The importance of nonpharmacologic approaches in management of osteoarthritis.

Treatment of the patient with osteoarthritis should be comprehensive, with nonpharmacologic approaches considered as primary therapy, and analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) assigned to an adjunctive role. These nonmedicinal approaches can include joint protection strategies; the use of thermal modalities (heat and cold) and transcutaneous electrical nerve stimulation (TENS); the development of exercise programs (that focus not only on the localized impairment, but on the functional limitations and disability secondary to inactivity); weight loss programs; the use of patellar tapping, wedged insoles, tidal irrigation (of the knee); and the introduction of coping skills and social support.