There is evidence that acupuncture can be considered as a viable treatment to reduce the pain and the physical dysfunction associated with osteoarthritis of the knee. This involves the management of pain and discomfort without medications.
At the level of the individual who has chronic pain we first have to work out which mechanisms are causing pain in that individual, and then proceed based on which mechanisms are causing pain in that individual. In a lot of chronic pain conditions, the pain may not be occurring because of damage or inflammation in the area of the body where someone is experiencing pain in the peripheral tissues, such as the knee.
The drug and non-drug therapies can be entirely different for each particular pain mechanism. So, patients need to empower themselves by rethinking where their pain is coming from and what types of doctors, therapists and treatments they should be seeing to get help with their pain. The patient can do a lot to direct their therapy in the right direction to help with their type of pain, including an awareness that a lot of drugs may only be marginally effective to treat chronic pain and have side effects. The patient has the best sense of what is going on in their body, and need to educate themselves and be more knowledgeable about managing their particular type of pain.
Osteoarthritis is by far the most common cause of arthritis, especially as people get to live longer and get tend to get heavier, especially in the western world. Nearly everyone will develop osteoarthritis if they live long enough and some of the most common areas to develop osteoarthritis are in the weight bearing areas such as the knees, the hips and the back.
Osteoarthritis was thought to be the classic peripheral pain condition where the degree of damage or inflammation seen on an x-ray or MRI or CAT scan would accurately predict who is experiencing pain and who is not experiencing pain. It was really thought to be a disease of the cartilage, and when the cartilage degraded, you eventually got bone rubbing on bone. And when bone is rubbing on bone, this would hurt. But 30% – 40% of people who have bone rubbing on bone have no pain, whereas 10% – 15% of these people do have severe knee pain. The point is that structural cartilage deterioration does not always cause pain – so what is causing this disparity? If there is no cartilage damage, then is the pain all in the head? Is it psychological? Then what is the appropriate drug and non-drug treatment?
The various underlying mechanisms of pain may need entirely different types of treatments because some people will not respond to opioids, surgical procedures or injections, and be more dependent on non-drug therapies. For example, the body’s two most potent internal analgesic systems are sleep and exercise, such as sleeping well and moving. Arthroplasty does not predictably relieve pain because not all people respond to a surgical procedure to remove their pain.
The sensory nerves throughout our body pick up things like heat, cold, chemicals, pressure and the like from the periphery. A lot of the information that is coming from the peripheral nerves is never supposed to be sent to the brain to be felt as pain. This is the information that most people don’t feel from the periphery, but people with a lot of chronic pain conditions do feel this information as pain. The pain is dependent on the pain pathways or neurotransmitters that inhibit and facilitate the transmission of pain to the brain, rather than what is happening out in the periphery. For example, it is not supposed to hurt to sit in a chair, but for people with chronic pain, sitting in a chair activates different nerves out in the periphery, and all of that information is allowed to go to the brain, to be felt as pain because the pain pathways to the brain are not working properly. A lot of things that aren’t supposed to hurt, do hurt, whereas normal people are more pain insensitive. For people with chronic pain, the normal filtering mechanisms whereby all the sensations that are going on in the peripheral tissues is not supposed to be felt as pain – but those filtering mechanisms are broken or absent or deficient, and this is why certain people experience pain for things that are not supposed to be painful. Sleep and exercise are some of the things that can assist these internal pain pathways. Only a third of the people in the general population have any type of chronic pain and usually have a low pain threshold and are more sensory sensitive.
These nerve pathways can be controlled. These nerve pathways can be changed.
Stress, anger, frustration and fear all amplify the overall experience of pain. Conversely, do something emotionally rewarding and it will have a pain relieving effect.
A rehabilitation approach can be particularly helpful for this type of pain – by getting people moving and getting people sleeping. Because of the pain, people reduce their activity levels. When you start becoming more active as a treatment for chronic pain, you have to start low, very slow and very gradually. The biggest mistake is to try to move straight into an exercise program. Slowly get better over time.
The NCBI website has an article on “Acupuncture and Osteoarthritis of the Knee”
There is strong evidence supporting the effectiveness of acupuncture for knee osteoarthritis. Please refer to AACMA – Australian Acupuncture and Chinese Medicine Association for The Acupuncture Evidence Project:
Further Related Reading:
Sinew acupuncture for Knee Osteoarthritis