Osteoarthritis (OA) of the knee is one of the most common maladies seen in a rheumatology office.

The standard forms of treatment include non-steroidal anti-inflammatory drugs (NSAIDS), topical analgesics (eg., "rubs"), injections of glucocorticoids ("cortisone"), injections of viscosupplements (lubricants), and bracing. Arthroscopic treatment - going into the joint with a small telescope and cleaning out the knee- is occasionally helpful. For advanced cases, surgery with joint replacement is needed.

However, there are other approaches that have been used that are non-invasive and can provide short term relief. These are termed "physical modalities". These physical measures such as electrical stimulation, electroacupuncture, and low level laser ("cold laser") therapies have been reported to be helpful as an adjunctive approach to pain relief for patients with OA of the knee.

Recent evidence has surfaced supporting the role of physical modalities. A recent study (Bjordal M, et al BMC Musculoskeletal Disorders 2007; 8) reviewed a total of 33 randomized, placebo-controlled studies where OA of the knee was treated using different modalities.

Treatments used in these studies included transcutaneous electrical nerve stimulation (TENS), a low level type of electrical stimulation, electroacupuncture (EA), where electrical impulses are delivered at specific points near and around the joint, low level laser therapy (LLLT) - also know as "cold laser", pulsed electromagnetic fields, manual acupuncture, static magnets, and ultrasound.

There was no clinically significant improvement after manual acupuncture, static magnets, and ultrasound therapies, and minimal improvement with pulsed electromagnetic fields. In contrast, there was significant clinical improvement following treatment with TENS, EA, and LLLT. The improvements were about the same for all three treatments.

From the data, the pain relieving effects of TENS was still present at 2-4 weeks following treatment and that of EA was retained for 8 weeks after the end of treatment. LLLT also appeared to give slight pain relief up to 8 weeks after treatment was discontinued.

The authors noted that while the sample sizes were small, the results seen with these physical modalities compared favorably with results seen with drug treatment for knee osteoarthritis. Also, electrical stimulation and low-level laser therapy had potentially fewer and less severe side-effects than that associated with NSAID therapy.

In addition, the beneficial effects of the physical modalities seemed to last longer after discontinuation which is also different than that occurring with NSAID, where the beneficial effects wear off once the drug is discontinued.

The bottom line is that physical modalities offer another potential option for patients suffering from the pain of OA of the knees. It is important to remember that many patients with OA of the knees may have co-morbid conditions- other medical problems- that may prohibit them from receiving oral medicines for their osteoarthritis. Physical modalities may provide a solution to pain relief.

About the Author

Nathan Wei, MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine. For more info: Arthritis Treatment