis
Medications are one of many ways to manage symptoms. In reality, the best approach is to combine them with other conservative methods to treat osteoarthritis, like:
This is usually done with physical therapy and occupational therapy. Both are medical specialties that help you:
- Get stronger to prevent your condition from worsening.
- Alleviate symptoms, both in the clinic and at home.
- Learn how to live with osteoarthritis.
- Create or request work adaptations so you can keep doing your job despite your condition.
Depending on your symptoms and lifestyle, you may have to do one or both therapies.
Home treatments are a staple for knee OA management. Doing them will help you control your symptoms on your own. The most common include:
- Applying hot/cold packs.
- Specific exercises or stretches.
- Wearing knee braces.
- Transcutaneous electrical nerve stimulation (TENS).
This will help: The best knee braces for knee osteoarthritis.
What is the best medicine to treat knee osteoarthritis?
Most people feel improvements with oral and topical NSAIDs. Just check with your doctor first before taking them.
What is the safest medication for knee joint osteoarthritis?
Paracetamol (acetaminophen) and dietary supplements. Both have little to no side effects, making them safe for most people.
What treatments are available for osteoarthritis of the knee?
Dozens – Home treatments, exercise, physical therapy, weight loss, medications, injections, arthroscopic surgery, total knee replacement surgery…
To make things easier, we made a full guide ranking the best treatments for this condition.
Conclusion: Pain medicine for osteoarthritis of the knee
Regardless of which medicine you choose, the main goal is to delay knee joint replacement surgery as much as possible.
But you won’t get there with pills, creams, or injections alone. You must do other treatments for knee osteoarthritis as well to protect your knees and prevent further deterioration.
- The Royal Australian College of General Practitioners. Guideline for the management of knee and hip osteoarthritis. 2nd edn. East Melbourne, Vic: RACGP, 2018. Retrieved on December 2021 from: https://www.racgp.org.au/download/Documents/Guidelines/Musculoskeletal/guideline-for-the-management-of-knee-and-hip-oa-2nd-edition.pdf
- Kolasinski, Sharon L et al. “2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.” Arthritis care & research vol. 72,2 (2020): 149-162. DOI: 10.1002/acr.24131
- American Academy of Orthopaedic Surgeons Management of Osteoarthritis of the Knee (Non-Arthroplasty) Evidence-Based Clinical Practice Guideline (3rd Edition). https://www.aaos.org/oak3cpg Published August 31, 2021.
- Cohen, Marc et al. “A randomized, double blind, placebo controlled trial of a topical cream containing glucosamine sulfate, chondroitin sulfate, and camphor for osteoarthritis of the knee.” The Journal of rheumatology vol. 30,3 (2003): 523-8.
- McAlindon, Timothy E et al. “Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial.” JAMA vol. 317,19 (2017): 1967-1975. DOI: 10.1001/jama.2017.5283
- Rabago, David et al. “Dextrose prolotherapy for knee osteoarthritis: a randomized controlled trial.” Annals of family medicine vol. 11,3 (2013): 229-37. DOI: 10.1370/afm.1504
- “Osteoarthritis.” National Institute of Arthritis and Musculoskeletal and Skin Diseases. Last Reviewed: October 2019. Retrieved on April 2022 from: https://www.niams.nih.gov/health-topics/osteoarthritis/diagnosis-treatment-and-steps-to-take