Stiffness, tenderness, bone spurs, swelling, and overall pain are all symptoms of osteoarthritis (OA), a condition that affects 32.5 million US adults. Osteoarthritis can damage any joint, but the knee is one of the most commonly affected joints, with approximately 46% of people developing knee OA during their lifetime.1

Beyond severe pain, what makes knee OA so debilitating is its impact on all facets of life.

A new survey – Standing Up to Knee Pain: The Physical, Social and Mental Impact of Knee OA –  sheds light on the impact of knee OA.2 The survey depicts physical effects, such as difficulty climbing stairs and sleeping, and demonstrates widespread consequences on patients’ mental health and social life. For instance, more than 9 in 10 patients (91%) reported missing out on social events, and 28% said their everyday mental health was negatively affected by their ongoing pain.2


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Current Treatments for Knee OA Pain Are Inadequate

When so many everyday activities and previously enjoyable tasks become negatively affected by pain, it’s no wonder that patients want relief as quickly and effectively as possible. Insights reveal that 100% of patients have tried some form of treatment to address their pain, such as over-the-counter medications (71%), ice/elevation (64%), physical therapy (57%), and injectable steroids or injectable hyaluronic acid gels (48%). Yet 97% still report that their condition negatively affects their daily lives.2

Innovative new treatments such as targeted cryoanalgesia may succeed where other treatments have failed, but many patients aren’t aware that effective drug-free options are available to treat their condition.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most commonly prescribed medications for OA pain and inflammation. However, a study presented at the Radiological Society of North America showed no positive impact of NSAIDs on joint inflammation.3 In addition, other research has shown that another standard pain relief treatment for arthritis, corticosteroid injections, may be associated with disease progression.4 Risks of corticosteroid injections include cartilage damage, death of nearby bone, joint infection, nerve damage, a flare of pain and inflammation, and even a temporary increase in blood sugar. This is especially concerning for patients living with diabetes. With obesity being the leading risk factor for knee OA and common risk factor for diabetes,5 health providers must consider how pain treatments affect their patients’ blood sugar.

Evidently, some of these current and most common methods to treat knee OA pain are falling short and not providing patients with the relief they need.

Risks of Treatment With Opioids

Further, the survey also found that 45% of patients reported using opioids or prescription painkillers in an attempt to manage knee OA pain.2 Often, opioids have been seen as the gold standard for treating pain, even though they result in side effects such as constipation, nausea, vomiting, confusion, and the risk for addiction and dependence. The US is also battling a devastating opioid epidemic, with 107,000 drug overdose deaths in 2021.6 This is especially an issue when coupled with the mental impact OA has on patients and the fact that patients with mental health challenges are twice as likely to have or develop substance use disorder.7

While exercise is one of the most effective treatments for mental health issues, such as depression, it becomes much more difficult for patients with knee OA – more than half of patients report that their overall health and fitness have been impaired by chronic knee pain.2  

Looking to Cryoanalgesia: A Safe and Effective Treatment

Immediate relief is essential, but as clinicians, we must ensure the long-term safety of patients, along with treatment of pain.

Keeping the opioid epidemic and the risks associated with opioids in mind, patients now have newer, innovative options, including nonopioids, for the treatment of their pain.

Cryoanalgesia has been considered as a safe and effective innovation that uses the body’s natural response to cold by temporarily freezing nerves rather than using drugs. It provides pain relief to the affected area that can last for an extended period. Cryoanalgesia may allow patients to return to their daily activities soon after treatment. While cold therapy is not a new concept, cryoanalgesia may be an effective, nonpharmacologic option that can treat pain.8 Research has also demonstrated that the potential benefits of cryoanalgesia include increased functional capacity and quality of life because of significant pain relief and improved use of physical exercise.9

Patients Live With OA for Half Their Lifespans

Although knee pain has been associated with older age, recent cases of knee OA among younger people are also being reported. In the Standing Up to Knee Pain survey, 40% of the patients were aged younger than 50 years, and 100% of them reported the negative impact that knee pain has on their day-to-day activities, which prompted them to seek treatment.2

As knee pain is becoming more prevalent among patients of all age groups, people are affected by knee pain for longer extended periods. The survey reported that nearly 3 in 5 (57%) patients have had knee pain for more than 5 years, and almost one-third (32%) have had knee pain for 10 years or longer.2 Because of lack of adequate treatment for knee OA, patients typically live with this condition for approximately 30 years,10 which is almost half of the average person’s lifespan. This makes effective pain relief and considering long-term consequences much more critical.

Impact of OA in Rheumatology

In the following years, rheumatologists may see an increase in the number of patients with chronic knee pain and knee OA. With recent research showing that current methods used to treat knee OA pain are falling short, provider and patient awareness of alternative treatments, such as cryoanalgesia, which can bridge the gap in current knee OA care, should be a priority. With long-lasting, nondrug interventions, we can ensure that we are providing our patients with the latest in pain management, especially for those who require alternative options.

Disclosure: The survey referenced in this article was conducted by Pacira Biosciences. Dr Carr has received compensation as a consultant for Pacira Biosciences.

Brian Carr, MD, is an orthopedic surgeon in Las Vegas, Nevada, specializing in knee & lower limb surgery at Las Vegas Concierge Orthopedics.

References

  1. Cleveland Clinic. Osteoarthritis of the knee. Updated on September 8, 2021. Accessed on January 9. 2023. https://my.clevelandclinic.org/health/diseases/21750-osteoarthritis-knee
  2. Pacira Biosciences, Inc. Standing up to knee pain survey: the physical, social and mental impact of knee OA. https://www.multivu.com/players/English/9104351-pacira-iovera-knee-pain-survey/docs/SurveyReport_1668548009212-303969155.pdf
  3. Radiological Society of North America (RSNA). NSAIDs may worsen arthritis inflammation. News release. Published on November 22, 2022. Accessed on January 9, 2023. https://www.prnewswire.com/news-releases/nsaids-may-worsen-arthritis-inflammation-301681834.html
  4. Radiological Society of North America (RSNA). Steroid injections worsen knee arthritis. Published on November 29, 2022. Accessed on January 10, 2023. https://press.rsna.org/timssnet/media/pressreleases/14_pr_target.cfm?id=2386
  5. Piva SR, Susko AM, Khoja SS, et al. Links between osteoarthritis and diabetesClin Geriatr Med. 2014;31(1):P67-87. doi:10.1016/j.cger.2014.08.019
  6. Centers for Disease Control and Prevention (CDC): National Center for Health Statistics. U.S. overdose deaths in 2021 increased half as much as in 2020 – but are still up 15%. Published on May 11, 2022. Accessed on January 10, 2023. https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/202205.htm
  7. Substance Abuse and Mental Health Services Administration (SAMHSA). National Survey on Drug Use and Health (NSDUH). Accessed January 10, 2023. https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health.
  8. Evans PJ. Cryoanalgesia. The application of low temperatures to nerves to produce anaesthesia or analgesiaAnaesthesia. 1981;36(11):1003-1013. doi: 10.1111/j.1365-2044.1981.tb08673.x
  9. Nygaard N-PB, Koch-Jensen C, Vægter HB, et al. Cryoneurolysis for the management of chronic pain in patients with knee osteoarthritis; a double-blinded randomized controlled sham trialBMC Musculoskelet Disord. 2021;22:228. doi:10.1186/s12891-021-04102-1
  10. Charlesworth K, Fitzpatrick J, Perera NKP, Orchard J. Osteoarthritis- a systematic review of long-term safety implications for osteoarthritis of the kneeBMC Musculoskelet Disord. 2019;20:151. doi:10.1186/s12891-019-2525-0

This article originally appeared on Rheumatology Advisor