Dear Alice,

I have bad knees. My knees hurt all of the time. My left knee is the worst. I play rugby, so my knees do get a lot of wear and tear. I have been told by my current doctor that there is nothing they can do and that all I can take for the pain is Ibuprofen. I have tried physical therapy with no results. Lately, my knees have been hurting me a lot. They hurt at night, when I walk, even when I am just sitting there. Ice and heat don't help either. Sometimes I won't sleep for two or three days at a time because the pain in my knees is so nagging and uncomfortable. I want to know how I can talk to the doctor assertively telling her that I need something more for the pain. I don't want to seem like what they are doing isn't enough, but it isn't. I am a college student on campus, I walk a lot, I need to be able to walk across campus with out having my knees hurt. If you have any advice for me it would be greatly appreciated...

Thanks,
In Pain

Dear In Pain,

Sometimes it can feel like the worst part about having aches and pain isn’t the discomfort itself — rather, it’s getting someone to listen to you and help with pain management. In fact, research suggests that fewer than half of patients who were seeking pain relief felt like their health care providers understood and appropriately cared for them. So what can be done about this — especially for you? Some options for taking action include strategizing what to discuss with your provider, how to describe your pain, and trying some do-it-yourself (DIY) home remedies for pain relief. If you adopt these strategies and find that your provider still isn’t adequately addressing your concerns, you may want to consider looking for a new provider who can better meet your needs.

Given that your time with your provider is often limited, you can focus on prioritizing what you want to address, elaborating on your knee pain (more on that in a bit), and firmly and directly asking them to listen to your concerns. Since you’re not feeling adequate relief from the current treatments, you may start by firmly telling your provider you’d like to change your treatment and possibly try something new. To inform whether an alternative treatment option might be appropriate for you, it might help to describe your knee pain in detail. Though you want to be respectful during this time, it’s okay to ensure your concerns aren’t being ignored or invalidated. You might try saying something like, “I know you’re busy and have other patients, but I need to talk with you about my knee pain, since the ibuprofen hasn’t been sufficient.” Since the feeling of pain can be such a subjective experience, it’s often difficult to effectively describe it to others. To get around this and properly describe your pain to your provider, it can be helpful to think about and keep track of the following:

  • Location: What’s hurting? Is your pain isolated to the knee or does it extend to the thighs, calves, and any other nearby area?
  • Frequency: How often does it hurt? Is the pain all the time, only at night, once a week, or only after rugby?
  • Severity: How bad is it? Is the pain strong, weak, sharp or dull?
  • Triggers: Are there any activities that seem to flare-up your pain or allow it to dull?
  • Impact: How does this pain affect your regular activities? You mentioned that sometimes you can’t sleep for days. Are there other ways it affects your life?

You may find it helpful to keep track of all this information about your pain symptoms by jotting down some notes, including dates. Once you have all of this information in one spot, you might find it easier to clearly describe your current experience of pain with your provider.

You may also consider asking your provider about specific treatments — namely, injections, therapy, and surgery — and inquiring about whether they’ll be helpful for you. Injections include corticosteroids to alleviate arthritis flare-ups, hyaluronic acid to reduce pain and increase mobility in the affected area, and platelet-rich plasma (PRP) to combat inflammation. Though you mentioned that physical therapy hasn’t been working for you, it might be worth another try with a new therapist or trying different techniques and stretches specifically for strengthening the muscles around your knee. Lastly, many people with aches and pains may think of surgery as an extreme option to address their pains. However, it’s worth asking your provider if they think it’s an option for you. Orthopedic surgeons perform specific surgeries to address severe knee pain, including arthroscopic surgery, partial knee replacement surgery, and total knee replacement surgery. By keeping these treatment options in mind, it’ll be easier to work with your provider to figure out what’s best for you.

In the meantime, there are DIY home remedies that may provide some temporary relief. Since ice and heat haven’t been working for you, other options include:

  • Compression. By compressing the knee with a compression sleeve or cloth, you can help maintain proper knee alignment, and prevent excess fluid from building up in the tissues, thereby reducing any swelling. But it's key to ensure that your compression is breathable and isn’t stopping circulation, as this can worsen the issue.
  • Elevation. By lifting your knee above your chest and comfortably resting them on pillows, you can reduce any painful swelling to the area.
  • Wearing shoe insoles. Using shoe insoles with arch supports and wedges under your heel may reduce any stress that reaches your knees, providing them with additional support.

Hopefully, with these strategies, you and health care provider will be able to work together to establish a pain relief regimen that works for you. If you find that they’re still not listening to you or understanding your concerns, you might consider getting a second opinion with a different provider. If you’re still nervous about assertively talking with your provider, role-playing with a trusted friend a couple times before your next visit might help you feel more prepared and comfortable for your next appointment.

Here’s to hoping you finally get the relief you “kneed”!

Alice!

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