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Knee osteoarthritis non-surgical options

With advanced knee osteoarthritis, a joint replacement operation may be recommended. However, there are other treatments that doctors may recommend to reduce pain and increase mobility before a surgical option.

Oral medication

Several medications may help reduce knee pain, and, in some cases, the inflammation that can cause joint swelling and discomfort. They include:

  • Paracetamol. This is the first medication to try as a knee OA treatment, say arthritis specialists. That is because it is relatively safe compared to other pain relievers, although too much can cause liver damage. Paracetamol does not lessen inflammation.
  • Nonsteroidal anti-inflammatory drugs ( NSAIDs). These can help relieve pain and fight the inflammation that may be adding to your pain. Some are available over-the-counter, for example ibuprofen. There are also prescription NSAIDs that your doctor can prescribe.
  • Other analgesics. When other pain-relievers fail to control pain, your doctor may prescribe stronger analgesics. These include opioid medications, for example codeine, often combined with paracetamol.

Topical analgesics

These creams, ointments and balms are rubbed onto the skin where you have joint pain. Most are available without a prescription and use one or more of the following to help control pain:

  • Capsaicin. Found naturally in chillies, capsaicin in a cream is available as a prescription from your GP. Capsaicin works by blocking the transmission of a pain-relaying substance called substance P to the brain. It may also work as a counter-irritant.
  • Counter-Irritants. These make the skin feel warm and are thought to work by irritating the same nerves as those responsible for sensing muscle or joint pain. By irritating these nerves the pain sensation felt from the muscles or joints is lessened. Examples of counter-irritants include salicylates and menthol.
  • NSAIDs - These work by inhibiting the cyclo-oxygenase enzymes that are responsible for triggering inflammation. Examples include ibuprofen and diclofenac.


Joint injections for knee OA may be an alternative for people who do not find relief from oral medications, or are unable to take them. Joint injections are given by your doctor. First your doctor may take fluid out of your knee with a needle and then inject one of the following:

  • Corticosteroids. These medications are related to cortisone, a hormone your body makes to fight inflammation. Injecting corticosteroids directly into affected knee joints can quickly and effectively reduce pain and inflammation. The relief can last from several weeks to several months.
  • Hyaluronic acid. These injections are designed to help boost the hyaluronic acid found naturally in your joints, which keep them moving smoothly. In people with osteoarthritis, the hyaluronic acid gets thinner and less slippery, injections may ease pain for six months to a year, sometimes longer. The National Institute for Health and Care Excellence (NICE) does not recommend the use of hyaluronic acid injections for the treatment of OA as their efficacy and cost-effectiveness have not been adequately demonstrated. This treatment is not generally available on the NHS.
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