{"id":68968,"date":"2023-04-05T10:41:58","date_gmt":"2023-04-05T16:41:58","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=68968"},"modified":"2025-12-11T07:47:11","modified_gmt":"2025-12-11T14:47:11","slug":"study-search-for-best-knee-osteoarthritis-pain-treatments","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/study-search-for-best-knee-osteoarthritis-pain-treatments\/","title":{"rendered":"A search for the best treatments for knee osteoarthritis pain"},"content":{"rendered":"<div style=\"margin-top: 0px; margin-bottom: 0px;\" class=\"sharethis-inline-share-buttons\" ><\/div><figure id=\"attachment_68971\" aria-describedby=\"caption-attachment-68971\" style=\"width: 640px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-68971\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2023\/03\/09113140\/Getty-older-adults-hiking-colorado-web.webp\" alt=\"four older adults hiking on a Colorado trial. The most frequent victim of osteoarthritis is the knee joint, which bears an outsized burden for everyday activities like standing, bending, walking and running.\" width=\"640\" height=\"384\" \/><figcaption id=\"caption-attachment-68971\" class=\"wp-caption-text\">The most frequent victim of osteoarthritis is the knee joint, which bears an outsized burden for activities like standing, bending, walking, running and hiking. Photo: Getty Images.<\/figcaption><\/figure>\n<p>For millions of people in the United States, creaking, cracking and grinding are unwelcome notes in the soundtrack of advancing age.<\/p>\n<p>The nagging noises are the result of <a id=\"\" href=\"https:\/\/www.uchealth.org\/diseases-conditions\/arthritis\/\">arthritis<\/a>, which painfully inflames and deteriorates the joints, tissues and bones around them. The more than <a id=\"\" href=\"https:\/\/www.cdc.gov\/arthritis\/basics\/\" target=\"_blank\" rel=\"noopener\">100 forms of the disease<\/a> affect nearly 60 million Americans. The most common form is osteoarthritis, which results primarily from joint wear-and-tear and inflammation.<\/p>\n<figure id=\"attachment_68987\" aria-describedby=\"caption-attachment-68987\" style=\"width: 200px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-68987\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2023\/03\/09141707\/Osteoarthritis-Knee-Pain-1-Larry-Moreland-web.webp\" alt=\"Dr. Larry Moreland, professor of Medicine in the Division of Rheumatology at the University of Colorado School of Medicine\" width=\"200\" height=\"268\" \/><figcaption id=\"caption-attachment-68987\" class=\"wp-caption-text\">Dr. Larry Moreland<\/figcaption><\/figure>\n<p>\u201cOsteoarthritis is part of the reward we get as we get older, although some people may have other things that trigger it before they get older,\u201d said <a href=\"https:\/\/www.uchealth.org\/provider\/larry-moreland-md\/\">Dr. Larry Moreland<\/a>, professor of Medicine in the <a id=\"\" href=\"https:\/\/medschool.cuanschutz.edu\/rheumatology\/\" target=\"_blank\" rel=\"noopener\">Division of Rheumatology<\/a> at the University of Colorado School of Medicine. Moreland treats patients with osteoarthritis and other forms of arthritis in the <a href=\"https:\/\/www.uchealth.org\/locations\/uchealth-rheumatology-clinic-anschutz\/\">UCHealth Rheumatology Clinic \u2013 Anschutz Medical Campus<\/a>.<\/p>\n<p>The most frequent victim of osteoarthritis is the knee joint, which bears an outsized burden for everyday activities like standing, bending, walking and running. Those demands generate chronic and debilitating pain for millions of people. Some turn to opioid medications for short-term but risky relief. Joint replacement surgery helps many, but it\u2019s not indicated for all patients, and many endure persistent pain after the procedure.<\/p>\n<p>Moreland leads a <a id=\"\" href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04504812\" target=\"_blank\" rel=\"noopener\">study<\/a> at the University of Colorado \u2013 Anschutz Medical Campus that addresses these dilemmas. It examines the effectiveness of various forms of non-narcotic and non-surgical treatments in treating knee osteoarthritis pain. The goal: develop evidence to guide clinicians in selecting the pain-relieving treatment best suited to their patients.<\/p>\n<h2><strong>An opportunity to combat knee pain<\/strong><\/h2>\n<p>The national multi-center trial, dubbed <a id=\"\" href=\"https:\/\/www.skoapstudy.org\/skoap-study.html\" target=\"_blank\" rel=\"noopener\">SKOAP<\/a>, sponsored by Johns Hopkins University, in collaboration with the <a id=\"\" href=\"https:\/\/www.niams.nih.gov\/\" target=\"_blank\" rel=\"noopener\">National Institute of Arthritis and Musculoskeletal and Skin Diseases<\/a>, is the largest study of osteoarthritis knee pain yet undertaken. It is part of the <a id=\"\" href=\"https:\/\/heal.nih.gov\/\" target=\"_blank\" rel=\"noopener\">National Institutes of Health-funded HEAL initiative<\/a>, which funds projects across the country that target the opioid addiction crisis.<\/p>\n<p>The SKOAP study design calls for two phases, both of which aim to measure changes in pain intensity after treatment. The first phase features \u201cconservative\u201d treatments composed of three components. Patients are randomly assigned to one of the three treatment groups.<\/p>\n<p>The groups include:<\/p>\n<ul>\n<li>\u201cBest practice\u201d treatments, including medications (nonsteroidal anti\u2011inflammatory drugs and acetaminophen), physical therapy and \u201cintegrative\u201d treatments, such as yoga and acupuncture.<\/li>\n<li>Best practice treatments are supplemented with <a id=\"\" href=\"https:\/\/www.drugs.com\/duloxetine.html\" target=\"_blank\" rel=\"noopener\">duloxetine<\/a>, an anti-depressant medication that can also help relieve knee osteoarthritis pain.<\/li>\n<li>Best practice treatments, duloxetine, and an eight-week training program to help patients cope with pain.<\/li>\n<\/ul>\n<h2><strong>Interventional pain management for knee osteoarthritis pain<\/strong><\/h2>\n<p>Patients in phase 2 are randomized to receive one of three treatments from study co-investigator <a href=\"https:\/\/www.uchealth.org\/provider\/rachael-rzasa-lynn-md-pain-medicine\/\">Dr. Rachael Rzasa Lynn<\/a>, an interventional pain specialist and <a href=\"https:\/\/som.cuanschutz.edu\/Profiles\/Faculty\/Profile\/20891\">CU associate professor of Anesthesiology<\/a> who practices in the <a href=\"https:\/\/www.uchealth.org\/locations\/uchealth-interventional-pain-management-anschutz\/\">UCHealth Pain Management Clinic \u2013 Anschutz Medical Campus<\/a>.<\/p>\n<figure id=\"attachment_68985\" aria-describedby=\"caption-attachment-68985\" style=\"width: 200px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-68985\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2023\/03\/09141703\/Osteoarthritis-Knee-Pain-3-Rachael-Rzasa-Lynn-web.webp\" alt=\"Dr. Rachael Rzasa-Lynn, interventional pain specialist and CU associate professor of Anesthesiology who practices in the UCHealth Pain Management Clinic \u2013 Anschutz Medical Campus.\" width=\"200\" height=\"268\" \/><figcaption id=\"caption-attachment-68985\" class=\"wp-caption-text\">Dr. Rachael Rzasa-Lynn<\/figcaption><\/figure>\n<p>Rzasa Lynn explained that the three treatments involve injections, nerve blocks and nerve ablations in the knee joint:<\/p>\n<ul>\n<li>Injections deliver hyaluronic acid, which helps to cushion and lubricate the joint, combined with a corticosteroid and an anesthetic.<\/li>\n<li>Nerve blocks deliver a long-acting anesthetic that numbs the nerves around the knee.<\/li>\n<li>Nerve ablation gently damages nerves around the knee with heat energy, thus preventing them from delivering pain signals.<\/li>\n<\/ul>\n<p>Patients who have already exhausted the treatments offered in the first phase can enroll directly in the second phase, Rzasa Lynn said.<\/p>\n<h2><strong>Searching for evidence-based solutions for knee osteoarthritis pain<\/strong><\/h2>\n<p>Rzasa Lynn emphasized that the purpose of SKOAP is to gather and sort through evidence gleaned from a variety of treatments. She noted that \u201cthere is still plenty of debate about what we should be doing for patients with chronic knee osteoarthritis pain.\u201d<\/p>\n<p>For example, she noted that hyaluronic acid injections have long been widely used by primary care providers, rheumatologists and orthopedists for the problem. \u201cBut there are questions about the utility of it compared to newer treatments.\u201d<\/p>\n<p>The SKOAP enrollment target \u2013 2,700 patients nationally \u2013 is also important, Rzasa Lynn added. \u201cIt is a pragmatic approach to a clinical trial that allows enrollment of a very large number of patients that would be difficult to study in a traditional trial design.\u201d<\/p>\n<p>The data will either support or refute current approaches she and her colleagues use to treat the pain of knee arthritis, she added \u2013 and that\u2019s a good thing for establishing a standard of care based on clinical evidence.<\/p>\n<p>\u201cThe more data we have, the better we can practice clinically and justify what we\u2019re doing so patients can get their treatments approved and covered,\u201d she said. The data could also help to raise awareness of effective treatment options among patients struggling with pain but \u201cnot yet ready to escalate to surgery,\u201d she added.<\/p>\n<h2><strong>Promise, not a panacea for knee pain<\/strong><\/h2>\n<p>Moreland emphasized that the SKOAP study was not designed to prevent patients from having knee replacement if it is indicated. Rather, the idea is to gather data with an eye toward developing a \u201csequenced strategy\u201d to help patients have \u201cless pain and an improved quality of life\u201d that allows them to safely do the activities that are most important to them.<\/p>\n<p>\u201cThat will vary from patient to patient,\u201d Moreland said. \u201cWe also want to come up with good options that prevent them from getting on narcotics.\u201d<\/p>\n<p>Researchers hope that SKOAP will help doctors address unanswered questions surrounding the best treatments for patients who sometimes get unproven and unneeded solutions to their knee pain.<\/p>\n<p><em>For more information about the SKOAP trial, contact Andrew Clauw: <\/em><a href=\"mailto:andrew.clauw@cuanschutz.edu\"><em>andrew.clauw@cuanschutz.edu<\/em><\/a><em> or 734-476-1146.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>For millions of people in the United States, creaking, cracking and grinding are unwelcome notes in the soundtrack of advancing age. The nagging noises are the result of arthritis, which painfully inflames and deteriorates the joints, tissues and bones around them. The more than 100 forms of the disease affect nearly 60 million Americans. The [&hellip;]<\/p>\n","protected":false},"author":2143,"featured_media":68971,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[2863,1163,183,1718,102],"class_list":["post-68968","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-knee-injury","tag-opioids","tag-orthopedics","tag-pain-care-management","tag-rheumatology"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.2) - 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