Call for practical knee pain guideline

A practical model for primary care management of pain in knee osteoarthritis is needed, according to experts speaking at the meeting.

Although a number of guidelines exist, confusion over best practice remains, with many first-step interventions used little, explained lead researcher Dr Mark Porcheret, Staffordshire GP and member of the Primary Care Society for Rheumatology.

He said guidelines often focused on disease pathology rather than the treatment of knee pain, resulting in most of them 'never being implemented'.

'What we need are practical tools to help people manage their pain,' he said.

Dr Porcheret designed a four-stage model of interventions for knee pain management, based on existing guidelines.

He then surveyed two practices in North Staffordshire to see what interventions were used to manage 201 patients over 50 years old with self-reported knee pain.

He found that heat and ice therapy and paracetamol, which are classified as step-one treatments, were the most common interventions used, being reported by 80 per cent and 70 per cent of patients respectively.

However, other first-step interventions, including provision of written information, and advice on weight loss and exercise, were all less commonly used than second-step interventions such as compound opioid analgesics, non-selective NSAIDs and walking aids.

In some cases, treatments from the later stages, such as topical NSAIDs or physiotherapy, were used before those in the first were tried.

At the most extreme, surgical referral, which should be reserved for the fourth-step use, was used before conservative alternatives.

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