Chronic Knee Pain: Medications or Injections?

 

Chronic knee pain is long-term pain in one or both knees. Many conditions can cause chronic knee pain, and treatment depends on the underlying cause of the pain. Medications may work for some patients, whereas others require injectable therapy.Knee pain

 

Causes of Chronic Knee Pain

 

Many conditions produce chronic knee pain. These include:

 

  • Chondromalacia – This condition is characterized by an aching, dull pain in the front of the knee behind the kneecap. This pain is worsened by climbing up and down stairs, and often flares up after prolonged sitting for a long time. Chondromalacia may make the knee joint catch or give way. The knee may also appear swollen or puffy, having a grinding or creaking sound with movement.

 

  • Arthritis – With knee arthritis, the knee will be stiff, swollen, and painful. The pain will increase with activity and get better with rest. Crepitus (cracking and creaking) can be heard with movement of the knee, and decreased mobility and stiffness is worse in the morning or after one has been sitting for a while.

 

  • ACL tear – An anterior cruciate ligament (ACL) tear can produce knee pain. This ligament is one of the four major structures that connect the shinbone (tibia) to the thighbone (femur).

 

  • Meniscus tear – The meniscus is a rubber, tough piece of cartilage that serves as a shock absorber between the tibia and femur. This structure can become torn when the knee is suddenly twisted.

 

  • Bursitis – The bursae are small sacs of fluid outside the knee joint. These sacs contain fluid that makes the ligaments and tendons of the knee joint glide smoothly with movement. With bursitis, these bursae are inflamed and painful.

 

  • Patellar tendinitis – When one or more of the tendons supporting the patella (kneecap) is irritated and inflamed, the condition is called tendinitis. This condition is common among runners, cyclists, and athletes who engage in jumping sports.

 

The Colorado pain management specialist will first recommend medications for knee pain. The type of medication used will depend on the severity of your pain. Options include:Knee_Injection

 

  • Non-steroidal anti-inflammatory drugs (NSAIDs) – These medications work by reducing inflammation and swelling. Examples include ibuprofen, naproxen, diclofenac, and ketoprofen.

 

  • Opioids – For severe pain, the doctor may prescribe an opioid analgesic. These include drugs such as tramadol, hydrocodone, and oxycodone.

 

  • Capsaicin cream – This medicine works by blocking the nerves that transmit pain messaged to the treated area. A pea-sized amount of the cream is applied to the affected joint up to four times a day. Capsaicin is made from hot chilies, and it can cause burning if it gets in the eyes.

 

  • Supplements – Some doctors recommend a trial of supplements, such as chondroitin sulfate, glucosamine, and S-adenosylmethionine (SAMe).

 

Injections

Injections are usually indicated when the patient does not have symptom relief with medications. Three knee injections are:

  • Hyaluronic acid – This substance is used to replace lost joint fluid. Hyaluronic acid occurs naturally in the joint and acts as a [ File # csp0729533, License # 2276657 ] Licensed through http://www.canstockphoto.com in accordance with the End User License Agreement (http://www.canstockphoto.com/legal.php) (c) Can Stock Photo Inc. / mrslevitejoint lubricant and shock absorber. For people with arthritis and other knee conditions, the joint loses fluid. Replacing it will lessen pain and inflammation. These injections are given weekly for 3-5 weeks, or once every 3 months, depending on the product.
  • Corticosteroid – To provide quick relief of inflammation and pain, the doctor may inject the knee joint with a corticosteroid. Because repeated injections can lead to cartilage breakdown, corticosteroid injections are not done that often.
  • Stem Cell Therapy – These injections involve amniotic fluid, which includes stem cells, growth factors and hyaluronic acid. The procedures are typically able to regenerate some of the damaged cartilage, which is amazing for pain relief and helping patients avoid the need for surgery.

Resources

Bijlsma JW, Berenbaum F, Lafeber FP. Osteoarthritis: an update with relevance for clinical practice.Bijlsma JW, Berenbaum F, Lafeber FP. Osteoarthritis: an update with relevance for clinical practice. Lancet. 2011 Jun 18;377(9783):2115-26.

Hochberg MC, Altman RD, April KT, et al. American College of Rheumatology: 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res

Lane NE, Schnitzer TJ. Osteoarthritis. In: Goldman L, Schafer AI, eds.Lane NE, Schnitzer TJ. Osteoarthritis. In: Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 270.