What to take for knee pain?

by Oliver Wang

“What can I do to make my knee pain go away?” is an all too common question. As knee pain becomes more prevalent in today’s society as people live longer and with higher BMIs, myths and cures for the ailment have exploded. Supplements, in particular, have become extremely popular in recent years as people try and find alternative ways in dealing with often very painful knees. Word-of-mouth, the rise of alternative medicine, distrust in our healthcare system, and ease of access are also contributors to their increasing popularity. And so even if you, as a patient, are proactive in doing your research on supplements and medications, it is difficult to differentiate fact from fiction and you end up staring at an aisle of hundreds of pill bottles at your local drugstore without a clue and leaving with your wallet a little emptier and your mind still not much at ease. 

Degenerative joint disease, also known as knee osteoarthritis (OA), is the most common cause of knee pain and is the result of progressive loss of articular cartilage from wear and tear in the knees. In more severe cases, surgery or injections may be necessary, but for the majority of patients, exercise routins, physical therapy, weight loss and bracing can ease the pain. Many also opt for medications and/or supplements. With my experience working in an orthopedic clinic and having family members of my own facing the same problem, I hope that by writing this article I can help you understand the products that are marketed for improving your knee pain and help you decide which ones are best for you

NSAIDs (such as Aspirin, Ibuprofen, and Naproxen) are over-the-counter medications with overwhelming support for their effectiveness in managing knee pain and other osteoarthritis symptoms. However, many negative side effects are attributed to their use, and increasingly so at high doses and with long-term use, and so it is important to take care in choosing which one is best for you and to talk with your doctor before starting one of these medications.

Glucosamine and Chondroitin Sulfate are by far the most popular supplements marketed for knee pain as they are components of the human connective tissue found in cartilage and bone in the knee in and in other joints. They claim not only to treat knee pain, but also improve joint function and slow the development of osteoarthritis. In terms of knee pain, some studies have shown a small effect, while others show no effect at all. However, recent studies show that when taken separate and/or together, these supplements do not slow down the development of osteoarthritis as marketed1. Overall, these supplements have little support for their reported effects, but their use has also shown few harmful side effects and thus experimenting with them may be warranted with the goal of reducing knee pain.

Lesser known supplements, shown in the chart (fatty acids, Vitamin D and E, Collagen, MSM, HA, Willow Bark, Tumeric/curcumin, Boswellia serrata, and Pycnogenol), are even more difficult to assess due to a lack of testing. And when studies are performed, some show minor benefits, but most show little to none at all. For example, more current research has shown no effect with Omega-3, Vitamin D and E, Collagen, HA in management of osteoarthritis, but that these supplements do have different health benefits beyond knee pain2,3. Also more recently, particular interest in newer supplements such as MSM, Boswellia serrata, and curcumin has increased but their effectiveness is still in question2. Another thing to note is that long-term effects of these supplements has yet to be explored and remains a mystery. But once again, much like Glucosamine and Chondroitin Sulfate, while there is little evidence for any benefits, there is also little evidence for harmful effects, and so their use does not carry much risk. 

Medication/Supplement

Reported Effect(s)

Study Results

NSAIDs (Aspirin, Ibuprofen, Naproxen, etc.)

Reduce pain, inflammation, and stiffness

Strong support for all reported effects

Glucosamine

Reduce pain, improves joint function and slows progression of osteoarthritis (OA)

Little or no effect on joint function and progression of OA. Possible reduction in pain

Chondroitin Sulfate

Reduce pain, inflammation, improves joint function and slows progression of osteoarthritis (OA)

Little or no effect on joint function and progression of OA. Possible reduction in pain

Omega-3 fatty acids

Reduce pain, inflammation, and stiffness

Inconclusive

Vitamin D and E

Reduce pain, slow progression of OA

Inconclusive

Collagen

Reduce pain, slow progression of OA

Inconclusive

MSM (Methylsulfonylmethane)

Reduce inflammation, formation of collagen

Inconclusive

HA (Hyaluronic Acid)

Joint lubrication

Inconclusive

Willow Bark Extract

Reduce pain, inflammation, and stiffness

Inconclusive

Tumeric/curcumin

Reduce inflammation

Inconclusive

Boswellia serrata extract

Reduce inflammation

Inconclusive

Pycnogenol

Reduce inflammation

Inconclusive

All in all, choosing supplements to approach worsening knee pain is a discussion you should be open to have with your doctor. After realizing the lack of quality research around the topic and the potential dangers associated with supplement use, you can take the appropriate steps in experimenting with these therapies. Most physicians in my practice do not make definitive recommendations on any supplements for knee pain due to a lack of medical evidence for their use and the financial strain that purchasing these products can have for you as their patient. Taking that into account, because each person’s case is a little different and because there are few risks to taking supplements (except NSAIDs), you may find one or all of them to be highly effective. The only way to know is by trying them. On the other hand, these supplements may prove no benefits at all, be extremely costly, trigger adverse side effects, and cause you undue stress and anxiety. Until more conclusive evidence is reported on these “cures,” what is most important is that you feel you have control over your own health and body and that you remain vigilant and aware of the uncertainty of supplements. 

Source List

  1. Wandel S, Juni P, Tendal B, et al. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta‐analysisBMJ. 2010;341(sep16 2):c4675. doi: 10.1136/bmj.c4675
  2. Xiaoqian Liu, Jillian Eyles, Andrew J McLachlan, Ali Mobasheri, Which supplements can I recommend to my osteoarthritis patients?, Rheumatology, 57(4), iv75-iv87. Retried from https://doi.org/10.1093/rheumatology/key005
    3. 
    Oe M, Tashiro T, Yoshida H, Nishiyama H, Masuda Y, Maruyama K, et al. . Oral hyaluronan relieves knee pain: a reviewNutr Res. (2016) 15:11. doi: 10.1100/2012/167928

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