The Patch: Alternative Treatment for Knee Pain

By: Shelagh McNally for Knee1

Osteoarthritis knee pain affects more than 20 million Americans annually. While the risk does increase as we get older, osteoarthritic knees are often genetic and twice as common in women than in men. This kind of chronic pain is not easily ignored and if left untreated, can limit daily functions and diminish quality of life.

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Recommended Exercises from the Arthritis Research Campaign : Exercise can help alleviate some of the more painful symptoms of OA knees, but the most important thing is to do your exercises daily. So, choose the ones you are best able to do regularly. 1. Straight leg raises. Sit back in your chair with a straight back. Straighten and raise one leg. Hold for 10 seconds, then slowly lower it. Repeat with the opposite leg. Do this at least 10 times on each side. If this exercise is too easy then try putting a weight on the ankle. 2. Leg lifts. Lying down, with your lower back on the floor, slowly lift one leg off the floor while keeping your leg straight. Only go a high as you can without straining. Hold the leg upright for 10 seconds and then slowly lower the leg. Repeat on the opposite leg. Do this at least 10 times on each side. If the exercise feels too easy then try it with an ankle weight. 3. Muscle Stretch. Lying down on your back, place a rolled up towel under one leg. Bend the other leg at the knee, keeping the foot on the ground. With the straight leg, push the back of the knee. 4. Quadriceps clenching exercise. Lying down or sitting. Clench the quadriceps (front thigh muscles). Hold for five seconds and release. Repeat several times. This exercise can be done standing or sitting. By constantly stimulating the quadriceps they become stronger and take pressure off the knee.

The usual treatment has been a variety of medications such as acetaminophen, Cox-2 inhibitors, opiate painkiller or non-steroidal anti-inflammatory drugs (NSAIDs). But these types of therapies carry many safety concerns, particularly Cox-2 inhibitors like Bextra which was recently pulled from the market. For many patients, popping some pills is not an effective way to deal with the constant pain of an arthritic knee. However, medicinal creams, gels and ointments, known as transdermal medicines, are gaining in popularity, particularly with physicians who work with chronic pain. “Topical analgesics and novel topical drug delivery systems, including patch systems, may help play an additional role due to better safety profiles and ability to target the actual area affected, without having to worry about systemic effects,” commented Dr. Steven Stanos, a director at the Rehabilitation Institute in the Chicago Chronic Pain Care Center.

A new study conducted by Dr. Alan Kivitz at the Altoona Arthritis and Osteoporosis Center in Pennsylvania looked at the Lidoderm patch as an effective alternative treatment for osteoarthritic knees. First approved in 1999 for treatment of postherpetic neuralgia (a painful complication of shingles), the Liboderm patch releases a continuous supply of 5 percent lidocaine into the skin. This anesthetic inhibits pain by blocking the signal before it reaches the brain. A typical dose would be three patches applied for up to 12 hours within a 24-hour period. Since it’s applied directly to the skin, relief is quicker and there are fewer side effects. In fact, only a small number of patients suffer from minor skin irritation, a small inconvenience when you consider the potential heart and stomach damage of some Cox-2 inhibitors.

Kivitz and his team speculated that the patch would have the same analgesic response when applied to arthritic joints and set about proving their theory with the study. A total of 143 patients, each suffering from osteoarthritis in one or both knees, were enrolled: 69 received the lidocaine patch while 74 were given 200 milligrams of celecoxib. After six weeks of treatment each participant was examined and it was found that 54 percent of the lidocaine patients experienced a 30 percent or greater improvement in pain reduction along with 62 percent of the celecoxib patients. “This is what we call clinically meaningful. With all of the concern about Cox-2 inhibitors, the study took on new potential meaning,” said Kivitz, “The results of this exploratory study suggest that Lidoderm patch can alleviate osteoarthritis knee pain. This is significant because this is the first comparison of a Cox-2 inhibitor compared to a topical treatment for osteoarthritis of the knee pain.”

It is looking like the lidocaine patch could be an appealing alternative for the millions suffering from this debilitating disease. Physicians may soon start prescribing the lidocaine patch for osteoarthritis. Of course, it would be considered an "off-label" use, since the FDA has not approved the patch for treatment of arthritic knees.

Last updated: 13-Jan-06