New joint pain treatments are ever-improving to help alleviate chronic pain and increase mobility. With current medical guidelines recommending a variety of options including physical therapy, injections, medical devices, oral medications, and more, it can be hard to discern which is the best without sifting through medical journals and studies for hours.
In recent years, several new arthritis pain treatments have emerged as promising alternatives to purely symptomatic treatments and more invasive treatment options like total knee replacement for knee joint pain. We are going to take a look at a few of these options below and dig in to see what clinical research has to say about them.
Non-Invasive Devices and Therapies
Exercise and Physical Therapy
Although not considered new, we feel that exercise and physical therapy deserve a place on our list as they can be used in conjunction with other treatment methods mentioned for improved pain management.
In a single, blind study, 56 patients with osteoarthritis knee pain were put into two random groups. The patients in the first group received exercise for knee muscles in combination with nonsteroidal anti-inflammatory drugs (NSAIDs) and 10 sessions of acupuncture and physiotherapy modalities. The other group received similar treatments but without the exercise program.
It was found that adding the exercises (6 exercises, stretching and strengthening the muscles around the knee) to other non-invasive treatments relieves pain and improves function of the knee in the short term.
In another study of 83 patients, it was found that a combination of manual physical therapy and supervised exercise yields functional benefits for patients with osteoarthritis of the knee and may delay or prevent the need for surgical intervention.
What we can learn here is that exercise and physical therapy are effective in the assistance of pain reduction.
The Arthritis Foundation recommends regular exercise to help combat knee pain.
Apostherapy® is an innovative treatment geared towards improving muscle control.
Developed by orthopedic and sports medicine specialists, AposTherapy® treats knee osteoarthritis by readjusting pressure on joints and re-educating muscles for a healthier walking pattern, even when not wearing the device.
Using a biomechanical device worn on the foot, this non-invasive, drug-free treatment program is simple and easy to use and can be worn during the patient’s regular routine.
AposTherapy® has been shown to reduce knee adduction moment while improving movement patterns and clinical symptoms, and the positive effect carries over to when the patient is not wearing the AposTherapy® device.
A study over a period of two years found the benefits of AposTherapy® to peak within the first few months and these benefits were maintained over the long term.
In the study above, one group was given the device and therapy plan and the other control group received the walking shoe without the biomechanical components and the same therapy plan as the active group.
Patients treated with AposTherapy® showed greater improvements at the study endpoint in all the study outcomes.
The groups also differed in the number of total knee replacements (TKRs) performed. Only one patient from the active group required a TKR during the study period (2.6%), while 5 patients (31%) of the control group required it during the two-year study period.
Another study examined the changes in patient-reported outcome measures and in functional tests.
AposTherapy® was found to reduce pain, increase mobility, and improve quality of life. Also, subjects assigned to AposTherapy® reported a reduction of over 56% in the consumption of over-the-counter painkillers.
Hyaluronic Acid or Hyaluronate Injections
This treatment is meant to restore fluid that helps lubricate joints by injecting the fluid directly into the knee.
An abstract from a 2016 study states that evidence of repeated courses of hyaluronic acid injections demonstrated an improvement in pain or function lasting up to 40 months (12 months after the last injection cycle) and that there may be a delay in the need for total knee replacement for around 2 years.
A 2018 clinical research review stated that improved hydrogels are being created to enhance the effect of treatment. One is called Gel-One, which is composed of a product called Gel-200.
This product was first shown to produce chondroprotective effects (a specific compound or chemical that delays progressive joint space reduction), anti-inflammatory effects and long-lasting pain reduction in osteoarthritis mouse models.
Although these findings are promising, there is an ongoing controversy over the effectiveness and sustainability of the injections for osteoarthritis patients. One of the main debates is the timing and duration of injection and whether it has an impact on its efficacy and sustainability.
Primarily, the main issue with this treatment is that it only masks the symptoms of arthritis. As with other medications and injections, it does not address the biomechanical roots connected to osteoarthritis.
Essentially, more studies need to be conducted here for it to be revered as a go-to way to treat arthritis.
We have talked quite a bit about the use of hyaluronic acid injections for osteoarthritis here if you would like to learn more.
IL-1 receptor antagonists
Administration of drugs containing IL-1ra has been shown to reduce inflammation and reduce pain in clinical trials, both in mice and humans. The subcutaneous injection is administered by the patient, at home. Interleukin-1 receptor antagonist (IL-1RA) regulates a variety of IL-1-related immune and inflammatory responses.
A study of 170 patients comparing doses of Anakinra (a modified human IL-1 receptor antagonist protein) with a placebo showed improvements and lowered pain after four days.
IL-1 receptor antagonists may have a degree of clinical and structural benefit that may be more beneficial for patients with severe osteoarthritis, but further research needs to be conducted.
Platelet-Rich Plasma (PRP) Injections
This is a minimally invasive intervention of an autologous blood product called platelet-rich plasma (PRP) that could be used to promote tissue regeneration.
Evidence suggests PRP might have a regenerative effect on some body tissues. PRP has been shown to provide some relief in early osteoarthritis in the knee and to be at least as effective as hyaluronic acid and steroid injections for symptom control.
A study carried out on 14 participants found improvements in constant, intermittent, and total pain scores. Pain was fully resolved in two patients during the course of the study, and improvements were also noted in patient satisfaction and goal-oriented outcomes.
More studies need to be conducted on a wider-scale to better understand if PRP is effective for long-term pain relief.
There are a ton of new medications being researched every day for treatment and relief of osteoarthritis. We are going to take a quick look at some of the newest ones below from a research and review article entitled: “Novel Treatments for Osteoarthritis: An Update”. You will also see supporting clinical research evidence throughout this section from a variety of other sources.
Serotonin–norepinephrine reuptake inhibitors
Serotonin and norepinephrine reuptake inhibitors (SNRIs) are a class of drugs that are effective in treating depression, but SNRIs are also being used for the treatment of chronic pain. These are normally in pill-form and taken orally.
Meta-analysis of 39 placebo controlled studies referenced here was performed to estimate the effect of antidepressants on chronic pain.
The average patient who received an antidepressant treatment had less pain than 74% of the patients who received a placebo. Patients here were given 60 mg/day and 120 mg/day, with the 60 mg/day dose showing better tolerability.
Recent evidence referenced in “Novel Treatments for Osteoarthritis: An Update” has implicated central sensitization as an important factor in mediating pain in osteoarthritis. Findings relating to this drug may explain the limited efficacy demonstrated by medications like NSAIDs.
In the cited trial, patients treated with Duloxetine exhibited significant improvements in average pain score. Duloxetine is recommended to patients who do not respond well to conventional pharmacological agents and has been approved for the treatment of chronic knee osteoarthritis by the Food and Drug Administration (FDA).
However, there are side effects. These include dry mouth, nausea, constipation, fatigue, and reduced appetite.
Strontium ranelate (SrR) dissociates the bone remodeling process. It changes the balance between bone resorption and bone formation. Its effect on bone structure makes it a potential disease modifying drug in the treatment of osteoarthritis. In clinical trials, these were in pill-form and taken orally.
A recent clinical trial studied 1,371 patients with knee osteoarthritis. Patients were randomized to receive strontium ranelate or a placebo on a daily basis for three years.
At the end of the study, patients taking strontium ranelate had a 30% reduction in the rate of decline in joint space width and a modest improvement in symptoms. There was a minimal effect on the overall pain score and the modest symptomatic benefit was only achieved with a higher dose.
There are many new arthritis and joint pain treatments being investigated every day and this article is meant to be an introduction, but we hope that you now have a bit more insight into where the industry is at and a better idea of the new treatment options that are being researched right now.
If you would like more information on our innovative drug-free alternative to relieving knee pain, click below to learn more about AposTherapy®.
Disclaimer: This article is for informational purposes only. If you are suffering from knee and joint pain, please consult with your doctor before undergoing any treatment plan.