ON Chiropractic Winter 2014 - Page 21

ON Chiropractic FEATURE STORY / OSTEOARTHRITIS slow disease progression and potentially delay or stave off surgery. In patients where the presence of central sensitization is identified, researchers encourage the use of neuroscience education over a biomechanical approach. Neuroscience education involves reducing pain and disability by helping the patient understand the biological processes underlying their pain. This approach “ other therapies have reported positive results. An RCT involving surgical hip osteoarthritis patients compared outcomes of patients who received education and manual therapy treatments by a chiropractor twice a week for six weeks to those of a control group that received only patient education. The combination of manual therapy and patient education was determined to be more effective. Patients who did not receive surgery reported that A combination of exercise therapy and patient education are likely to be the most efficacious supplements to your standard chiropractic treatment protocols.” is specifically recommended in central sensitization cases where the patient has developed maladaptive or coping strategies in response to their painn. Practice guidelines have been developed to help explain central sensitization to patients with chronic MSK pain.m Spinal Manipulative Therapy: here is not sufficient evidence to definitively state that spinal manipulation has a positive impact on the treatment or management of osteoarthritis. Randomized controlled trails (RCTs) have demonstrated that osteoarthritis patients who have received spinal manipulation in conjunction with T 20 WINTER 2014 the benefits of their care were maintained at 12 months.D Another study examined three groups of hip and knee osteoarthritis patients. One group received manual therapy, one received exercise therapy and one received both therapies. Both the manual therapy and the exercise approaches were more effective than the control group with results maintained at 12 months. There was no additional benefit to the combination of manual therapy and exercise therapy. In this RCT the manual therapy was performed by physiotherapists.q Another RCT of hip osteoarthritis patients found that manual therapy provided no additional effects over exercise therapy, but did increase patient satisfaction. Manual therapy was provided by physiotherapists in this study as well.Q Modalities and Acupuncture: ith respect to knee osteoarthritis, there are multiple studies that indicate that modalities, specifically interferential current (IFC), TENS, low level laser and acupuncture are beneficial. The evidence is inconclusive with respect to patients managing hip, spine and other forms of osteoarthritis. W Prescription Medications and NSAIDs: ver the counter and prescription medication use is very common for osteoarthritis patients. As osteoarthritis is most prevalent among seniors, the connection between narcotic prescription and NSAID use and the significantly increased risk of falls and fractures is particularly concerning. Side effects and the risk of dependency are also concerning. Chronic use of NSAIDs specifically is linked to numerous side effects, including upper and lower gastrointestinal (GI) damage, cardiovascular events, renal toxicity, increased blood pressure and deterioration of congestive heart failure. 40% of chronic NSAID users report upper GI symptoms, such as reflux, dyspepsia and ulcers. Many of these side effects are more common in the elderly.w O Nutraceuticals & Contemporary/ Alternative Therapies: lucosamine and hyaluronic acid use among osteoarthritis patients has been recently studied G with moderate benefits. Glucosamine can be beneficial in knee osteoarthritis. Hyaluronic acid was shown to result in a mild reduction in pain and is also correlated with increased risk of adverse events. Capsaicin, Indian frankincense, methyl-sulphonyl-methane and rose hip may also have moderate benefits. Other cont