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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

PainSci » bibliography » Weng et al 2023
updated

One article on PainSci cites Weng 2023: What Works for Pain?

PainSci notes on Weng 2023:

This enormous meta-analysis concludes that exercise is a modestly effective treatment for hip/knee arthritis:

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.

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.

But on average? Activity and exercise are quite safe and somewhat helpful.

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 (17 431 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.

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