With chronic pain being such a prevalent symptom of OA and one in three people with the condition reporting a daily pain level of 7 or above on a scale of 1-10, it came as a surprise that NICE’s draft guidelines state that analgesics like paracetamol and strong opioids plus popular nutritional supplement glucosamine should not be prescribed.
Dr Paul Chrisp, director for the Centre for Guidelines at NICE explained:
“This is because new evidence has shown there was little or no benefit to people’s quality of life, pain or psychological distress and particularly in the case of strong opioids, there was evidence that they can cause harm in the longer term, including possible addiction.”
Instead, say the guidelines, doctors should first offer ‘tailored therapeutic exercise’ to all OA patients (for example local muscle strengthening and general aerobic fitness exercises).
If pharmacological treatments are still needed to manage OA or to support exercise, then the guidelines advise a topical non-steroidal anti-inflammatory drug (NSAID) as the first point of call. If they prove ineffective, then an oral NSAID can be considered.
Osteoarthritis (OA) affects an estimated 8.75 million people over 45 in the UK and, according to the charity Versus Arthritis (versusarthritis.org), it’s the leading cause of pain and disability in the country.
“Due to pain levels, some people with osteoarthritis may be fearful or reluctant to engage in exercise,” recognises Disha Shah, a musculoskeletal physiotherapist at Ascenti (ascenti.co.uk) the UK’s biggest independent physio provider. “This is completely normal, especially if you experience pain when doing everyday activities. But studies show that exercising will have many benefits, including helping to reduce pain and joint stiffness, weight loss plus improved mood and self-esteem too.”
It’s important to expect that exercise can be difficult to begin with, she adds, and in some cases, joint pain may increase when you start a new exercise regime.
“So take it steady and adjust your programme accordingly with the help of a professional such as a physiotherapist,” says Disha.
Always check with a healthcare professional before starting an exercise regime if you have OA. “Everyone with OA is different so exercise that’s personalised to the individual, tailored to their activity levels and progression of their condition is best,” says Disha. “Generally, you should include flexibility, strengthening, aerobic and balance exercises like playing bowls or tai chi. Ascenti recently launched the Reach app that provides daily physio support to help you get back to doing the things you love through digital triage, personalised video exercise plans and 24/7 access to online clinician support.”
Also, take a look at the free online programme – Let’s Move – from Versus Arthritis (versusarthritis.org)