Non-Pharmacological Therapies for Osteoarthritis of the Hand, Hip, and Knee
Recent recommendations from The Canadian Medical Association represent a monumental shift in pain management. Physicians, now more than ever are recommending conservative pain management strategies including but not limited to: low-impact exercise, acupuncture and massage therapy as part of a multidimensional treatment approach for patients suffering from osteoarthritis related pain.
Wear and tear associated with osteoarthritis is common in the general population, the good news is that there are a number of non-pharmacological therapies that have been shown to improve function in patients who suffer from osteoarthritis related pain:
• Massage Therapy - Has been shown to provide pain relief for osteoarthritis of the knee (Perlman et al. 2019)
• Self-Acupressure - Has been shown to provide pain relief for osteoarthritis of the knee (Li et al. 2018)
• Joint Mobilizations - Has been shown to provide pain relief for osteoarthritis of the knee (Courtney et al. 2016)
• Acupuncture - Has been shown to yield short and long-term improvement in function and pain relief in patients who suffer from osteoarthritis related knee pain (Lin et al. 2016, Vickers et al. 2018).
• Low Impact Exercise - Has been shown to have a significant impact not only on patient symptoms and physical function, but also on intake of painkillers and sick leave (Skou et al. 2017).
Key Take Home
Non-pharmacological therapeutic interventions are being embraced by the medical community because they are often simple to carry out, economical, and have relatively minor side effects. There are a number of non-pharmacological options for osteoarthritis that patients can discuss with their physician. None of these options are a panacea, but they may help you put together an individualized multi-modal program to manage osteoarthritis related symptoms.
More to Explore
Alentorn-Geli et al. (2017). The Association of Recreational and Competitive Running With Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther.
Ali et al. (2017). Massage Therapy and Quality of Life in Osteoarthritis of the Knee: A Qualitative Study. Pain Med.
Arendt-Nielsen, L. (2017). Joint pain: more to it than just structural damage? Pain.
Busse et al. (2017). Guideline for opioid therapy and chronic noncancer pain. CMAJ.
Chen, L., & Michalsen, A. (2017). Management of chronic pain using complementary and integrative medicine. BMJ.
Corbett et al. (2013). Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta-analysis. Osteoarthritis Cartilage.
Courtney et al. (2016). Joint Mobilization Enhances Mechanisms of Conditioned Pain Modulation in Individuals With Osteoarthritis of the Knee. JOSPT
Davis et al. (2017). Cross-cultural adaptation and implementation of Good Life with osteoarthritis in Denmark (GLA:D™): group education and exercise for hip and knee osteoarthritis is feasible in Canada. Osteoarthritis Cartilage.
Dilek et al. (2013). Efficacy of paraffin bath therapy in hand osteoarthritis: a single-blinded randomized controlled trial. Arch Phys Med Rehabil.
Dor, A., & Kalichman, L. (2017). A myofascial component of pain in knee osteoarthritis. J Bodyw Mov Ther.
Dunning et al. (2018). Periosteal Electrical Dry Needling as an Adjunct to Exercise and Manual Therapy for Knee Osteoarthritis: A Multi-Center Randomized Clinical Trial. Clin J Pain.
Fuggle et al. (2019). Safety of Opioids in Osteoarthritis: Outcomes of a Systematic Review and Meta-Analysis. Drugs Aging.
Gregori et al. (2018). Association of Pharmacological Treatments With Long-term Pain Control in Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis. JAMA.
Hunter, D.J., & Bierma-Zeinstra, S. (2019). Osteoarthritis. Lancet.
Juberg et al. (2015). Pilot study of massage in veterans with knee osteoarthritis. J Altern Complement Med.
Kraus et al. (2019). Effects of Physical Activity in Knee and Hip Osteoarthritis: A Systematic Umbrella Review. Med Sci Sports Exerc.
Krishnasamy et al. (2018). The role of skeletal muscle in the pathophysiology and management of knee osteoarthritis. Rheumatology (Oxford).
Levitsky et al. (2019). Joint Mobilization of the Hands of Patients With Rheumatoid Arthritis: Results From an Assessor-Blinded, Randomized Crossover Trial. J Manipulative Physiol Ther. https://www.ncbi.nlm.nih.gov/pubmed/30879707
Li et al. (2018). Self-Acupressure for Older Adults With Symptomatic Knee Osteoarthritis: A Randomized Controlled Trial. Arthritis Care Res (Hoboken).
Lin et al. (2016). The Effects of Acupuncture on Chronic Knee Pain Due to Osteoarthritis: A Meta-Analysis. The Journal of Bone & Joint Surgery.
MacPherson et al. (2017). Acupuncture for chronic pain and depression in primary care: a programme of research. Southampton (UK): NIHR Journals Library.
Nahin et al. (2016). Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States. Mayo Clin Proc.
Newberry et al. (2017). Treatment of Osteoarthritis of the Knee: An Update Review. Agency for Healthcare Research and Quality (US)
Pan et al. (2017). The association of knee structural pathology with pain at the knee is modified by pain at other sites in those with knee osteoarthritis. Clin Rheumatol.
Perlman et al. (2019). Efficacy and Safety of Massage for Osteoarthritis of the Knee: a Randomized Clinical Trial. J Gen Intern Med.
Salamh et al. (2017). Treatment effectiveness and fidelity of manual therapy to the knee: A systematic review and meta-analysis. Musculoskeletal Care.
Siemieniuk et al. (2017). Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. BMJ.
Skelly et al. (2018). Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review. Agency for Healthcare Research and Quality.
Skou, S.T., & Roos, E.M. (2017). Good Life with osteoArthritis in Denmark (GLA:D™): evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide. BMC Musculoskelet Disord.
Stukstette et al. (2012). A multidisciplinary and multidimensional intervention for patients with hand osteoarthritis. Clin Rehabil.
Vickers et al. (2018). Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. The Journal of Pain.
Villafañe et al. (2012). Radial nerve mobilization decreases pain sensitivity and improves motor performance in patients with thumb carpometacarpal osteoarthritis: a randomized controlled trial. Arch Phys Med Rehabil.
Woods et al. (2017). Cost-effectiveness of adjunct non-pharmacological interventions for osteoarthritis of the knee. PLoS One.
Xu et al. (2017). The Effectiveness of Manual Therapy for Relieving Pain, Stiffness, and Dysfunction in Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Pain Physician.
Zeng et al. (2019). Association of Tramadol With All-Cause Mortality Among Patients With Osteoarthritis. JAMA.