Arthritis: physical therapies
A number of health professionals and practitioners offer physical therapies as ways of relieving the pain associated with arthritis. These include physiotherapy and acupuncture.
Physiotherapists use a wide range of techniques to treat the pain, stiffness and lack of mobility experienced by people with arthritis. These may include thermotherapy (the application of heat or cold), massage, joint mobilisation, and assessment of posture and the development of individualised exercise programmes.
Balneotherapy (mineral baths or spa therapy) has been used in both rheumatoid arthritis and osteoarthritis. A review of clinical trials on balneotherapy for rheumatoid arthritis concluded that although many of the findings were positive, the scientific evidence was weak and that future trials should avoid the flaws of earlier studies. Another review of trials of balneotherapy for osteoarthritis concluded that there is currently insufficient evidence to tell if spending time in mineral baths improves physical function or quality of life. The safety of balneotherapy has not been well studied.
Transcutaneous electrical nerve stimulation (TENS) is a form of electrical therapy used by physiotherapists. Some studies have shown TENS to be effective in relieving pain and improving muscle strength in people with rheumatoid arthritis of the hand and wrist, whereas other studies have not found such benefits. Similarly, a review of clinical studies of TENS in people with osteoarthritis of the knee was unable to conclude whether TENS was effective because the studies were too small and the results were conflicting. More research is needed to clarify the benefits of TENS in arthritis.
Low-level laser therapy
Low-level laser therapy has been used over the past decade as a non-invasive treatment for rheumatoid arthritis. The therapy involves a light source that generates light of a single wavelength which stimulates a chemical reaction in cells. In a review of clinical trials, low-level laser therapy was shown to reduce pain and morning stiffness in people with rheumatoid arthritis, with few side effects. However, this therapy does not appear to have long-lasting effects, and it is not clear whether the positive effects extend beyond rheumatoid arthritis of the hands. Another review found conflicting evidence of benefit when people with osteoarthritis were treated with low-level laser therapy.
Acupuncture appears to be a safe and effective addition, and sometimes alternative, to conventional therapies for certain health problems. It involves inserting fine needles into the skin at precise points, changing the experience of pain. These acupuncture points lie on specific channels of energy through the body called meridians. By stimulating the acupuncture points with a needle, it is believed that blockages in the flow of energy through the meridians can be cleared.
Western medicine research suggests that the mechanism of action of acupuncture may involve the stimulation and release of chemicals such as opioids (natural pain killers) in the nervous system as well as interfering with the transmission of pain messages along nerves.
Acupuncture may provide short-term pain relief for some people with arthritis by breaking the ‘pain cycle’ but, as with many complementary treatments, its results are quite variable. People differ in many ways and what may work for one person may not necessarily work for another. Moreover, while it does appear to relieve pain for some people with arthritis, relief is often only temporary, and treatment can be time-consuming and expensive. Scientific studies so far have not shown definitely that acupuncture is useful in rheumatoid arthritis. However, there is limited evidence that acupuncture improves pain and function in people with osteoarthritis of the knee.
The efficacy of acupuncture in relieving arthritis pain therefore remains controversial, particularly in terms of its effectiveness in the management of chronic (long-lasting) pain. It would appear to be more effective on fibromyalgia and soft-tissue pain than on rheumatoid arthritis and other systemic inflammatory conditions.
If you are unhappy with your conventional treatment, you may wish to ask your doctor if he or she thinks that acupuncture might help.
Last Reviewed: 09/11/2009
1. Verhagen AP, Bierma-Zeinstra SMA, Boers M, Cardoso JR, Lambeck J, de Bie R, de Vet HCW. Balneotherapy for rheumatoid arthritis. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD000518. DOI: 10.1002/14651858.CD000518. Updated Aug 2007. Available from: http://www.cochrane.org/reviews/en/ab000518.html (accessed Nov 2009).
2. Verhagen AP, Bierma-Zeinstra SMA, Boers M, Cardoso JR, Lambeck J, de Bie R, de Vet HCW. Balneotherapy for osteoarthritis. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD006864. DOI: 10.1002/14651858.CD006864. Updated Oct 2007. Available from: http://www.cochrane.org/reviews/en/ab006864.html (accessed Nov 2009).
3. Christie A, Jamtvedt G, Dahm KT, et al. Effectiveness of nonpharmacological and nonsurgical interventions for patients with rheumatoid arthritis: an overview of systemic reviews. Physical Therapy 2007; 87: 1697-1715.
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5. Juhl C. Short term beneficial effects of low level laser therapy for patients with rheumatoid arthritis [commentary]. Aust J Physiotherapy 2006; 52: 224.
6. National Center for Complementary and Alternative Medicine. Acupuncture for pain [website]. May 2009. Available from: http://nccam.nih.gov/health/acupuncture/acupuncture-for-pain.htm (accessed Nov 2009).
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