What to take for knee pain?
by Oliver Wang
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 routines, 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, 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 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|
|Boswellia serrata extract||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.
- Wandel S, Juni P, Tendal B, et al. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta‐analysis. BMJ. 2010;341(sep16 2):c4675. doi: 10.1136/bmj.c4675
- 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 review. Nutr Res. (2016) 15:11. doi: 10.1100/2012/167928