Joint pain and osteoarthritis: Management

Man holding knee

Managing joint pain and osteoarthritis

Joint pain can impinge on all areas of a person’s life, particularly in older individuals.

Together with education, a range of non-pharmacological and pharmacological techniques is available to help manage pain and flare-ups1 and help keep patients moving.

Guideline recommendations for treating joint pain and osteoarthritis

Stepwise management of osteoarthritis

NICE guidelines recommend a stepped approach to management1

Management of osteoarthritis may require a combination of non-pharmacological and pharmacological modalities.1

Guidelines recommend a stepped approach for the pharmacological management of osteoarthritis.1

More than one pain treatment might be needed

Image of lady holding her knee

Additional support might be needed to cover pain flares

Chronic joint pain is often accompanied by acute inflammatory flares.2

During this flare-up pain, patients may require additional short-term pain relief.2

  • Patient education and lifestyle changes

    Patient education around disease progression and management issues is helpful to encourage proactive self-management.1,3-5

    Guidance from NICE for the holistic management of patients with osteoarthritis includes:1,5

    • Weight management if appropriate
    • Exercise to include local muscle strengthening and general aerobic fitness

    Advise people with osteoarthritis where they can find further information on the condition, specific types of exercise, management of symptoms, how to access additional support such as peer-to-peer and support groups and the benefits and limitations of treatment.1

  • Exercise

    Exercise is a key part of maintaining healthy joints and should be a core recommendation as part of the holistic management of osteoarthritis.5 Advise people that joint pain may increase when they start therapeutic exercise. Explain that, although there may be initial discomfort, regular exercise is beneficial for the joints. Exercise in the long term will reduce pain, increasing functionality and quality of life.5

  • Physical therapy

    Physical therapy can be offered as part of the management of osteoarthritis.5 Advice may be given on muscle strengthening exercises, aerobic fitness training and how to pace activities to ensure a balance of activity and rest.5 Advice may also be given on protective joint supports.5

  • Transcutaneous electrical nerve stimulation (TENS)

    NICE guidance advises against the use of TENS as there is insufficient evidence of the benefit.1

  • Pharmacological treatment

    Topical NSAIDs are a first line treatment option for patients with osteoarthritis.

    According to NICE guidance, pharmacological treatments should be used if required in addition to non-pharmacological treatments and to support therapeutic exercise.1,5 They should be used at the lowest effective dose for the shortest possible time.

    A topical NSAID should be offered to people with knee osteoarthritis and should be considered for people with osteoarthritis that affects other joints.1,5

    If topical medicines are ineffective or unsuitable, consider and oral NSAID for people with osteoarthritis and take account of:1,5

    • Potential gastrointestinal, renal, liver and cardiovascular toxicity
    • Any risk factors the person may have such as age, pregnancy, current medication and comorbidities

    Offer a gastroprotective treatment for people with osteoarthritis while they are taking an oral NSAID.

    Do not routinely offer paracetamol or weak opiods unless they are only used infrequently for short-term relief and all other pharmacological treatments are contraindicated, not tolerated or ineffective.1,5

    Do not offer glucosamine or strong opioids for people with osteoarthritis.1,5

    Rubefacients should not be offered for treating osteoarthritis.5

  • Surgery

    The NICE guideline recommends use of non-surgical core treatments, including therapeutic exercise, for at least 3 months before any referral for consideration of joint surgery.5 Consider referral to an orthopaedic surgeon if non-surgical management is ineffective or unsuitable after 3 months, depending on clinical judgement if:5

    • Symptoms of joint pain, stiffness, reduced function or progressive joint deformity are substantially impacting on the person’s quality of life
    • There is diagnostic uncertainty or atypical features
    • Initial management strategies are ineffective, not tolerated or unsuitable
    • There is sudden worsening of symptoms

How can patients with joint pain be helped?

Grandad and granddaughter

Nick

Nick, 70, wakes with pain and stiffness each morning, but does not want this to control his life or his choices.

He already receives multiple oral medications and is concerned that adding more will increase his risk of side effects.

Nick tries to stay active by gardening and going for walks but this can sometimes be a struggle.

He wants sustained relief from his pain so that he can do the things he enjoys such as playing with his grandchildren.

Voltarol Max Strength Pain Relief 2.32% Gel provides clinically proven joint pain relief in a convenient, twice-daily application, and is indicated for treatment of osteoarthritis pain.

Find out more & PI

Wendy

Wendy

Wendy has experienced intermittent knee pain for 5 years. The pain disrupts her sleep and limits her previously active lifestyle and social life making her feel anxious and depressed.

Her doctor recommended weight loss and exercise as a remedy. But chronic pain creates a lack of motivation and she feels her pain prevents her from exercising.

Voltarol Osteoarthritis Joint Pain Relief 1.16% Gel is as effective as oral ibuprofen with a reduced risk of systemic side effects.13

Find out more & PI

Understanding joint pain and osteoarthritis

Causes icon

Causes

Find out about the causes of joint pain and osteoarthritis.

Find out more

Signs and symptoms icon

Signs and symptoms

Explore an overview of how to recognise joint pain and osteoarthritis and know when to refer patients.

Find out more

Image of Voltarol pack with the logo Voltarol Academy

Science academy

Discover the Voltarol science academy which includes information on how to manage patients’ pain and useful resources.

Find out more

Learn more

Voltarol Max Strength Pain Relief 2.32% Gel

Voltarol Max Strength Pain Relief 2.32% Gel Diclofenac Diethylammonium for joint pain

All day relief from joint pain when applied morning and evening.

Learn more

Voltarol Osteoarthritis Joint Pain Relief 1.16% Gel

Voltarol Osteoarthritis Joint Pain Relief 1.16% Gel Diclofenac Diethylammonium

As effective as oral NSAIDs in osteoarthritis.6

Learn more

Orders Icon

Educational resources

Access videos and interactive content for pharmacy.

Access now