You should be recommending topicals for knee pain

A 2011 study co-funded by the American College of Rheumatology Research and Education Foundation and the National Institutes of Health looked at knee pain trends in the American population.

After analyzing data from six National Health and Nutrition Exam Surveys (NHANES) and three Framingham Osteoarthritis Study examination periods, researchers noted that knee pain and symptomatic knee osteoarthritis has “increased substantially” over the past couple of decades.

What’s behind this growing number of lower extremity issues?

Common knee pain causes

Though the researchers initially thought that the aging U.S. population, increased obesity rates, and specific types of knee osteoarthritis were to blame, their results weren’t that conclusive.

Instead, they found that obesity was only partially responsible for the rise in knee-related issues. Also, though symptomatic knee osteoarthritis seemed to increase in older individuals, radiographic knee osteoarthritis did not.

In fact, osteoarthritis in general is still the most common disease impacting the knee area today according to the U.S. National Library of Medicine, stating that this condition involves the knee’s cartilage gradually wearing away.

However, injuries to the knee area are also a major concern, with the American Academy of Orthopaedic Surgeons (AAOS) reporting that some of the most common knee injuries are fractures, dislocations, and injuries to the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), or collateral ligaments.

Meniscal tears and tendon tears tend to happen frequently as well, according to the AAOS.

Knee-based treatment options

When treating most knee issues, the AAOS recommends that individuals use the RICE method (rest, ice, compression and elevation).

Non-steroidal anti-inflammatory medications can also help provide relief with issues related to pain and swelling.

In some cases, a health care provider may suggest immobilizing the knee area to keep it from moving or recommend engaging in physical therapy to restore proper movement, function and strength, according to the AAOS.

Another option to consider is the use of topicals.

Using topicals for knee pain relief

Many studies have been conducted in an effort to assess how effective topicals are at lessening knee pain and some of this research has indicated promising results.

For instance, a 2010 study published in Pain Physician involved 20 patients with chronic knee pain. Some participants took ibuprofen three times a day to help deal with the pain and the remaining subjects applied a topical gel four times daily.

After two weeks, the participants’ levels of pain were reassessed. Those who used topicals reported “significant improvements” in knee pain, stiffness and function. Their patient satisfaction levels improved as well. Conversely, the ibuprofen group shared improvements in physical function only.

A 2017 review published in The American Journal of the Medical Sciences adds that, when it comes to the management of conditions such as degenerative knee osteoarthritis, current treatment guidelines suggest topicals as “first-line therapy.” This is especially true for older patients, a population at risk of suffering negative side effects when taking oral pain relievers.

Knee pain and oral medications

This review goes on to explain that individuals taking oral non-steroidal anti-inflammatory drugs (NSAIDs) in higher doses or for longer durations can develop gastrointestinal issues, cardiac and renal concerns, and have potential drug interactions. That makes this category of drugs a less-than-ideal option.

In a 2018 news release, the American Journal of Managed Care adds that topical analgesics are also better than opioid prescriptions because of these drugs’ negative side effects. These effects include opioid-induced constipation, feeling sedated, nauseated, and dizzy. Opioids can also cause respiratory depression, drug dependency and overdose-related death.

Topical treatment options

The three types of topicals highlighted in the 2017 review as providing knee pain relief include:

• Capsaicin: Binds to the skin’s heat-sensitive receptors, creating an analgesic effect while also serving as an anti-inflammatory.
• Topical NSIADs: Create local and systemic analgesic and anti-inflammatory effects via inhibition of the cyclooxygenase (COX) enzyme.
• Salicylates: Counter-irritants similar to NSAIDs that alter or offset joint-related pain by impacting the associated nerves.

Additionally, cooling topical therapies are often used to reduce inflammation, pain and edema, whereas topical heat therapy works to relax muscles in the knee area and improve circulation.

Safe topical use

The one main concern when using topicals safely is the risk of burns, according to the U.S. Food & Drug Administration (FDA). Therefore, if pain or swelling occurs where the topical is applied or if the skin blisters in that area, the FDA recommends seeking immediate medical attention.

Topicals should also not be applied in conjunction with heat (whether via a heating pad, heat lamp or other heat source) or to areas of the skin that are open or irritated. Bandages should also not be used where topicals have been administered.

Though there are many causes of knee pain, topicals can help provide relief without the side effects commonly associated with oral pain relievers. To use them safely, watch for adverse skin reactions, don’t use them in conjunction with heat, and don’t apply bandages to the topical area.