Exercise may be as effective as pharmacotherapy in managing osteoarthritis pain

1. In this network meta-analysis, there was no difference between exercise, oral non-steroidal anti-inflammatory drugs (NSAIDs), and paracetamol with respect to pain relief associated with osteoarthritis (OA) at up to 24 weeks of follow-up.

2. Furthermore, there was no significant difference between the three groups with respect to functional improvement at up to 24 weeks of follow-up.

Evidence Rating Level: 1 (Excellent)

Osteoarthritis (OA) represents a significant disease burden in older individuals and current pharmacological therapy such as oral non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol may lead to adverse side effects. Although exercise is a mainstay of treatment, it is unknown whether it has analgesic effects equivalent to that of pharmacotherapy. As a result, the objective of the present network meta-analysis was to summarize the trials that directly or indirectly compared exercise with oral NSAIDs and paracetamol to evaluate its analgesic effect in osteoarthritis.

Of 46,635 identified studies, 152 (n= 17,431) randomized controlled trials were included from database inception to January 2022. Studies were included if they compared exercise therapy with oral NSAIDs and paracetamol on osteoarthritis pain or function. Studies were excluded if they were secondary analyses, used a cross-over design, investigated post-operative pain, or had less than 1 week of follow-up. Study quality was assessed using the Cochrane risk of bias assessment tool. The study was conducted following PRISMA guidelines The primary outcome was OA pain or function.

The results demonstrated that exercise had similar effects on pain control and functional improvement compared to oral NSAIDs and paracetamol at short-, medium-, and long-term follow-up. Although the analgesic and functional benefits of exercise gradually decreased over time, there was no significant difference in these effects compared to the pharmacotherapy groups. The study was limited by the inclusion of only participants who had knee or hip OA which may limit generalizability to other types of OA. Nonetheless, this review provided further evidence of the benefits of exercise in OA– particularly its potential to rival the functional and analgesic effects of pharmacotherapy.

Click to read the study in British Journal of Sports Medicine

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