Osteoarthritis: Understanding Joint Pain and Your Treatment Options

Cartilage is the smooth, resilient tissue covering the ends of bones inside a joint. It allows the surfaces to glide over each other and helps distribute the forces that pass through the joint with every step or movement.

In osteoarthritis, cartilage changes. But describing the condition as passive wear and tear caused by ageing is inaccurate. Osteoarthritis involves the whole joint, and several structures can contribute to symptoms.

Osteoarthritis is therefore an active process involving the whole joint, influenced by interacting mechanical, inflammatory and metabolic factors. This also explains why two people with similar X-rays can experience very different symptoms.

Cartilage itself contains no pain-sensing nerve fibres. Cartilage damage alone therefore does not explain what you feel. Joint pain arises from several structures within and around the joint, and how much it hurts depends on many influences.

When pain has been present for a long time, the nervous system can sometimes become increasingly sensitive to pain signals. This does not mean the pain is imaginary. It means that persistent pain can become more complex than the amount of structural change visible on an X-ray or scan.

That is why, when osteoarthritis causes persistent pain, we look beyond the imaging findings alone and consider the broader pain picture.

Symptoms differ from person to person and from joint to joint, but several patterns are common.

Osteoarthritis can also affect other joints, notably the feet, the shoulders and the spine.

Knee osteoarthritis is often noticed when walking, on stairs, when standing up from a chair, during prolonged standing or in sport. Many people describe a knee that feels warm after exertion, sometimes mild swelling, and less confidence in the stability of the leg.

Hip pain is often felt around the groin, but it can also be experienced in the thigh, the buttock or sometimes around the knee. Putting on socks, getting into a car or walking longer distances frequently become harder.

In the hands, osteoarthritis commonly affects the base of the thumb and the finger joints. It causes pain, stiffness, reduced grip strength and sometimes visible changes to the joints, making it harder to open a jar, turn a key or write.

There is rarely a single cause. Osteoarthritis usually develops where several factors meet, and their relative weight differs from person to person.

None of this implies personal blame. Understanding which factors genuinely matter in your situation is far more useful than assuming osteoarthritis behaves identically in everyone.

Imaging is not always required. In many adults over 45 with typical activity-related joint pain and little or no prolonged morning stiffness, osteoarthritis can often be diagnosed clinically.

Clinically means through your symptoms, your medical history and a physical examination, without routine imaging.

X-rays or other investigations become useful when the presentation is atypical, the diagnosis is uncertain, another condition is suspected, or the result would genuinely influence management. The NICE clinical guideline describes this approach in detail.

This section explains the broader established treatment landscape for osteoarthritis. Not every approach described here is provided at Centre Algos, but these are well-established components of osteoarthritis management and are important to understand.

Exercise is part of osteoarthritis treatment, not simply general lifestyle advice. It is one of the best documented ways to reduce pain and improve function.

Some temporary discomfort when beginning appropriate exercise does not necessarily mean additional joint damage is occurring. An individual exercise programme should nevertheless be built with a professional who knows your situation, rather than from a web page.

Where excess body weight contributes to loading of the lower-limb joints, weight reduction may improve pain and function. This is a mechanical and metabolic factor rather than a judgement, and it is not relevant for everyone living with osteoarthritis.

You may already have been prescribed pain-relieving or anti-inflammatory medication as part of conventional osteoarthritis care. This can include topical or oral NSAIDs and, in some situations, other pain medication.

At Centre Algos, we take any medication you are using into account when reviewing your symptoms, previous treatments and overall health. We do not automatically oppose conventional medication, but we also look at whether other approaches may have a place in your individual treatment strategy.

Corticosteroid injections can reduce inflammation and may provide short-term pain relief for some people with osteoarthritis. They are not generally considered a long-term solution.

In a two-year randomized clinical trial published in JAMA in 2017, 140 people with symptomatic knee osteoarthritis received either 40 mg of the corticosteroid triamcinolone or saline, a sterile salt-water solution used as the comparison injection, every three months.

The corticosteroid group experienced significantly greater cartilage volume loss than the saline group, while there was no significant difference in knee pain between the groups over the study period.

This does not mean that cortisone destroys cartilage in every situation. It does raise legitimate concerns about repeated corticosteroid injections of this type and frequency, and it supports weighing the possible short-term benefit against the possible risks.

Knee or hip replacement can be appropriate and effective for well-selected patients. It is considered when pain, stiffness and loss of function substantially affect quality of life and suitable non-surgical approaches no longer provide sufficient relief.

Treating osteoarthritis without surgery therefore does not mean avoiding surgery at all costs. It means genuinely exploring appropriate conservative options first, and recognising surgery as a good decision when it is clinically indicated.

We do not work with a standard treatment package. Depending on your situation, some of the following may be discussed with you.

Percutaneous hydrotomy is one of the treatments we may consider for persistent osteoarthritis-related joint pain. It involves very fine superficial injections of physiological saline, with selected therapeutic substances when appropriate, around the area being treated.

Its formal scientific evidence base remains more limited than that of established core osteoarthritis treatments. We explain what is known, what remains uncertain and why we may consider the treatment in your individual situation before deciding together whether it is appropriate.

Learn more about percutaneous hydrotomy

Osteoarthritis is not only a mechanical problem. In some people, broader factors such as low-grade inflammation, metabolic health (how the body regulates blood sugar, energy use and related processes), nutritional status, sleep, recovery and other health conditions may influence pain, function and how the condition evolves over time.

At Centre Algos, we may therefore look beyond the joint itself when this is clinically relevant. Functional biology can help us explore factors such as metabolic balance, inflammatory patterns and nutritional status, particularly when symptoms are persistent or when the clinical picture suggests that broader health factors may be contributing.

This does not mean that every person with osteoarthritis needs extensive testing. We use testing selectively, based on your symptoms, medical history and clinical situation, and integrate relevant findings into the wider treatment plan.

Learn more about functional biology and micronutrition

Phytotherapy may be considered as a supportive component of an individual treatment plan, depending on your symptoms, overall health and other treatments. When appropriate, we integrate it into the broader pain-management strategy rather than using it as a replacement for established osteoarthritis care.

Some presentations should not simply be assumed to be osteoarthritis and deserve a medical assessment, calmly but without waiting too long.

If joint pain is stopping you from walking comfortably, exercising, sleeping well or doing activities that matter to you, a consultation can help clarify what may be contributing to your symptoms and which treatment options may be appropriate.

At Centre Algos, we review your symptoms, medical history, previous examinations and treatments and your broader clinical situation. We then discuss the available options with you and build an individual plan together. You can request a consultation or read about our approach to chronic pain.