NSAIDs are commonly prescribed to temporarily relieve pain and reduce inflammation in the knee. They are often used in conjunction with other treatments such as physiotherapy or injections. NSAIDs can be taken orally or applied topically and are generally used for short-term symptom management.
Not typically painful, but some gastrointestinal discomfort, such as stomach pain or nausea, can occur with oral NSAIDs.
NSAIDs are effective for short-term symptom relief but do not address the underlying cause of knee pain. They are best used as part of a comprehensive treatment plan.
Yes, there are several effective alternatives and complementary treatments for knee pain. Before considering surgery, Dr Khoo always recommends a comprehensive non-surgical plan. First-line alternatives include paracetamol, often used for mild to moderate pain, though recent evidence suggests limited efficacy for severe arthritis. Other treatments include physiotherapy to strengthen the supporting muscles, weight loss for overweight patients, and intra-articular injections, such as a steroid shot to manage acute flares of inflammation, or newer gel injections like hyaluronic acid. For those with severe osteoarthritis where conservative treatments have failed, a joint replacement remains the most definitive surgical solution to relieve chronic pain and restore function.
While there aren't many specific foods you must avoid, the main concern is alcohol. Consuming alcohol, especially in large amounts, while taking oral NSAIDs dramatically increases the risk of serious stomach and intestinal bleeding. Both alcohol and NSAIDs can irritate the stomach lining, and using them together amplifies that irritation. Dr Khoo generally advises patients to keep alcohol intake to a minimum or avoid it altogether, particularly during the initial phase of taking oral tablets. Beyond alcohol, some patients find that taking their NSAID with food or milk helps reduce general stomach upset or irritation, though this does not mitigate the risk of a bleed.
Many other health conditions can significantly affect the safety of taking NSAIDs. If you have a history of stomach ulcers or gastrointestinal bleeding, oral NSAIDs are usually avoided or prescribed only with strong stomach-protecting medication. People with heart disease, a history of stroke, or uncontrolled high blood pressure also need to be extremely cautious, as NSAIDs can increase cardiovascular risk. Furthermore, any pre-existing kidney disease or asthma can be worsened by NSAIDs. Dr Khoo’s approach is highly individualised: you must inform your doctor of your complete medical history so they can weigh the pain relief benefit against your personal health risks before recommending any specific NSAID.
It's absolutely essential to discuss all your current medications, including over-the-counter drugs, supplements, and herbal remedies, with your GP or specialist before starting an NSAID. Dr Khoo often sees patients who are unaware of potential interactions. For instance, combining oral NSAIDs with certain blood thinners, like warfarin or even low-dose aspirin, significantly increases the risk of bleeding in the stomach. Taking them with some blood pressure medications or diuretics can also impact your kidney function. This is why a thorough medication review is a necessary part of your treatment preparation. Never assume a medication is safe to combine with an NSAID without specific medical advice; the risks, particularly for your gastrointestinal or cardiovascular health, can be quite serious.
No, NSAIDs cannot cure your knee condition. Whether you have an injury or chronic osteoarthritis, NSAIDs are purely a symptomatic treatment. They work by reducing the inflammation and pain signals in your knee, helping you feel more comfortable and mobile. Think of them like temporarily cutting the power to a fire alarm—they stop the noise but don't repair the underlying fire. Dr Khoo emphasises that the true management of conditions like osteoarthritis relies on non-drug treatments, such as physiotherapy, weight management, and specific exercises. NSAIDs are best used as a tool to help you tolerate and participate fully in these essential therapeutic activities.
You’ll know NSAIDs are effective if you experience a noticeable and consistent reduction in your knee pain and stiffness. The key is to monitor whether you can perform daily activities, such as walking, gardening, or climbing stairs, with greater ease and less discomfort. NSAIDs work relatively quickly, sometimes providing relief within hours, but the anti-inflammatory benefits build up over a few days. If the pain relief is minimal after a couple of weeks, or if you still rely heavily on the medication just to get through the day, they may not be providing enough clinical benefit. Dr Khoo reminds patients that the goal is not total pain eradication, but significant improvement to enable better participation in crucial physiotherapy and exercise.
The duration for taking NSAIDs depends heavily on the type (oral versus topical) and the nature of your knee condition. For acute injuries, a short course of a few days to a couple of weeks is usually sufficient. For chronic conditions like osteoarthritis, Dr Khoo’s preference is to use them intermittently, for short, planned courses, to manage flares or intense pain. Long-term, continuous use of high-dose oral NSAIDs is strongly discouraged due to the increased risk of gastrointestinal and cardiovascular side effects, particularly if you have other risk factors. Topical NSAIDs (gels) are generally much safer for prolonged use as less of the medicine is absorbed systemically, but even their long-term use should be reviewed regularly with your doctor.
The most common side effects of oral NSAIDs relate to the gut, including indigestion, heartburn, stomach pain, or sometimes mild nausea. However, Dr Khoo stresses that the serious side effects are what we monitor most closely. These include a heightened risk of gastrointestinal bleeding or ulcers, and a possible increased risk of cardiovascular issues like heart attack or stroke, particularly with high doses and long-term use. Less common, but still important, are potential effects on kidney function, especially in older patients or those already managing kidney issues. If you are using a topical NSAID gel, side effects are usually limited to mild skin irritation or rash at the application site.