Management of Joint Pain in Older Adults

Non-Pharmacological Interventions

The British Medical Journal recommends exercise and physical activity, including local muscle strengthening and aerobic fitness, for older adults with joint pain 1
Weight loss is recommended for overweight or obese individuals with joint pain to reduce joint strain 1
Using shoes with shock-absorbing properties can help reduce joint pain 1
Local heat or cold therapy can relieve joint pain 1

The British Medical Journal recommends acetaminophen as the first-line pain reliever for older adults with joint pain, to be taken regularly 1
Topical non-steroidal anti-inflammatory drugs (NSAIDs) can relieve joint pain, and should be considered if acetaminophen is not effective 1
Topical capsaicin preparations can relieve joint pain 1
Intra-articular injection of corticosteroids can be considered for severe pain, with moderate evidence supporting its use 1, 2

The European League Against Rheumatism (EULAR) and the National Institute for Health and Care Excellence (NICE) do not recommend glucosamine and chondroitin products for joint pain, except for chondroitin sulfate in hand OA 1, 3, 4
Chondroitin sulfate has a slower onset of action compared to NSAIDs, but its effects may persist for up to three months after discontinuation, with a conditional recommendation for hand OA by EULAR 3, 4, 5
Glucosamine and chondroitin have low toxicity profiles, but patients taking glucosamine should be monitored for elevations in serum glucose levels 6, 7
The American Academy of Orthopaedic Surgeons (AAOS) strongly recommends against using chondroitin sulfate for knee and hip OA, and conditionally recommends against it for hand OA, except in cases where patients have limited options 6
Turmeric or ginger extract may be considered for knee OA with limited options, but evidence is limited 8

The European League Against Rheumatism (EULAR) conditionally recommends chondroitin sulfate for hand OA, but not for knee or hip OA 3, 4
The American Academy of Orthopaedic Surgeons (AAOS) recommends exercise therapy, weight management, physical therapy, and topical NSAIDs as first-line approaches for osteoarthritis management, with evidence supporting their efficacy 6
Patients insisting on supplements should be informed of the limited evidence for efficacy and monitored for adverse effects, particularly glucose levels in patients taking glucosamine 6

Chondroitin sulfate may provide modest benefit for hand osteoarthritis with minimal risk, but its use for knee and hip osteoarthritis is not supported by current high-quality evidence 3, 4, 5
Non-pharmacological approaches and pharmacological interventions, such as exercise, weight management, topical and oral NSAIDs, and intra-articular corticosteroid injections, are recommended for joint pain relief instead of glucosamine and chondroitin supplements 6, 7