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Finding Relief: What’s the Best Painkiller for Knee Pain?
Knee pain is a common problem among adults of all ages. It can have many causes, including arthritis, traumatic injury, and stress on structures of the knee over time.
Sometimes knee pain is mild and goes away on its own, requiring no special treatment. But for persistent or moderate to severe knee pain, it’s important to see a doctor for evaluation. Some underlying issues can get worse on their own, and you may have better outcomes with earlier treatment.
You should seek emergency medical care following a knee injury if you have intense pain or sudden swelling, or if you can’t stand on your knee. Make an appointment to see a doctor as soon as possible if you have severe knee pain from any cause, or if the area is badly swollen, red, or warm and tender.
For knee pain that doesn’t require immediate attention, here’s what you should know about painkillers and related options for knee pain relief.
Knee pain is generally understood as pain or discomfort in or around your knee joint. You may feel pain:
- Close to the skin surface above or behind your knee
- Deep inside your knee
- In more than one area of your knee or leg
Where you feel knee pain, how often you feel it, and whether it’s linked to certain activities can help you and your doctor figure out what may be causing it.
There are many possible causes of knee pain, including:
- Arthritis
- Sudden injuries
- Overuse injuries
- Infections in the knee area
Sudden knee injuries can include bone fractures, sprains (minor ligament injuries), torn ligaments, or torn cartilage. Overuse injuries can include bursitis (inflammation of a fluid-filled cushioning structure) and tendinitis (tendon inflammation).
Both sudden injuries and overuse injuries can cause pain, swelling, and difficulty walking or doing other activities. Arthritis (usually osteoarthritis) can cause knee pain and stiffness, especially after periods of inactivity, along with reduced range of movement.
Osteoarthritis typically causes “more of a dull, achy pain that’s intermittent,” says Cara Hall, MD, a sports medicine specialist at Keck Medicine of the University of Southern California in Los Angeles. “People can feel that all over — it can be underneath the kneecap, deeper inside, or in the outer areas of the knee.”
Painkillers and related treatments for knee pain fall into a few general categories:
- Over-the-counter (OTC) medications
- Prescription medications
- Topical creams and gels
- Natural and complementary remedies (such as supplements or acupuncture)
For most people, it’s safe to take OTC medications like ibuprofen (Advil) or acetaminophen (Tylenol) for a limited duration, but you should check with a doctor before taking them for a longer period of time. Topical creams and gels are generally the safest first-line treatment option.
There are two main categories of OTC oral painkillers (taken by mouth):
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Acetaminophen (Tylenol)
Over-the-counter NSAIDs include ibuprofen (Advil) and naproxen (Aleve). These drugs reduce both pain and inflammation. Acetaminophen (Tylenol), on the other hand, relieves pain but doesn’t reduce inflammation, notes Nicholas Hernandez, MD, an orthopedic surgeon at the University of Washington Medicine in Seattle.
“Over-the-counter painkillers can be really effective for knee pain, especially wear-and-tear type pain,” or pain from overuse, says Dr. Hernandez. But acetaminophen, in particular, varies in effectiveness. “Some people say Tylenol doesn’t do a whole lot for them, but some people do find it effective for pain relief,” Hernandez adds.
Talk to your doctor about taking an OTC painkiller if you have kidney or liver problems. NSAIDs can cause gastrointestinal issues and are potentially harder in your kidneys, while Tylenol can be harder on your liver.
“A common question is, can I take it every day?” says Hernandez. “If you’re going to do that, it’s good to talk closely with your primary-care physician to make sure your organs are functioning properly, and they can monitor that.”
If OTC options aren’t enough to control your knee pain, or if you can’t take them because of other health conditions, your doctor may prescribe medication.
Prescription options for knee pain include:
- Higher-strength nonsteroidal anti-inflammatory drugs (NSAIDs)
- Corticosteroid (steroid) injections
Commonly prescribed NSAIDs for knee pain related to arthritis include celecoxib (Celebrex) and diclofenac (Voltaren).
“Prescription NSAIDs are quite useful to decrease inflammation and help with pain” for some people, says Dr. Hall. She cautions that these drugs are not the best choice if you have a history of stomach ulcers, gastric bypass surgery, or high blood pressure.
Corticosteroids can be taken by mouth, but are more often injected into the knee area for knee pain. “I tend to avoid oral steroids. I prefer to deliver them directly to the area,” says Hall, due to the lower risks and potentially higher efficacy of this method.
Several creams, gels, and patches are available to reduce knee pain:
- NSAID gels and creams
- Lidocaine gel or patches
- Capsaicin cream or patches
Topical NSAIDs include diclofenac (Voltaren), as well as preparations containing ibuprofen and ketoprofen. While these treatments may be effective for some arthritis pain, Hall says they “tend to work really well for conditions like patellar tendinitis,” an overuse injury that affects a tendon close to the skin's surface.
Lidocaine is an analgesic (numbing agent) that can be applied to the skin surface as a gel or patch. It can be used in combination with other topical treatments like NSAIDs for some additional benefit, says Hall.
Capsaicin creams and patches contain an ingredient derived from chili peppers, and help block pain signals to your nerves. They tend to be more effective for osteoarthritis than other forms of knee pain.
Relief for knee pain often requires several different approaches. For many people, that includes physical therapy, typically a program of exercises and stretches.
Physical Therapy
“Physical therapy is amazing at building strength and increasing mobility, especially when it comes to overuse injuries that may occur because your body has a muscular imbalance,” says Hall.
A review of 152 studies involving more than 17,000 participants found that for knee or hip osteoarthritis, exercise had beneficial effects on pain and function similar to drug treatments such as NSAIDs and acetaminophen.
Dietary Supplements
When it comes to dietary supplements, “There’s not any conclusive evidence of a gold standard” for knee pain, says Hernandez. But turmeric supplements may be helpful for some people with osteoarthritis, he notes. A research review involving 10 studies found that taking a supplement of turmeric (curcumin) extract led to better pain and function outcomes than a placebo (inactive pill).
The combination supplement of glucosamine and chondroitin has also shown some promise for osteoarthritis in studies. One research review involving eight studies found that compared with a placebo, glucosamine and chondroitin led to slight improvement in knee osteoarthritis outcomes.
And in one smaller study, taking omega-3 supplements in the form of krill oil led to modest improvements in knee pain and stiffness in adults with mild to moderate knee osteoarthritis.
Acupuncture
For some people with osteoarthritis, acupuncture can lead to lasting improvement in knee pain. A research review involving four studies and close to 1,400 participants found that compared with “sham acupuncture,” in which participants thought they were getting the treatment, real acupuncture led to improvements in knee pain and function that lasted 4.5 months after treatment completion.
Weight Loss and Nutrition
In people with overweight or obesity, weight loss can help with knee pain in osteoarthritis. “Losing a tiny amount of weight is a ton of weight off the knee,” says Hall.
Hernandez says that a healthy, nutrient-rich diet can also help with knee pain. Taken together, “Physical therapy, exercise, nutrition, and weight loss are just as important as some of the medications,” he says.
When deciding on an approach to treat knee pain, it’s important to take several factors into account:
- Known or suspected causes of your pain
- Pain severity
- Potential risks and side effects of treatments
- Other health conditions you have
- Guidance from a healthcare professional
Remember that while self-treating knee pain is appropriate in some situations, it’s critical to get a doctor’s evaluation for lasting or moderate to severe knee pain.
The Takeaway
- Knee pain can have many causes, including injuries, overuse, and arthritis.
- Over-the-counter medications can be effective for knee pain, but don’t take them indefinitely without a doctor’s input.
- Prescription treatments and physical therapy can be hugely beneficial for knee pain.
- There is evidence supporting certain dietary supplements for knee pain caused by osteoarthritis.
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