Arthritis Pain: 3 New Treatments to Try Before Surgery

Senior Couple Exercising In Park
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Too often, arthritis sufferers find themselves between two unappealing options: living with chronic pain or going under the knife. In fact, arthritis pain is the leading cause of disability in American adults 18 and older -- affecting half of all adults over age 50. And because most replacement knee and hip joints last just 10 to 15 years -- if patients take it easy -- doctors are reluctant to perform knee and hip replacements on younger patients, who may need multiple surgeries over their lifetime.

Happily, there's plenty of hope out there, as researchers look for nonsurgical options to help boomers go actively into their 40s, 50s, and beyond. Here are three new treatments for arthritis to try before surgery:

1. Prolotherapy

In a prime example of what's old is new again, prolotherapy -- invented in the 1950s and 1960s but overlooked for decades in favor of more invasive treatments -- has had a resurgence. Pioneered by an Ohio surgeon, George Hackett, who was dissatisfied with the success he was getting with surgery, prolotherapy consists of a series of injections into the connective tissue around an arthritic or injured joint, with the aim of triggering the body's own inflammatory healing response.

How it works: A dextrose-based solution is injected into the tendons and ligaments surrounding an injured joint (knee, spine, hip, shoulder, or hand), causing inflammation that in turn spurs the body to regenerate ligaments, tendons, and cartilage to support and stabilize the joint. It's not an overnight solution; in order to achieve results, treatments typically occur every four to six weeks over a period of six months to a year.

Reasons to believe: Over the years, research results on prolotherapy were mixed, leading to skepticism among mainstream doctors about its efficacy, and it fell out of favor. Some insurance companies don't cover it, considering it experimental. But recent anecdotal clinical evidence has been convincing enough that prolotherapy has increasingly been offered by spine and arthritis clinics and osteopaths as an alternative to surgery or cortisone shots. Both the prestigious Mayo Clinic and Harvard Medical School currently both offer prolotherapy and train therapists in the technique.

What's more, rigorous research has resumed over the past decade; several randomized double-blind, placebo-controlled studies of prolotherapy for osteoarthritis of the knee have been published, and others are in progress. One study at Bethany Medical Center in Kansas City, Kansas, found that after 12 months of treatment, patients experienced a 44-percent decrease in pain, a 63-percent decrease in swelling, an 85-percent decrease in buckling, and an increase in range of motion of 14 degrees. A team led by David Rabago, a physician at the University of Wisconsin, is engaged in an ongoing collaborative research project to follow prolotherapy patients via MRI, documenting verifiable structural improvements to the knee as a result of prolotherapy.

More new arthritis treatments to try before surgery

2. Viscosupplementation with hyaluronic acid

How it works: A relatively new way to ease arthritis pain in the knee, viscosupplementation -- also known as hyaluronic acid therapy -- consists of injecting hyaluronic acid derivatives (brand names Synvisc, Hyalgan) into the knee joint. Hyaluronic acid, which is a naturally occurring substance found in the fluid that surrounds joints, acts as a lubricant and allows the bones to move more smoothly over each other. It also acts as a sort of shock absorber for the joints.

Reasons to believe: Originally, hyaluronic acid therapy was thought to provide only temporary symptomatic relief, lasting a year or more, but recent research has demonstrated that viscosupplementation can significantly decrease the rate at which the joint is deteriorating and extend the time until surgery is necessary. In fact, over the past ten years, a number of studies have found the treatment, which is much less invasive than surgery, to be up to 90 percent effective for osteoarthritis of the knee.

Patients love the treatment because it's done on an outpatient basis with little or no recovery time. Insurers love it because it's cheap, costing an average of $800-$1,000, as opposed to anywhere from $10,000 to $30,000 for a knee replacement. The FDA has only approved viscosupplementation for the knee, and only for osteoarthritis, but researchers are currently studying its use in the ankle and hip. Many doctors are also now allowing patients to have multiple repeat treatments, an approach that's been popular in Europe for some time. Although some viscosupplements are currently approved to treat ankle osteoarthritis in Europe, the FDA has not given approval for this use in the United States.

3. Prescription anti-inflammatory cream

In 2007, the first prescription topical anti-inflammatory treatment for osteoarthritis was approved by the FDA, and it's quickly becoming a popular option, particularly for those with arthritis in the joints closer to the surface of the skin, such as the wrists, fingers, feet, and knees.

How it works: Diclofenac gel (brand name Voltaren) is a topical version of oral diclofenac sodium, a nonsteroidal anti-inflammatory (NSAID) medication similar to aspirin, ibuprofen, or naproxen. The difference lies in the delivery system: By applying the gel through the skin and bypassing the digestive system, it avoids many of the problems that make NSAIDs difficult to tolerate, such as gastrointestinal distress and the risk of stomach bleeding and ulcers. While some of the active ingredient does get into the bloodstream, experts say, 94 percent less is absorbed from the gel than from an oral medication.

Reasons to believe: Recent studies have shown that topical diclofenac reduced pain by 45 to 50 percent. The gel also offers a safer alternative for older patients and those at risk for heart disease, for whom NSAIDs aren't recommended.

Note: Another topical cream that's recently become popular for treating osteoarthritis is capsaicin cream, made from the heat-giving ingredient in chili peppers. Sold over the counter and by prescription under the brand names Zostrix, Arthricare, and Trixaicin, capsaicin cream was originally used to relieve the pain of shingles and neuralgia but has also been found to work for arthritis, particularly if the painful joints are close the skin's surface. (For this reason, no topical cream works well for arthritis of the hips.) Capsaicin is also available in the form of extended-release patches and pads.

Caution: In 2009 the FDA issued a warning that diclofenac sodium has been associated with liver toxicity, although the problems were primarily found among those taking the oral form of the drug. To reduce the chance of liver problems, make sure your doctor knows if you're taking any other drugs that can affect the liver, such as statins, methotrexate, and other oral NSAIDs. The FDA now recommends that those using diclofenac have their liver function tested after four to six weeks of use. However, many people with osteoarthritis are going to use diclofenac gel primarily for short-term flare-ups; in this case ask your doctor if monitoring is necessary.

Melanie Haiken

Melanie Haiken discovered how important it is to provide accurate, targeted, usable health information to people facing difficult decisions when she was health editor of Parenting magazine. See full bio

over 4 years, said...

My back pain came on suddenly, possibly from a class room, room change. It has lasted now every day for 21/2 years, and has affected my left leg, which gets stiff when I walk. I have had many MRI's and nerve conductive tests. My doc says my back looks "pretty good". I was given injections, three to be exact over the course of a year...none have helped. Not one doctor has told me what it could be. Does anyone think this could be arthritis? I was tested for RA and came back negative. My doc says it could be fibro., but I think not, as I feel like all my problems (legs, arms, neck) are stemming from the central place that hurts all the back. Thanks for your thoughts on what you think, and what other doctors I could possibly go see. This is who I have seen thus far: neurologist (2) rhem'tolist(2) neuro surgeons(3) pain management doctor. All have said that for my age of back (structurely) looks good, and that the injections I have had would, or should have helped my pain if it was nerve related. Any thoughts...much appreciated

over 5 years, said...

Great article! I am a physician in Tulsa, Oklahoma and have been performing prolotherapy for the past 5 years (visit with excellent results. I noticed 1 comment from someone stating that she couldn't find anyone in Oklahoma City who performs prolotherapy. We are working on opening a clinic in Oklahoma City in addition to our Tulsa clinic. If there is anything we can do to help ANY patient, please let us know!

almost 6 years, said...

I have fibromyalgia and osteoarthritis in my spine and shoulders. I was just prescribed Lyrica for my pain, but I read the reviews of this drug and many people spoke about the bad side-effects of this drug. Has anyone out there ever takern Lyrica? I would like to know what you think about it. Thank you!

almost 6 years, said...

Thank you for this article! I am facing surgery in 3 places on my spine and need to know about any alternative treatments! I will mention these to my doctor and see if I can try them before I undergo spinal fusion! I'll try just about any alternative treatment before I go under the knife! I am in such severe pain that I'm about ready to give in to surgery, but hope to try these!

about 6 years, said...

Can't think of any improvements to suggest

about 6 years, said...

i need prolotherapy but can't find anyone in oklahoma city that does it and all the doctors i've asked mostly say they have either never heard of it or don't know anything about it and don't know anyone who performs the procedure. i've tried everything but surgery which they say i'm not a good candidate for. i have multiple herniated or bulging discs, both cervical and lumbar.

over 6 years, said...

We have seen countless patients under Chiropractic care, by reducing subluxation (misalignments of the spinal joints), reduce the risk and slow the onset of Osteoarthritis! Consider specific and corrective Chiropractic care and BE proactive, rather than wait for the arthritis to set in and be reactive. 85 in 100 adults suffer LBP, 3 in 10 adults suffer neck pain; all of this associated with arthritis and degenerative joint diseases. Preventitive and wellness chiropractic care has been highly successful in pain reduction and has shown optimal quality of life and function as an outcome for hundreds of thousands of people!

over 6 years, said...

Aquatic Physical Therapy can be very beneficial. Ask your Doctor for a referral.

over 6 years, said...

I have been diagnosed with Osteoarthritis and this article was excellent.

over 6 years, said...

I have used theVoltaren cream on my feet and it work WONDERFULL