Comparative efficacy of exercise therapy and oral non-steroidal anti-inflammatory drugs and paracetamol for knee or hip osteoarthritis: a network meta-analysis of randomised controlled trials
Eight pages on PainSci cite Weng 2023: 1. Guide to Repetitive Strain Injuries 2. What Works for Chronic Pain? 3. Bone on Bone 4. Bone-on-bone, Part 2: Should we ever say it? (Member Post) 5. Do you get any joint pain relief from your workouts? 6. Preventing arthritis and tendinitis is easier than you think (with patience) 7. Exercise for arthritis is underwhelming 8. Exercise is anti-inflammatory medicine for injuries (Member Post)
PainSci commentary on Weng 2023: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.
This enormous meta-analysis concludes that exercise is a modestly effective treatment for hip/knee arthritis in the short term:
Exercise has similar effects on pain and function to that of oral NSAIDs and paracetamol. Given its excellent safety profile, exercise should be given more prominence in clinical care, especially in older people with comorbidity or at higher risk of adverse events related to NSAIDs and paracetamol.
The data also shows diminishing returns over time, dwindling to a trivial benefit.
But this data shows that exercise is quite safe and somewhat helpful — and therefore also obviously not harmful.
This is not surprising science, of course. That conclusion is based on one-hundred and fifty-two trials. 😮 That is a whole bunch of trials! The effect of exercise on arthritis is one of the better studied questions in the science of pain. We have seen this result before, many times. But it’s nice to see the data synthesized in a mighty meta-analysis for the BJSM.
Nor is it especially exciting science: pain relief in the same league as the common pain meds isn’t exactly dazzling stuff. Last I checked, no one was claiming that their ibuprofen is a miracle cure for their arthritis. Also, your mileage may vary in a big way; not everyone is going to get a pain-relief benefit from a workout, and some will actually get the opposite (“exercise intolerance” is common in people with chronic pain). But ibuprofen can fail and backfire too… and, hoo boy, that stuff is a lot more dangerous than exercise (see Bally), and many people cannot take NSAIDs at all.
The important conclusion here is that exercise might actually help arthritis, and definitely doesn’t generally make it worse.
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
OBJECTIVE: Clinical guidelines recommend exercise as a core treatment for knee or hip osteoarthritis (OA). However, how its analgesic effect compares to analgesics, for example, oral non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol-the most commonly used analgesics for OA, remains unknown.
DESIGN: Network meta-analysis.
DATA SOURCES: PubMed, Embase, Scopus, Cochrane Library and Web of Science from database inception to January 2022.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials (RCTs) comparing exercise therapy with oral NSAIDs and paracetamol directly or indirectly in knee or hip OA.
RESULTS: A total of n=152 RCTs (17431 participants) were included. For pain relief, there was no difference between exercise and oral NSAIDs and paracetamol at or nearest to 4 (standardised mean difference (SMD)=-0.12, 95% credibility interval (CrI) -1.74 to 1.50; n=47 RCTs), 8 (SMD=0.22, 95% CrI -0.05 to 0.49; n=2 RCTs) and 24 weeks (SMD=0.17, 95% CrI -0.77 to 1.12; n=9 RCTs). Similarly, there was no difference between exercise and oral NSAIDs and paracetamol in functional improvement at or nearest to 4 (SMD=0.09, 95% CrI -1.69 to 1.85; n=40 RCTs), 8 (SMD=0.06, 95% CrI -0.20 to 0.33; n=2 RCTs) and 24 weeks (SMD=0.05, 95% CrI -1.15 to 1.24; n=9 RCTs).
CONCLUSIONS: Exercise has similar effects on pain and function to that of oral NSAIDs and paracetamol. Given its excellent safety profile, exercise should be given more prominence in clinical care, especially in older people with comorbidity or at higher risk of adverse events related to NSAIDs and paracetamol.
related content
- “Vigorous physical activity, incident heart disease, and cancer: how little is enough?,” Ahmadi et al, Eur Heart J, 2022.
- “Daily physical activity is negatively associated with thyroid hormone levels, inflammation, and immune system markers among men and women in the NHANES dataset,” Klasson et al, PLoS ONE, 2022.
- “Association of Muscle-Strengthening and Aerobic Physical Activity With Mortality in US Adults Aged 65 Years or Older,” Webber et al, JAMA Netw Open, 2022.
- “Moderators of the effect of therapeutic exercise for knee and hip osteoarthritis: a systematic review and individual participant data meta-analysis,” Holden et al, The Lancet Rheumatology, 2023.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Gabapentinoids and Risk of Hip Fracture. Leung 2024 JAMA Netw Open.
- Classical Conditioning Fails to Elicit Allodynia in an Experimental Study with Healthy Humans. Madden 2017 Pain Med.
- Topical glyceryl trinitrate (GTN) and eccentric exercises in the treatment of mid-portion achilles tendinopathy (the NEAT trial): a randomised double-blind placebo-controlled trial. Kirwan 2024 Br J Sports Med.
- Placebo analgesia in physical and psychological interventions: Systematic review and meta-analysis of three-armed trials. Hohenschurz-Schmidt 2024 Eur J Pain.
- Recovery trajectories in common musculoskeletal complaints by diagnosis contra prognostic phenotypes. Aasdahl 2021 BMC Musculoskelet Disord.