Pain relief is a complex area. We’re all familiar with over-the-counter remedies. And most of us will have had prescriptions for more advanced pain management too. But the slew of different names can be overwhelming – particularly if you’re suffering from persistent knee pain for the first time.
With that in mind, we thought it would be useful to write a brief overview of the types you might encounter on your knee treatment journey. Although this isn’t a how-to guide for self-treatment – any ongoing pain needs to be properly investigated and treated by a medical professional on a person-by-person basis – we hope it will shed some light on the categories of pain relief available.
Medication-based painkillers
Capsaicin cream
Capsaicin is a chemical that acts on ‘Substance P’, a neuropeptide (or messenger molecule) in our bodies that modulates nerve pain. Capsaicin is found in chilli peppers – you’ll know it from the tingling sensation in spicy food – and has been found by various studies to improve pain and tenderness. It’s available as a cream or gel, which you rub into the skin around the knee. A form known as Zacin is used to relieve osteoarthritis pain.
Paracetamol
Paracetamol (also known as acetaminophen) sits in a drug category of its own. It’s a readily-recommended, easily available medicine used for a wide range of pains. One of its key advantages is that side effects are rare. Unlike opioids, it doesn’t create dependence either (though psychological dependence is possible). Studies have also found it to be effective for easing arthritis pain.
More about paracetamol (NHS)
NSAIDs
NSAID stands for non-steroidal anti-inflammatory drug. Since swelling is common to many types of knee condition (see our Starter guide to swollen knees), this can make them useful for short-term relief of inflammation as well as pain. There are some 20 different types of NSAID, the best-known being ibuprofen and aspirin. But they can be inappropriate for some patients, for instance people with asthma or stomach ulcers, and aren’t recommended for long-term use.
Opioids
Opioids work by attaching themselves to brain receptors and blocking the transmission of pain signals. They’re very effective at this, which is why they’re often prescribed after major surgery or serious injury. The downsides are that they can be addictive, and come with a range of potential side effects. Milder forms of opioid include tramadol and codeine (known as co-codamol when combined with paracetamol). Stronger types include morphine and fentanyl.
More about tramadol, codeine, co-codamol, morphine and fentanyl (NHS)
Tricyclic antidepressants
The name suggests a drug for anxiety or depression – which in fact is why it was originally developed – but at low dosage this type of medication can be used for pain relief too. It works by raising the levels of serotonin, a chemical that’s linked to mood. It’s commonly prescribed for back pain, fibromyalgia, migraines, and for osteoarthritis-related knee pain. The best-known form of tricyclic antidepressant is amitriptyline.
More about amitriptyline (NHS)
Other types of pain management
These days, medication isn’t the only focus for pain relief. In fact the advice around painkillers has been changing – particularly when it comes to managing persistent pain. In 2021, for example, NICE (the National Institute for Health and Care Excellence) issued new guidance for treating primary chronic pain (pain that can’t be explained by a chronic condition); its recommendations included things like exercise, psychological therapies and acupuncture, in place of long-term medication, and some of these approaches may be appropriate for chronic knee conditions too. Broadly, these non-medication categories include:
Physical therapies – such as massage, hydrotherapy and a tailored exercise programme; also hot and cold packs (for more about these, see: When to use heat and cold treatments on a knee injury)
Mind and body techniques – such as acupuncture, which is now used by many GP practices and pain clinics across the NHS (see more at the NHS Acupuncture page)
Psychological therapies – such as cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT)
Another helpful new resource for pain management is the ESCAPE-pain course. Created by a rehabilitation scientist (originally for knee pain but now applied more widely), it provides advice and exercises for managing joint pain in a group setting. You can read more about it here: ESCAPE-pain review: a course to help you manage knee pain
The bottom line? Ongoing knee pain can be a huge challenge, but nobody should have to face it alone. These days, there’s a whole range of options and techniques that we can bring to bear on your own situation, whatever condition or injury you’re facing. Medication is just one part of that spectrum.
Are you suffering from persistent knee pain? If so, it’s important to have it properly investigated. You can do that here in the clinic by booking an appointment with us. We’ll make sure you’re seen, examined and treated as soon as possible.
