Patellofemoral Syndrome Medication
- Author: Patrick J Potter, MD, FRCSC; Chief Editor: Consuelo T Lorenzo, MD more...
Two approaches to medicating symptoms of patellofemoral syndrome are recognized. These approaches are administration of analgesic medication and administration of nonsteroidal anti-inflammatory drugs (NSAIDs). Analgesics commonly are restricted to acetaminophen or aspirin. The choices of NSAIDs available for management of joint pain are expanding continuously. Consider tolerance of medication (which may result in epigastric distress), prior history of gastric ulceration, renal disease, possible interaction with other medications, and cost. The NSAIDs all have similar efficacy, but changes in formulation have been made to reduce the frequency of adverse effects. Selective cyclooxygenase 2 (COX-2) inhibitors have fewer gastrointestinal adverse effects.
Nonsteroidal anti-inflammatory drugs
No NSAID has been found to be more effective in treating symptoms of patellofemoral syndrome than any other, although tolerances of NSAIDs vary between individuals. Listed below are the commonly used NSAIDs. These NSAIDs are used predominantly in the adult population. Except for the COX-2 NSAIDs, most have similar adverse effect profiles, and most have the same effect on prostaglandins.
Inhibits prostaglandin synthesis by decreasing activity of enzyme cyclo-oxygenase, which in turn decreases formation of prostaglandin precursors.
Inhibits prostaglandin synthesis by decreasing activity of the enzyme cyclo-oxygenase.
The decreased activity of cyclo-oxygenase results in decreased formation of prostaglandin precursors, which in turn results in reduced inflammation.
May inhibit cyclo-oxygenase enzyme, which in turn inhibits prostaglandin biosynthesis.
These effects may result in analgesic, antipyretic, and anti-inflammatory activities.
DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Rapidly absorbed. Inhibits prostaglandin synthesis. Metabolism occurs in liver by demethylation, deacetylation, and glucuronide conjugation.
For relief of mild to moderate pain and inflammation. Small dosages initially are indicated in small and elderly patients and in those with renal or liver disease.
Doses over 75 mg do not increase therapeutic effects. Administer high doses with caution and closely observe patient for response.
Nonacidic NSAID rapidly metabolized after absorption to a major active metabolite that inhibits cyclo-oxygenase enzyme, which in turn inhibits pain and inflammation.
For relief of mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing activity of cyclo-oxygenase, which results in a decrease of prostaglandin synthesis.
For relief of mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing activity of cyclo-oxygenase, which is responsible for prostaglandin synthesis.
Decreases activity of cyclo-oxygenase, which in turn inhibits prostaglandin synthesis. These effects decrease formation of inflammatory mediators.
Decreases activity of cyclo-oxygenase, which in turn inhibits prostaglandin synthesis. Results in a decreased formation of inflammatory mediators.
Cyclo-oxygenase-2 (COX-2) inhibitors
Although increased cost can be a negative factor, the incidence of costly and potentially fatal GI bleeds is clearly less with COX-2 inhibitors than with traditional NSAIDs. Ongoing analysis of cost avoidance of GI bleeds will further define the populations that will find COX-2 inhibitors the most beneficial.
Inhibits primarily COX-2. COX-2 is considered an inducible isoenzyme, induced during pain and inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID GI toxicity. At therapeutic concentrations, COX-1 isoenzyme is not inhibited, thus GI toxicity may be decreased. Seek lowest dose of celecoxib for each patient.
Piva SR, Fitzgerald GK, Irrgang JJ, et al. Associates of physical function and pain in patients with patellofemoral pain syndrome. Arch Phys Med Rehabil. 2009 Feb. 90(2):285-95. [Medline].
Price JL. Patellofemoral syndrome: how to perform a basic knee evaluation. JAAPA. 2008 Dec. 21(12):39-43. [Medline].
Finnoff JT, Hall MM, Kyle K, Krause DA, Lai J, Smith J. Hip strength and knee pain in high school runners: a prospective study. PM R. 2011 Sep. 3(9):792-801. [Medline].
Kettunen JA, Visuri T, Harilainen A, et al. Primary cartilage lesions and outcome among subjects with patellofemoral pain syndrome. Knee Surg Sports Traumatol Arthrosc. 2005 Mar. 13(2):131-4. [Medline].
Schutzer SF, Ramsby GR, Fulkerson JP. Computed tomographic classification of patellofemoral pain patients. Orthop Clin North Am. 1986 Apr. 17(2):235-48. [Medline].
Bolgla LA, Malone TR, Umberger BR, et al. Reliability of electromyographic methods used for assessing hip and knee neuromuscular activity in females diagnosed with patellofemoral pain syndrome. J Electromyogr Kinesiol. 2009 Jan 2. [Medline].
Ferrari D, Kuriki HU, Silva CR, et al. Diagnostic accuracy of the electromyography parameters associated with anterior knee pain in the diagnosis of patellofemoral pain syndrome. Arch Phys Med Rehabil. 2014 Apr 15. [Medline].
Syme G, Rowe P, Martin D, et al. Disability in patients with chronic patellofemoral pain syndrome: a randomised controlled trial of VMO selective training versus general quadriceps strengthening. Man Ther. 2009 Jun. 14(3):252-63. [Medline].
Kooiker L, Van De Port IG, Weir A, et al. Effects of physical therapist-guided quadriceps-strengthening exercises for the treatment of patellofemoral pain syndrome: a systematic review. J Orthop Sports Phys Ther. 2014 Jun. 44(6):391-B1. [Medline].
Chiu JK, Wong YM, Yung PS, Ng GY. The effects of quadriceps strengthening on pain, function, and patellofemoral joint contact area in persons with patellofemoral pain. Am J Phys Med Rehabil. 2012 Feb. 91(2):98-106. [Medline].
Alba-Martin P, Gallego-Izquierdo T, Plaza-Manzano G, Romero-Franco N, Nunez-Nagy S, Pecos-Martin D. Effectiveness of therapeutic physical exercise in the treatment of patellofemoral pain syndrome: a systematic review. J Phys Ther Sci. 2015 Jul. 27 (7):2387-90. [Medline]. [Full Text].
van der Heijden RA, Lankhorst NE, van Linschoten R, et al. Exercise for treating patellofemoral pain syndrome. Cochrane Database Syst Rev. 2015 Jan 20. 1:CD010387. [Medline].
Collins N, Crossley K, Beller E, Darnell R, McPoil T, Vicenzino B. Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: randomised clinical trial. BMJ. 2008 Oct 24. 337:a1735. [Medline]. [Full Text].
Barton CJ, Menz HB, Crossley KM. Clinical Predictors of Foot Orthoses Efficacy in Individuals with Patellofemoral Pain. Med Sci Sports Exerc. 2011 Feb 8. [Medline].
Teitge RA. Patellofemoral syndrome a paradigm for current surgical strategies. Orthop Clin North Am. 2008 Jul. 39(3):287-311, v. [Medline].
Lankhorst NE, van Middelkoop M, van Trier YD, et al. Can We Predict Which Subjects With Patellofemoral Pain Syndrome Are More Likely to Benefit From Exercise Therapy: A Secondary Explorative Analysis of a Randomized Controlled Trial. J Orthop Sports Phys Ther. 2015 Jan 27. 1-24. [Medline].
Devan MR, Pescatello LS, Faghri P, Anderson J. A Prospective Study of Overuse Knee Injuries Among Female Athletes With Muscle Imbalances and Structural Abnormalities. J Athl Train. 2004 Sep. 39(3):263-267. [Medline]. [Full Text].
Johnston LB, Gross MT. Effects of foot orthoses on quality of life for individuals with patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2004 Aug. 34(8):440-8. [Medline].
Karlsson J, Thomee R, Sward L. Eleven year follow-up of patello-femoral pain syndrome. Clin J Sport Med. 1996 Jan. 6(1):22-6. [Medline].