Osteoarthritis Pain

Managing Osteoarthritis Pain

The goals of OA therapy are to decrease pain, maintain or improve function, and provide education about the disease and its management. Treatment guidelines for arthritis pain management developed by the American Pain Society (APS), the American College of Rheumatology (ACR), and the American Geriatrics Society (AGS) recommend beginning treatment with nonpharmacologic therapies and when necessary, adding efficacious and cost-effective pharmacologic therapies.

Nonpharmacologic Approaches

An important component of overall therapy for OA is nonpharmacologic approaches, particularly those that promote patient self-management. Exercise and weight loss (if appropriate) are two important strategies for promoting patient self-management. Light or moderate physical activity may help prevent physical decline or restore function. Assistive devices can decrease pain and improve function when used appropriately. Clinical studies have reported pain reduction and enhanced function 6 to 12 months after initiating treatment with heel wedges or braces, but benefits vary and tend to decline with advanced arthritis.⁴³ Like other persistent pain conditions, patients with osteoarthritis pain may have psychosocial cormorbidities. Participation in an exercise program is one method of decreasing isolation and promoting self-confidence.

Patients should be evaluated for muscle strength, physical function, mobility, and ambulation. Referrals should be made for physical therapy and/or occupational therapy to reduce impairments in range of motion, strength, flexibility and endurance. Conditioning exercises (e.g., moderate walking, low-impact aerobic exercises) can improve pain and functional disability,⁴⁴ but must be individualized according to the patient’s age, severity of arthritis and generalized conditioning. Adults should lose weight if their BMI is greater than 30 and follow a long-term weight management program.