WHY PARACETAMOL WON’T HELP . . . AND THE TREATMENTS THAT WILL

OSTEOARTHRITIS patients all have one thing in common: pain.

Controlling that pain is vital — not only to make life bearable, but also to help you stay fit and strong.

For many, paracetamol is the first line of defence. Unfortunately, ‘paracetamol has very little effect on osteoarthritis pain’, says Professor Philip Conaghan, a consultant rheumatologist who runs a clinic at Leeds Teaching Hospitals.

A 2016 study of 74 trials published in the Lancet found that paracetamol had a 0 to 4 per cent chance of improving osteoarthritis pain.

The next option is a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen or diclofenac.

NSAIDs are highly effective at relieving arthritis pain, the same 2016 study concluded. However, the pills aren’t for everyone. They can have side-effects, including stomach problems. They may also interfere with other medicines, including those for high blood pressure.

But these problems can be avoided with NSAIDs in cream or gel form that are rubbed on the skin. Doctors can prescribe these. Weaker formulations can be got over the counter.

Capsaicin cream, also prescribed, can be offered if topical NSAIDs aren’t helping. Derived from chilli peppers, it blocks the nerves that carry pain messages to the brain.

Opioid painkillers, such as codeine, may be a last resort but these are not very effective for osteoarthritis. A 2014 review by the authoritative Cochrane Collaboration found that

for little opioids If osteoarthritis pain opioids were used better can for become addictive. But for than placebos. any length of time, many, such as ‘the constipation and drowsiness’, major issues are things says Professor Conaghan. ‘With a bit too much opiod in your system they can be a cause of falls.’

Some patients may be offered injections of steroids into their knee. This may buy them up to six weeks’ pain relief, he explains. ‘We use them as “circuit-breakers”, to give a

patient a good window of opportunity to really work on building up their muscles.’

Many people, however, are discovering that the key to relief from the pain of osteoarthritis is not drugs, but exercise.

NHS England is rolling out an exercise rehabilitation programme for people with chronic knee and hip joint pain — ESCAPE-pain is a six-week rehabilitation programme of two hour-long classes a week. It’s now running in more than 200 community settings, including leisure centres and church halls.

Each class involves 40 minutes of exercises tailored to each patient’s ability, from stretches to riding stationary bikes. It’s suitable for anyone over 45 with knee or hip osteoarthritis. Research showed the long-term benefits are comparable to those of outpatient physiotherapy for chronic knee pain.

Your GP can refer you, or some classes allow self-referral. Go to

escape-pain.org to find a class.