Harvard Men's Health Watch

Osteoarthritis relief without more pills

It's possible to ease arthritis pain and stiffness without medication, but it takes some work.

Here are some steps you can take to reduce your reliance on medication to control symptoms and stay functional.

For mild wear-and-tear osteoarthritis, an occasional dose of an over-the-counter pain reliever may be all you need to control the pain and stiffness associated with osteoarthritis and keep living your life as you please.

But as osteoarthritis progresses from mild to moderate to severe, the doses required to control pain can start to escalate without any promise of slowing down the underlying damage to joint cartilage. Men start looking for ways to cope with osteo-arthritis without more pills.

"They already have a medication list, and they are not looking to add to it," says Dr. Robert Shmerling, associate professor of medicine at Harvard-affiliated Beth Israel Deaconess Medical Center.

There are some things men with osteoarthritis can do to reduce reliance on medication, starting with maintaining a healthy weight, exercising regularly, and giving physical therapy a try—especially for osteoarthritis in the weight-bearing joints of the knees and hips.

Other options, like acupuncture and ultrasound treatment, are not backed as strongly by research. But these, too, may be worth a try. "For moderate to severe osteoarthritis, pain medications don't always do the trick," Dr. Shmerling says. "Even a small benefit could be worth pursuing, because we don't have great alternatives."

Maintain a healthy weight

Keeping trim is one of the best things anyone with knee or hip osteoarthritis can do. "For people who are overweight or obese and have osteoarthritis, even modest weight loss reduces symptoms," Dr. Shmerling says.

Studies have found that overweight people with knee osteoarthritis who lose weight feel less pain and are more functional in their daily lives. Even losing 5% of your current weight—if you are overweight—could make a noticeable difference. (For a 200-pound man, that means losing 10 pounds.)

Exercise regularly

Men with osteoarthritis in the hips or knees are advised to exercise regularly. This both improves general aerobic fitness and stretches and strengthens the muscles that support an arthritic joint. Doing so reduces pain and stiffness and improves daily functioning. The evidence for the benefit of exercise is strongest for knee arthritis, but less so for hip arthritis.

Research suggests that regular exercise could even slow the progression of osteoarthritis if you start exercising early in the course of the disease—before the joints have sustained more damage and cartilage loss.

Even if exercising is painful, you still benefit. "If people can find something they can do and can tolerate it, we urge them to do it," Dr. Shmerling says. "It's not just a matter of reducing pain. You don't want a stiff joint to get stiffer, so moving is always better than not moving."

For those with milder osteoarthritis, brisk walking or even light jogging are good options. Men with more advanced or painful osteoarthritis in the knees and hips can swim, do water aerobics, and bike to get exercise without putting as much weight on ailing joints. "Also consider cross training—for example, walking one day and biking the next—so you won't get bored and you'll be more likely to stick with it," Dr. Shmerling says.

Try physical therapy

Treatment guidelines for osteoarthritis endorse physical therapy. That means going to a clinic regularly to work with a physical therapist. Especially if you have severe arthritis, a physical therapist can help to design an appropriate exercise program that strengthens the knee without causing excessive pain and swelling. For example, men with osteoarthritis behind the kneecap would be advised to avoid deep knee bends and other moves that require pronounced flexing of the joint.

Some physical therapists offer additional services, such as ultrasound and transcutaneous electrical nerve stimulation (TENS), to ease pain.
If done properly, ultrasound and TENS are not likely to cause any harm, although their effectiveness is not well established.

In ultrasound therapy, the physiotherapist uses a blunt wand to deliver high-frequency sound energy into the affected joint. This produces soothing warmth, but research has not clearly shown that ultrasound treatments reduce pain and stiffness or improve day-to-day functioning.

With TENS, you use pairs of stick-on electrodes to deliver low-voltage electrical pulses across the painful area of the joint. It's not clear how TENS works; it may block or scramble pain signals, act directly on the joint tissues, or both. Some research suggests TENS provides temporary relief during painful flare-ups.

Anyone with a credit card and an Internet connection can order a TENS device online. If you do so, ask your doctor or physical therapist for advice on how to use it safely.

Some research shows that acupuncture helps to relieve osteoarthritis knee pain.


Acupuncture has grown in popularity as a treatment for osteoarthritis. Some good-quality research shows that acupuncture may add pain relief on top of medication and physical therapy. It may require a month or two of weekly treatments to find out if it works for you. The typical cost of acupuncture ranges from $65 to $125 per session. Private insurers often don't pay for it, nor do Medicare or Medicaid.

Performed by a reputable and experienced practitioner, acupuncture is safe. "I don't refer a lot of patients for acupuncture, but I certainly don't discourage it," Dr. Shmerling says.

Dietary supplements

Many people with osteoarthritis look to dietary supplements as either an alternative or an add-on to conventional treatment. The most popular osteoarthritis supplements contain glucosamine and chondroitin sulfate, substances naturally present in cartilage. People take this supplement in the hope of reducing pain or slowing down joint deterioration, but several well-designed clinical trials—mostly targeting knee osteoarthritis—do not strongly support these benefits.

As with any dietary supplement, limited regulation enables unscrupulous companies to distribute products that don't contain the active ingredients they claim. When you buy joint health supplements, understand you may not be getting what you are paying for.

How to use acetaminophen for osteoarthritis

Acetaminophen (Tylenol and numerous other brands) does not control pain effectively for everyone with osteoarthritis, but it's worth a try before you reach for a nonsteroidal anti-inflammatory drug (NSAID). "Give it a few weeks, and if it doesn't work, stop taking it," Dr. Shmerling says.

Acetaminophen reduces pain but not swelling; NSAIDs, such as ibuprofen (Advil, Motrin) and naproxen (Aleve), treat both pain and inflammation. However, NSAIDs can harm the lining of the stomach and intestines. This is why most treatment guidelines recommend acetaminophen as the "try-this-first" pain reliever for arthritis.

Acetaminophen can harm the liver in high enough doses, so you need to be mindful of how much you take. For healthy adults, the FDA has set the maximum daily dose at 4,000 milligrams (mg). However, the trend has been to cut this back to 3,000 mg to create an extra margin of safety. People who have liver disease or who drink alcohol regularly should cut the maximum daily dose to 2,500 mg or less.

And don't forget that many over-the-counter cold and flu remedies also contain significant amounts of acetaminophen. These should be included in your daily tally.

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