Treatment Current treatments for osteoarthritis can relieve symptoms such as pain and disability, but there is no cure for osteoarthritis. Treatment focuses on controlling pain, minimizing joint damage, and improving or maintaining function and quality of life. Massage can be an important component in treatment, contributing to pain relief, flexibility, and an overall sense of wellness. Patient education is considered an essential element of management of osteoarthritis. Effective education programs, such as the Arthritis Foundation Self-Help Program, are designed to teach pain management techniques, help individuals develop an exercise program and manage fatigue and stress, and provide information about effective use of medications. 7 Weight loss Overweight and obesity increases the pressure on the lower back, hips, and knees. It doesn’t take much weight loss for benefits to appear. Losing weight is especially significant for osteoarthritis of the knee. One study showed that obese people with osteoarthritis of the knee had a dramatic improvement of function with a rapid loss of 10 percent of their weight. 8 Exercise Exercise is one of the best treatments for osteoarthritis. The right exercise program can strengthen muscles, increase flexibility, help maintain a healthy weight, and improve mood and outlook. However, certain activities such as running, jogging, and tennis put pressure on affected joints. Alternative exercise activities that put less pressure on the joints are walking, yoga, swimming, and water aerobics. Quadriceps strengthening exercises are recommended for individuals with knee osteoarthritis. For elderly individuals with osteoarthritis of the hip or knee, levels of exercise that contribute to cardiovascular conditioning are especially important because of their increased risk for cardiovascular disease. Medicine Drug therapy for pain management is most effective when combined with exercise and weight loss, according to the American College of Rheumatology. Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen Massage therapy The benefits of massage to those suffering from osteoarthritis include increasing blood circulation, which can help reduce swelling and increase flexibility, relief of muscular aches and tension, and enhancing overall relaxation and a sense of wellness. The relaxation produced by massage can help break the cycle of pain and stress that often accompanies arthritis. The National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health, affirms that there appear to be few risks to massage therapy when used appropriately and provided by a trained massage professional. 11 The scientific reasons why massage is beneficial are not clearly understood by researchers. It is known that changes occur in the muscles when certain forces are applied, but the physiology of these changes is not clear. It is also known that massage enhances relaxation and reduces stress, which makes some diseases worse. NCCAM is sponsoring scientific studies to try to answer questions about the biochemical changes that occur in the body during massage. These are some of the proposed theories about ways in which massage therapy might produce its known benefits: 11 ● Provide stimulation that helps block pain signals to the brain. ● Produce a shift from the sympathetic nervous system, which responds to stress by helping to mobilize the body for action, to the parasympathetic nervous system, which responds by slowing the heart and breathing rates, dilating the blood vessels, and increasing activity in the digestive tract.
and naproxen are the most common medications given for osteoarthritis. 9 COX-2 inhibitors, available only by prescription, are another class of NSAIDs. Patients who are already taking medication for osteoarthritis and add the treatment of weight loss or exercise are encouraged to try reducing the dosage of the analgesic agent they are taking, to reach the lowest possible level of medication for relief. Glucosamine and chondroitin are dietary supplements that have been widely promoted as a treatment for osteoarthritis. Scientific studies of the efficacy of glucosamine and/or chondroitin are conflicting, however. A major clinical trial sponsored by the National Institutes of Health found that the combination of glucosamine and chondroitin sulfate did not provide significant relief among all participants, but did seem to be effective in relieving pain for those with more severe pain. 10 If patients wish to use the supplements, they are advised to work with their physician to explore the pros and cons of all treatment options and to be circumspect in purchasing them, because supplements are considered food and are not regulated as rigorously as are drugs by the Food and Drug Administration. Other treatments In addition to the primary treatments of weight loss, exercise, and medication, some people use a cane or splint to help take pressure off painful joints. Splints should be properly fitted by an occupational therapist or physician and, to avoid stiffness and weakness in the joints and muscles, should be used only for limited periods of time. Topical creams, gels, and sprays, such as the commercial products Zostrix, Icy Hot, and Ben Gay, contain ingredients that can work in several different ways. For example, the ingredients may stimulate the nerve endings to distract the brain from the joint pain or block the action of a neurotransmitter called substance P that sends pain messages to the brain. Surgical modalities are sometimes recommended for patients with severe pain that has not responded satisfactorily to medical therapy. 9 Surgery may be done to remove loose pieces of bone and cartilage from the joint, to reposition bones, or for a complete joint replacement. ● Stimulate the release of chemicals such as serotonin and endorphins. ● Induce beneficial biomechanical changes such as preventing fibrosis and increasing the flow of lymph, a fluid that is part of the body’s immune system. ● Improve sleep, which has a role in pain and healing. ● Induce positive responses as a result of the interaction between the massage therapist and the patient. The public rates massage highly as a treatment for osteoarthritis. In a national survey conducted by Consumer Reports in 2004, responders found deep-tissue massage to be especially effective for osteoarthritis and fibromyalgia, saying that massage therapy provided more relief than medication. 12 The survey also found that deep-tissue massage was one of the top three alternative medical treatments recommended by physicians for a number of ailments. Although rigorously designed scientific studies of the benefits of massage are sparse, a 2003 review of research included three randomized controlled trials that specifically evaluated massage and found massage to be effective. 13 Since that review, some additional scientific studies have shown the benefits of massage therapy in specific types of osteoarthritis. In one randomized control trial, half of the individuals with osteoarthritis of the knee were given Swedish massage twice a week for the first four weeks, and then weekly for an additional four weeks. 14 In comparison to the control group that did not receive massage, the subjects had significantly less pain and stiffness and better knee function.
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Book Code: MTX1323
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