Chronic arthritis pain guide

Chronic osteoarthritis pain (12 weeks or longer), online

For adults 18 to 74 who were told by a clinician that they have osteoarthritis in a knee, hip, or hand. You were examined in person in the last 12 months. Your usual arthritis pain has lasted 12 weeks or longer. A doctor reads your answers and sends a written plan.

Start online

Start a $59 online review for Chronic osteoarthritis pain.

Osteoarthritis is joint pain and stiffness. It happens when a joint wears down over time. It is the most common kind of arthritis. It often affects the knees, hips, and hands. Doctors' guides say to start with exercise and other care that is not a medicine. An anti-inflammatory gel or pill is next. A medicine like duloxetine is for pain that these do not fix. It may help some people. This visit is for adults 18 to 74 who were told by a doctor, nurse practitioner, or physician assistant that they have osteoarthritis in a knee, hip, or hand. They also examined you in person in the last 12 months. We do not examine you. We do not order scans or tests. You get a written plan. If you need a medicine and it is safe for you, the doctor may send one. We never send opioids, tramadol, gabapentin, pregabalin, or muscle relaxers.

If treatment is appropriate, your physician can send a non-controlled prescription to your pharmacy and provide portal instructions for the next step.

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Already in ongoing care with us for this? Check-ins are $39 (your first one is free).

Quick facts

You must be physically located in Virginia or West Virginia at the time of request.
Starts at $59
No insurance needed
No app download
Physician review around the clock
Non-controlled prescriptions can be sent to your pharmacy when appropriate
A work or school note can be included when medically appropriate
Response times apply 24/7, every day

Common symptoms

Pain and stiffness in a knee, hip, or hand that have lasted 12 weeks or longer
Your usual arthritis pain, not a new kind and not in a new place
Soreness or stiffness that limits your sleep, work, or daily life
Pain in a joint that a clinician already diagnosed as osteoarthritis

May fit online care

Adults 18 and older
You are 18 to 74
A doctor, nurse practitioner, or physician assistant told you that you have osteoarthritis in your knee, hip, or hand
That clinician examined you in person for this joint in the last 12 months
Your joint pain has lasted 12 weeks or longer
It is your usual arthritis pain, not a new kind, not in a new place, and not much worse over days or weeks
Your main pain is in a knee, hip, or hand
For a medicine, you also tried exercise and an anti-inflammatory gel or pill and they did not help enough, or an anti-inflammatory is not advisable for you
For duloxetine, you are 25 to 74. If you are 18 to 24, you get the written plan without duloxetine
You take no opioid, and no gabapentin, pregabalin, or benzodiazepine for this pain
You have none of the warning signs below

Look for another care setting

A joint that is hot and swollen, or red and swollen (call 911 or go to the ER now).
A joint that is newly out of shape, or out of place after a fall, twist, or blow, very bad pain after a fall, twist, or blow, or pain from a serious accident, like a car crash (call 911 or go to the ER now).
New numbness, tingling, or no feeling around a joint after an injury (call 911 or go to the ER now).
A leg or arm that is suddenly weak, or weakness that is getting worse fast (call 911 or go to the ER now).
You cannot put weight on your leg or walk, and this is new (call 911 or go to the ER now).
Chest pain, trouble breathing, coughing up blood, or fainting (call 911 or go to the ER now).
A seizure, vomiting blood, or bloody, black, or tarry poo, right now or just now. If you take duloxetine, stop the medicine. Call 911 or go to the ER now.
After you start duloxetine: trouble breathing or wheezing, hives, or swelling of your face, lips, tongue, or throat. Blisters, a peeling rash, or sores in your mouth. You cannot pee at all. Stop the medicine. Call 911 or go to the ER now.
After you start duloxetine: you feel very agitated. You see or hear things that are not there. You are confused, or your heart races. You sweat a lot with a fever. You shake, or your muscles twitch or feel stiff. Stop the medicine. Call 911 or go to the ER now.
After you start duloxetine: eye pain, a change in your vision, or swelling or redness in or around your eye. Stop the medicine. Call 911 or go to the ER now.
Thoughts of ending your life, or of hurting yourself or someone else: call or text 988 now. Call 911 if you are in danger. After you start duloxetine, do the same if you are acting on dangerous impulses. Stop the medicine.
After you start duloxetine, a sign that says to stop the medicine counts even if it went away. It counts if it happened at any time since your last visit. Use the list it is in. If a sign in the 911 list that says to stop the medicine happened and it has stopped, go to the ER today.
A fever of 100.4°F (38°C) or higher, chills, or feeling very sick (go to the ER today).
Swelling, warmth, or redness in one calf, which can be a blood clot (go to the ER today).
In the last 4 weeks, any of these happened and it has stopped, and no doctor or nurse has checked it. Numbness, tingling, or no feeling around a joint after an injury. Sudden weakness in a leg or arm, or weakness that is getting worse fast. Chest pain, trouble breathing, coughing up blood, or fainting. A seizure. Vomiting blood, or bloody, black, or tarry poo (go to the ER today).
On a form from us, since your last visit, any sign in the 911 list happened and it has stopped, except the joint signs in the 7-day list. Examples are fainting, a seizure, or vomiting blood. If that sign says to stop the medicine, stop it (go to the ER today).
You fell, twisted a joint, or got hit in the last 4 weeks, and a joint or bone has new swelling, bruising, or pain, but you can walk and the joint is not newly out of shape or out of place (go to the ER or urgent care today).
New numbness or tingling in an arm, leg, hand, or foot, or numbness that is spreading (go to the ER or urgent care today).
Your knee is locked right now: it is stuck and you cannot bend or straighten it (go to the ER or urgent care today).
A joint that has newly become badly swollen, even if it is not hot or red (go to the ER or urgent care today).
After you start duloxetine: new trouble starting to pee or a weak stream. Stop the medicine (go to the ER or urgent care today).
After you start duloxetine: your skin or eyes turn yellow. Your pee is dark. You itch, or you have pain in the upper right belly. Stop the medicine (go to the ER or urgent care today).
After you start duloxetine: bleeding that will not stop. Large bruises you cannot explain. A bad headache with feeling weak, unsteady, or unable to think clearly. Stop the medicine (go to the ER or urgent care today).
After you start duloxetine: any new skin rash. Stop the medicine (see a doctor in person today).
After you start duloxetine: new or worse sadness, worry, or panic attacks. Feeling very agitated or restless. New anger or irritability. A burst of high energy with little need for sleep, or racing thoughts. Stop the medicine (see a doctor in person today).
Your pain is different from your usual arthritis pain, like a new kind of pain, pain in a new place, or pain that got much worse over days or weeks (see a doctor in person within 7 days).
New pain at rest or at night that is different from your usual pain (see a doctor in person within 7 days).
Weight loss without trying (see a doctor in person within 7 days).
Cancer in the past (see a doctor in person within 7 days).
Cancer now or being treated for cancer. A weak immune system, like HIV, a transplant, medicine that lowers your immune system, or steroid pills for 3 months or more. Or surgery on the joint or a steroid shot into the joint in the last 3 months (see a doctor in person within 7 days).
In the last 4 weeks, your joint started to lock for a short time or to give way (see a doctor in person within 7 days).
Your hip or hand joint is stuck right now: you cannot bend or straighten it (see a doctor in person within 7 days).
In the last 4 weeks, one of these joint signs happened and it has stopped, and no doctor or nurse has checked it. A joint that was hot and swollen, or red and swollen. A joint that was newly out of shape or out of place after a fall, twist, or blow. Very bad pain after a fall, twist, or blow, or pain from a serious accident. Not being able to put weight on your leg or walk (see a doctor in person within 7 days).
On a form from us, since your last visit, one of those joint signs happened and it has stopped (see a doctor in person within 7 days).
You take an MAOI (phenelzine, tranylcypromine, selegiline, rasagiline, isocarboxazid, or a brand such as Marplan, Nardil, Parnate, Azilect, or the Emsam patch) now or in the last 14 days. Or you take linezolid (Zyvox) or methylene blue now or in the last 24 hours. Or a doctor says you need one of these. Stop duloxetine now, if you have it. The doctor who prescribes that medicine decides what to do. If you take duloxetine, tell that doctor. We send no plan to stop slowly. We send no more duloxetine. If a list above also fits you, follow that list and stop duloxetine now (see your own doctor).
No doctor, nurse practitioner, or physician assistant has told you that you have osteoarthritis in this joint, or you are not sure (see your own doctor).
You were last examined in person for this joint more than 12 months ago, or never (see your own doctor).
Your main joint pain is in another joint, like your neck, shoulder, foot, ankle, or elbow (see your own doctor).
You have gout, rheumatoid arthritis, or another kind of inflammatory arthritis, or your joints are stiff for more than 30 minutes every morning (see your own doctor).
The doctor said you need a scan or tests that you have not had yet (see your own doctor).
You take any opioid for any reason, like tramadol, methadone, or buprenorphine (see the doctor who prescribes it).
You take gabapentin, pregabalin, or a benzodiazepine for this pain now (see the doctor who prescribes it).
You want a prescription for an opioid, tramadol, gabapentin, pregabalin, or a muscle relaxer (see your own doctor).
You are under 18, or 75 or older (see your own doctor).
When you ask for a medicine or at a check-in, you have no blood pressure reading from the last 7 days, or your reading is 140/90 or higher (see your own doctor).
At a check-in, you have a new health problem or a new medicine that makes duloxetine unsafe for you (see your own doctor).
You are not clearly better after 12 weeks of your plan, or your 13-week duloxetine course has ended and you want to keep taking it (see your own doctor).
Your joint pain started less than 12 weeks ago (use our osteoarthritis flare visit).
Your main pain is in your low back (use our chronic low back pain visit).
Pregnant, might be, or trying to get pregnant (see your pregnancy doctor or midwife).
If more than one fits, follow the first one.

What to have ready

Which joint hurts (knee, hip, or hand), and who told you it is osteoarthritis and when
The date of your last in-person exam for this joint
What exercise or other care you tried, for how long, and whether it helped
Which anti-inflammatory gel or pill you tried, and what happened
Every medicine, vitamin, and supplement you take
A blood pressure reading from the last 7 days (a pharmacy machine or a home cuff is fine), with its date and where it was taken. You need one before any medicine

What happens next

Standard

$59

Within 6 hours

Priority

$99

Within 3 hours

Rush

$149

Within 1 hour

Start the request on the website, answer a few questions to check that this visit fits you, and choose how fast you want an answer (the response window). If your concern still fits this service, a physician reviews it and sends you a secure update after you sign in. When appropriate, non-controlled prescriptions can be sent to your pharmacy, and a basic work or school note can be included at physician discretion.

Your physician

Every visit is personally reviewed by Ankur Fadia, MD. He is board-certified, has extra training in heart care (a cardiology fellowship), and is a member of Alpha Omega Alpha, a medical honor society. He is licensed in Virginia and West Virginia, and your care is never handed off to someone else.

About Ankur Fadia, MD Verify Virginia medical license Verify West Virginia medical license Verify board certification

How does the visit work?

The doctor reads your answers. We do not examine you. We do not order scans or tests. You get a written plan. Exercise is the main treatment. Walking, a stationary bike, swimming, and strength exercises all help. Start slowly and build up. A physical therapist can teach you safe exercises. You book one yourself. Heat or cold on the joint can ease pain. If you are overweight, losing 5 percent of your body weight can help your knees and hips. A cane can help when a knee or hip makes walking hard. If you need a medicine and it is safe for you, the doctor may send one. If you are not clearly better after 12 weeks, see your own doctor.

Can this visit prescribe tramadol or an opioid?

No. We never send opioids, tramadol, gabapentin, pregabalin, or muscle relaxers. If you take an opioid now, or you want a prescription for one of these, please see your own doctor.

Do I need an X-ray?

No test is ordered here. We do not order scans or tests. If the doctor who examined you said you need a scan or tests that you have not had yet, please see your own doctor.

I have a flare of my usual arthritis. Can I use this visit?

If your joint pain started less than 12 weeks ago, please choose our osteoarthritis flare visit instead. This visit is for your usual arthritis pain that has lasted 12 weeks or longer.

Can I use a gel on my knee with duloxetine?

Yes. A gel that you rub on the joint is OK. Ask your pharmacist, and use it as the label says. Do not take ibuprofen, Advil, Motrin, naproxen, Aleve, or aspirin with duloxetine. Together they raise the chance of bleeding. If a doctor prescribed you a daily aspirin, do not stop it. Tell us. Tell us if you bruise or bleed easily.

Which medicine can the doctor send?

Only duloxetine (Cymbalta). Medicine is not the first step. You must have tried exercise and an anti-inflammatory gel or pill, and they did not help enough, or an anti-inflammatory is not advisable for you. You must be 25 to 74. If you are 18 to 24, you get the written plan without duloxetine. The safety questions must be clear. You need a blood pressure reading from the last 7 days below 140/90. Duloxetine starts at 30 mg for 7 days, then 60 mg, for up to about 13 weeks. It may help some people. It comes with a free 2-week form. A plan to stop it slowly is free.

Will I need a check-in?

If the doctor sends a medicine, we check in with you. The first check-in is free. Later check-ins have a price that is shown before you pay. If you get a written plan and no medicine, we check in once at about 4 weeks. That is free. Each time, we ask for a new blood pressure reading. We also ask again about your health, your other medicines, and pregnancy. If you have no reading, or it is 140/90 or higher, we cannot send medicine, and you see your own doctor.

What if I need a new medicine later?

Do not start new medicines without first checking with your doctor. Tell every doctor and pharmacist that you take duloxetine. Before each fill, we ask about your medicines again. If a doctor says you need an MAOI, linezolid, or methylene blue, stop duloxetine now if you take it, and tell that doctor. If you start a medicine that is not safe with duloxetine, we do not send your next fill. See your own doctor.

When do I need care right away?

Read the lists from the top. If more than one fits, follow the first one. Do not wait for our reply. Call 911 or go to the ER now if you have any of these. A joint is hot and swollen, or red and swollen. A joint is newly out of shape, or out of place after a fall, twist, or blow. You have very bad pain after a fall, twist, or blow, or pain from a serious accident. You have new numbness, tingling, or no feeling around a joint after an injury. A leg or arm is suddenly weak. You cannot put weight on your leg or walk, and this is new. You have chest pain, trouble breathing, coughing up blood, or fainting. You have a seizure, or you vomit blood, or you have bloody, black, or tarry poo. Do not drive yourself. Call 911 or ask someone to drive you. Some of these can be a joint infection, a broken bone, or a blood clot. If a sign on this page says to stop the medicine, stop it. If you have thoughts of ending your life, or of hurting yourself or someone else, call or text 988 now.

What does the visit cost?

This is one visit. The price is shown before you pay. If the doctor sends a medicine, the first check-in is free. Later check-ins have a price that is shown before you pay. The 2-week duloxetine form and a plan to stop duloxetine slowly are free. You pay the pharmacy for the medicine.

Other conditions we treat

Not quite what you have? Here are other conditions we treat.

Achilles tendinitis Acute low back pain Acute muscle strain Ankle / wrist sprain Bursitis Chronic low back pain