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, Perlman et al. 2019)
• 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

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.

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.

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.

Juberg et al. (2015). Pilot study of massage in veterans with knee osteoarthritis. J Altern Complement Med.

Krishnasamy et al. (2018). The role of skeletal muscle in the pathophysiology and management of knee osteoarthritis. Rheumatology (Oxford).

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. (in-press). 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. (OPEN ACCESS)

Skelly et al. (2018). Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review. Agency for Healthcare Research and Quality.

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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.