Multidisciplinary Integrative Approach to Treating Knee Pain in Patients with Osteoarthritis

Home is he brought, and laid in his sumptuous bed,

Where many skillful leaches him abide,

To salve his hurts, that yet still freshly bled.

–Edmund Spenser, The Faerie Queene, book I, canto 5, lines 145–147

Osteoarthritis of the knee is a major cause of morbidity, physical limitation, and increased health care utilization, including total joint arthroplasty, among the elderly in developed countries. Because osteoarthritis has no cure, the important goal of therapy is to relieve pain and stiffness and maintain or improve physical function (1, 2). Nonpharmacologic therapy, which includes patient education, social support, physical and occupational therapy, aerobic and resistive exercises, and weight loss, is the cornerstone of a multidisciplinary approach to managing patients with osteoarthritis. Pharmacologic therapies for osteoarthritis of the knee include simple analgesics (such as acetaminophen); nonsteroidal anti-inflammatory drugs (NSAIDs), including cyclooxygenase-2 selective inhibitors; intra-articular therapy, including glucocorticoids and hyaluronate preparations; topical agents (such as capsaicin); nutritional supplements (such as glucosamine and chondroitin sulfate); and investigational agents (such as matrix metalloprotease inhibitors and bisphosphonates). Unfortunately, these therapies, particularly NSAIDs, may have clinically significant adverse effects (3, 4).

Many patients with osteoarthritis use complementary and alternative medicine, and increasing numbers of physicians prescribe it (5). Complementary and alternative medicine therapies, including acupuncture, herbal products, meditation, and massage, among others, are popular despite the far-from-conclusive scientific evidence that they are effective in osteoarthritis. A systematic review found that patients receiving acupuncture had moderate improvement in knee pain and function compared with control patients enrolled on a waiting list to see the acupuncturist. In addition, “real” acupuncture was more effective than “sham” acupuncture (6). A systematic review of herbal products used to treat osteoarthritis reported convincing evidence that avocado soybean unsaponifiables and topical capsaicin were effective and reported weak evidence for several other …