Osteoarthritis is a common concern and one of the leading causes of pain and disability in older adults. The pain contributes to the reduction in physical activity, resulting in atrophy and weakness and worsening physical activity participation. To break this vicious cycle of physical decline, physicians and physical therapists often target pain. For physicians, the common approach is pain medication, while exercise is the treatment of choice for physios (putting manual therapy and lifestyle education aside for now). With respect to pain, which treatment is more effective? This network meta-analysis (PMID: 36593092) sought to answer the question.
This MA only included randomized clinical trials that directly compared exercise with oral NSAIDs and paracetamol, or studies comparing exercise therapy with “any common comparator that may be shared with oral NSAIDs and paracetamol (usual care/ no treatment/waiting list control, glucosamine sulphate/chondroitin sulphate, intra-articular hyaluronic acid, topical NSAIDs, acupuncture).” Cross-over designs and combined treatment interventions were excluded. This left 152 studies for analysis. The most common was exercise vs. usual care/waitlist/no treatment (n=106) and only four directly compared exercise with oral NSAIDs and paracetamol.
The data showed no difference in pain or function between exercise and oral NSAIDs and paracetamol. The pooled effect sizes for both were small to moderate (0.41 (95% CI 0.23 to 0.59) for pharmacological treatments and 0.46 (95% CI 0.34 to 0.59) for exercise). Remember, this study is strictly looking at pain and self-reported function (which is heavily influenced by pain). It is not saying exercise and medication are equally beneficial overall. Medication does not induce the same adaptations to the musculoskeletal, cardiopulmonary, metabolic, or nervous systems.