Nonpharmacological approaches to pain in osteoarthritis. Available options.

Many treatments or techniques have been developed to combat pain in osteoarthritis. These can reduce drug consumption and toxicity, or even delay the need for joint replacement surgery. Pain management in osteoarthritis should start with education, psychological support and environmental measures, reassuring patients that such pain is a reversible state, not associated with aging and irreversible loss of ability. Physiotherapy and exercises are very important for maintaining muscle strength, joint stability and mobility, but should be closely monitored for optimal efficacy. Splints and weight reduction in the obese are useful, depending on the joints involved. Preventive surgery such as cruciate ligament repair or osteotomy should be considered for cases with moderate osteoarthritis. Intraarticular lavage is effective in the short term, and the effectiveness is increased with the use of an arthroscope when meniscus tears or cartilage fragments are associated with osteoarthritis. Nonconventional therapies such as homeopathy, acupuncture and transcutaneous electrical nerve stimulation can be tried at all stages; even if not really efficient, most of these techniques are usually innocuous. Doctors should be aware of these neglected techniques for a better, well tolerated and cost-effective management of pain associated with osteoarthritis.