Non-Pharmacological Pain Management for Knee Osteoarthritis

Conservative care for knee osteoarthritis

A Review of Treatment Options for Knee Osteoarthritis

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 multi-modal treatment approach for patients suffering from osteoarthritis knee pain.

Degenerative meniscus and osteoarthritis of the knee is common in the general population. This post gives a brief overview of non-pharmacological pain management strategies for osteoarthritis related knee pain.

Massage Therapy for Osteoarthritis of The Knee

Massage therapy has been shown to improvement in function in patients who suffer from osteoarthritis related knee pain, studies have looked at the effect of:
• Massage Therapy (Ali et al. 2017)
• Acupressure (Li et al. 2018)
• Joint Mobilizations (Courtney et al. 2016)

Why Does Massage Therapy Work?

In this condition sensitization of nociceptive pathways may result in patients with osteoarthritis perceiving relatively low level stimuli as being overtly painful. In terms of clinical responses to massage therapy, soft tissue mobilization and oscillatory joint mobilization has an effect on supraspinal processes which influence nociceptive processing and therefore OA-related pain.

Additionally a biopsychosocial framework helps put into context the interconnected and multidirectional interaction between: physiology, thoughts, emotions, behaviors, culture, and beliefs.

Acupuncture for Osteoarthritis of The Knee

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. 2016Vickers et al. 2018).

Why Does Acupuncture Work?

If you use Occam's razor, the insertion of an acupuncture needle is a form of novel stimuli, that functions by sending anti-nociceptive input to the neuroimmune system. 

Preferential sites for acupuncture stimulation are associated with areas rich in specialized sensory receptors such as muscle spindles, Golgi tendon organs, ligament receptors, Paciniform and Ruffini’s receptors (joint capsules), deep pressure endings (within muscle belly), and free nerve endings (muscle and fascia).

All of these areas are highly innervated and as a result there are a number of physiological changes across different areas of the peripheral and central nervous systems including: peripheral receptors, dorsal horn of the spinal cord, brainstem, sensorimotor cortical areas, and the mesolimbic and prefrontal areas (Chen et al. 2017).

Low Impact Exercise

Good Life with osteoArthritis in Denmark (GLA:D™) is an evidence-based education and supervised neuromuscular exercise program. This program 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 Point

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 a individualized multi-modal program to manage osteoarthritis related symptoms.


More to Explore

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