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Nonpharmacological Approaches to Pain in Osteoarthritis

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Many treatments or techniques have been developed to combat pain in osteoarthritis. These can reduce drug consumption and toxicity, or even delay the need for joint replacement surgery. Pain management in osteoarthritis should start with education, psychological support and environmental measures, reassuring patients that such pain is a reversible state, not associated with aging and irreversible loss of ability. Physiotherapy and exercises are very important for maintaining muscle strength, joint stability and mobility, but should be closely monitored for optimal efficacy. Splints and weight reduction in the obese are useful, depending on the joints involved. Preventive surgery such as cruciate ligament repair or osteotomy should be considered for cases with moderate osteoarthritis. Intra-articular lavage is effective in the short term, and the effectiveness is increased with the use of an arthroscope when meniscus tears or cartilage fragments are associated with osteoarthritis. Nonconventional therapies such as homeopathy, acupuncture and transcutaneous electrical nerve stimulation can be tried at all stages; even if not really efficient, most of these techniques are usually innocuous. Doctors should be aware of these neglected techniques for a better, well tolerated and cost-effective management of pain associated with osteoarthritis.

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References

  1. Hawley DJ, Wolfe F. Pain, disability, and pain/disability relationships in seven rheumatic disorders. A study of 1522 patients. J Rheumatol 1991; 18: 1552–7.

    PubMed  CAS  Google Scholar 

  2. Puett DW, Griffin MR. Published trials of nonmedical and non-invasive therapies for hip and knee osteoarthritis. Ann Intern Med 1994; 121: 133–40.

    PubMed  CAS  Google Scholar 

  3. Schnitzer TJ. Osteoarthritis treatment update. Minimizing pain while limiting patient risk. Postgrad Med 1993; 93: 89–92.

    PubMed  CAS  Google Scholar 

  4. Dieppe P. Management of osteoarthritis of the hip and knee joint. Curr Opin Rheumatol 1993; 5: 487–93.

    Article  PubMed  CAS  Google Scholar 

  5. Forman MD, Malamet R, Kaplan D. A survey of osteoarthritis of the knee in the elderly. J Rheumatol 1983; 10: 282–6.

    PubMed  CAS  Google Scholar 

  6. Salaffi F, Cavalieri F, Nolli M, et al. Analysis of disability in knee osteoarthritis. Relationship with age and psychological variables but not with radiographic score. J Rheumatol 1991; 18: 1581–6.

    PubMed  CAS  Google Scholar 

  7. Davis MA, Ettinger WH, Neuhaus JM, et al. Correlates of knee pain among US adults with and without radiographic knee osteoarthritis. J Rheumatol 1992; 19: 1943–9.

    PubMed  CAS  Google Scholar 

  8. Hannan MT, Anderson JJ, Pincus T, et al. Educational attainment and osteoarthritis. Differential associations with radiographic changes and symptom reporting. J Clin Epidemiol 1992; 45: 139–47.

    Article  PubMed  CAS  Google Scholar 

  9. Calfas KJ, Kaplan RM, Ingram RE. One-year evaluation of cognitive-behavioral intervention in osteoarthritis. Arthritis Care Res 1992; 5: 202–9.

    Article  PubMed  CAS  Google Scholar 

  10. Hampson SE, Glasgow RE, Zeiss AM, et al. Self-management of osteoarthritis. Arthritis Care Res 1993; 6: 17–22.

    Article  PubMed  CAS  Google Scholar 

  11. Lorig KR, Mazonson PD, Holman HR. Evidence suggesting that health education for self-management in patients with chronic arthritis has sustained health benefits while reducing health care costs. Arthritis Rheum 1993; 36: 439–46.

    Article  PubMed  CAS  Google Scholar 

  12. Baum J. A review of the psychological aspects of rheumatic diseases. Semin Arthritis Rheum 1982; 11: 352–8.

    Article  PubMed  CAS  Google Scholar 

  13. Weinberger M, Tierney WM, Cowper PA, et al. Cost-effectiveness of increased telephone contact for patients with osteoarthritis: a randomized, controlled trial. Arthritis Rheum 1993; 36: 243–6.

    Article  PubMed  CAS  Google Scholar 

  14. Rene J, Weinberger M, Mazzuca SA, et al. Reduction of joint pain in patients with knee osteoarthritis who have received telephone calls from lay personnel whose medical treatment regimes have remained stable. Arthritis Rheum 1992; 35: 511–5.

    Article  PubMed  CAS  Google Scholar 

  15. Dexter PA. Joint exercises in elderly persons with symptomatic osteoarthritis of the hip or knee: performance patterns, medical support patterns and the relationship between exercising and medical care? Arthritis Care Res 1992; 5 (1): 36–41.

    Article  PubMed  CAS  Google Scholar 

  16. Allegrante JP, Kovar PA, MacKenzie CR, et al. A walking education program for patients with osteoarthritis of the knee: theory and intervention strategies. Health Educ Q 1993; 20: 63–81.

    Article  PubMed  CAS  Google Scholar 

  17. Kovar PA, Allegrante JP, MacKenzie CR, et al. Supervised fitness walking in patients with osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med 1992; 116: 529–34.

    PubMed  CAS  Google Scholar 

  18. Fisher NM, Pendergast DR, Gresham GE. Muscle rehabilitation: its effects on muscular and functional performance of patients with knee osteoarthritis. Arch Phys Med Rehabil 1991; 72: 367–74.

    PubMed  CAS  Google Scholar 

  19. Chamberlain MA, Care G, Harfield B. Physiotherapy in os- teoarthrosis of the knees. A controlled trial of hospital versus home exercises. Int Rehab Med 1982; 4: 101–6.

    CAS  Google Scholar 

  20. Pothier B, Allen ME. Kinesiology and the degenerative joint. Rheum Dis Clin North Am 1990; 16: 989–1002.

    PubMed  CAS  Google Scholar 

  21. Panush RS, Holtz HA. Is exercise good or bad for arthritis in the elderly? South Med J 1994; 87: S74–8

    PubMed  CAS  Google Scholar 

  22. Ytterberg SR, Mahowald ML, Krug HE. Exercise for arthritis. Baillieres Clin Rheumatol 1994; 8: 161–89.

    Article  PubMed  CAS  Google Scholar 

  23. Falconer J, Hayes KW, Chang RW Effect of the ultrasound on mobility in osteoarthritis of the knee, a randomized clinical trial. Arthritis Care Res 1992; 5: 29–35

    Article  PubMed  CAS  Google Scholar 

  24. Jan MH, Lai JS. The effects of physiotherapy on osteoarthritic knees of females. J Formos Med Assoc 1991; 90: 1008–13.

    PubMed  CAS  Google Scholar 

  25. Stelian J, Gil I, Habot B, et al. Improvement of pain in elderly patients with degenerative osteoarthritis of the knee treated with narrow-band light therapy. J Am Geriatr Soc 1992; 40: 23–6.

    PubMed  CAS  Google Scholar 

  26. Elkayam O, Wigler I, Tishler M, et al. Effect of spa therapy in Tiberias on patients with rheumatoid arthritis and osteoarthritis. J Rheumatol 1991; 18: 1799–803.

    PubMed  CAS  Google Scholar 

  27. Meade TW, Dyer S, Browne W, et al. Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment. BMJ 1990; 300: 1431–7.

    Article  PubMed  CAS  Google Scholar 

  28. Feibel A, Fast A. Deep heating joints: a reconsideration. Arch Phys Med Rehabil 1976; 57: 513–4.

    PubMed  CAS  Google Scholar 

  29. Dequeker J, Goris P, Utterhoeven R. Osteoporosis and osteoarthritis (osteoarthrosis), anthropometric distinctions. JAMA 1983; 249: 1448–52.

    Article  PubMed  CAS  Google Scholar 

  30. Felson DT, Zhang Y, Anthony JM, et al. Weight loss reduces the risk for symptomatic knee osteoarthritis in women. The Framingham Study. Ann Intern Med 1992; 116: 535–9.

    PubMed  CAS  Google Scholar 

  31. Sasaki T, Yasuda K. Clinical evaluation of the treatment of osteoarthritic knees using a newly designed wedged insole. Clin Orthop Relat Res 1987; 221: 181–7.

    PubMed  Google Scholar 

  32. Thompson JA, Jennings MB, Hodge W. Orthotic therapy in the management of osteoarthritis. J Am Podiatr Med Assoc 1992; 82: 136–9.

    PubMed  CAS  Google Scholar 

  33. Tohyama H, Yasuda K, Kaneda K. Treatment of osteoarthritis of the knee with heel wedges. Int Orthop 1991; 15: 31–3.

    Article  PubMed  CAS  Google Scholar 

  34. Callahan CM, Drake BG, Heck DA, et al. Patient outcomes following tricompartmental total knee replacement. A meta-analysis. JAMA 1994; 271: 1349–57.

    Article  PubMed  CAS  Google Scholar 

  35. Goggia PP, Christensen CM, Schmidt C. Total hip replacement in patients with osteoarthritis of the hip, improvement in pain and functional status. Orthopedics 1994; 17: 145–50.

    Google Scholar 

  36. Cushnaghan J, McCarthy C, Dieppe P. Medial taping of the patella: a new treatment for osteoarthritis? Br J Rheumatol 1993; 32 Suppl. 1: 105

    Google Scholar 

  37. Prodromos CC, Andriachhi TP, Galante JO. A relationship between gait and clinical changes following high tibial osteotomy. J Bone Joint Surg 1985; 67A: 1188–94

    Google Scholar 

  38. Andersson C, Gillquist J. Treatment of acute isolated and combined ruptures of the anterior cruciate ligament. A long-term follow-up study. Am J Sports Med 1992; 20: 7–12.

    Article  PubMed  CAS  Google Scholar 

  39. Miller MD, Fu FH. The role of osteotomy in the anterior cruciate ligament-deficient knee. Clin Sports Med 1993; 12: 697–708.

    PubMed  CAS  Google Scholar 

  40. Livesley PJ, Doherty M, Needoff M, et al. Arthroscopic lavage of osteoarthritic knees. J Bone Joint Surg (Br) 1991; 73: 922–6.

    CAS  Google Scholar 

  41. Dawes PT, Kirlew C, Haslock I. Saline washout for knee osteoarthritis. Results of a controlled study. Clin Rheumatol 1987; 6: 61–3.

    Article  PubMed  CAS  Google Scholar 

  42. Chang RW, Falconer J, Stulberg SD, et al. A randomized, controlled trial of arthroscopic surgery versus closed-needle joint lavage for patients with osteoarthritis of the knee. Arthritis Rheum 1993; 36: 289–96.

    Article  PubMed  CAS  Google Scholar 

  43. Christensen BV, Iuhl IU, Vilbek H. Acupuncture treatment of severe knee osteoarthrosis. A long-term study. Acta Anaesthesiol Scand 1992; 36: 519–25.

    Article  PubMed  CAS  Google Scholar 

  44. Taylor P, Hallet M, Flaherty L. Treatment of osteoarthritis of the knee with transcutaneous electrical nerve stimulation. Pain 1981; 11: 233–46.

    Article  PubMed  CAS  Google Scholar 

  45. Berkson DL. Osteoarthritis, chiropractic and nutrition. Osteoarthritis considered as a natural part of three stage subluxation complex. Its reversibility, its relevance and treatability by chiropractic and nutritional correlates. Med Hypotheses 1991; 36: 356–67.

    Article  PubMed  CAS  Google Scholar 

  46. Jason MIV. A limited role for manipulation. BMJ 1986; 293: 1454–5.

    Article  Google Scholar 

  47. Trock DH, Bollet AJ, Dyer RH, et al. A double-blind trial of the clinical effects of pulsed electromagnetic fields in osteoarthritis. J Rheumatol 1993; 20: 456–60.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Service de Rhumatologie A, Hôpital Cochin, 27 rue du Faubourg Saint Jacques, F75014, Paris, France

    Serge Perrot &  Charles-Joel Menkes

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  1. Serge Perrot
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  2. Charles-Joel Menkes
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Perrot, S., Menkes, CJ. Nonpharmacological Approaches to Pain in Osteoarthritis. Drugs 52 (Suppl 3), 21–26 (1996). https://doi.org/10.2165/00003495-199600523-00005

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