Among geriatric conditions that increase with age is a common chief complaint of knee pain that affects mobility. For the “oldest old,” getting around is the most common problem. Difficulty doing errands alone and mobility-related limitations are the two most common types of disability for those over age 90, according to the U.S. Census Bureau.
Osteoarthritis (OA) is the most prevalent joint disease and a leading source of chronic pain and disability in the United States.
According to a study done by Front Public Health, OA accounts for more than 80% of the disease’s total burden. For the 85-plus population, OA is the second most common chronic condition and cause of chronic pain and disability (after hypertension). Fifty-two percent of 85 year olds had a diagnosis of OA in one study. Because pain management will continue to be a vexing clinical and health policy problem as virtually all analgesics have remarkable risks in older adults, nonpharmacologic treatments can help.
Key causes of OA
The cause of knee OA includes many factors, with injury, obesity, genetics and a history of high-impact activity among them.
Often, knee OA pain is worse with movement and use of the joint. As knee OA worsens, the patient loses range of motion and mobility.
The signs and symptoms include pain with walking, climbing stairs, bending, swelling, limping and insomnia due to pain. There is currently no way to reverse the deterioration of the knee joint, so treatment includes ameliorating the symptoms, lifestyle changes and/or surgery with the goal of maintaining the activity level of the patient.
Treatment starts with possible weight loss, activity modification, exercises, proper footwear and the use of a cane, knee braces or sleeves.
Pain management includes oral as well as intra-articular pharmacologic options. Joint replacement surgeries are effective and cost-effective for patients with significant symptoms or functional limitations, providing improvements in pain, function and quality of life.
Chinese medical perspective
According to Chinese medicine, the “oldest old” lack kidney essence, as this essential “substance” declines with age. Therefore, the common complaints of old age aren’t a disease as much as a physiological decline of kidney essence. From a Chinese Medical perspective, this decline includes the deficiency of kidney yin, body fluids, yin substance of each organ, essence and blood.
These yin fluids contribute to the smooth function of joints. Yin deficiency develops over many years and manifests as dryness – dry mouth, dry skin or dry eyes. The prolonged yin-deficient condition leaves a feeling of heat and thirst.
The yin-deficiency tongue of the elderly shows a lack of tongue coating, with possible red tongue body. As for the symptoms of elderly knee OA, a weakness of the limbs may be additionally caused by other more complex diagnoses.
Other organs play a significant role in arthritis as well. The liver stores the blood and governs tendons. The kidney stores the essence and governs the bones, and the spleen governs the transformation, transportation and dominates the muscles.
The role of acupuncture
Using acupuncture points, the treatment for chronic knee pain due to osteoarthritis will focus on the deficiencies of older age, especially of yin deficiency. Your acupuncturist will choose points based on your individual constitution.
Treatment goals may include:
• Strengthening kidney yin (joint lubrication).
• Supporting spleen qi (muscle and tendon support).
• Electro-acupuncture will increase circulation and reduce pain locally.
• An external liniment will increase the lasting effects of the acupuncture and treat the local knee pain as well.
Research on the effectiveness of acupuncture in treating the pain of knee OA revealed many studies with positive results:
• In one study published in 1999, 73 patients received either standard care or acupuncture, and it was concluded that acupuncture is an effective and safe adjunctive therapy to conventional care for patients with OA of the knee. Another study in 2004 showed that acupuncture seems to provide improvement in function and pain relief as an adjunctive therapy for OA of the knee when compared with credible sham acupuncture and education control groups.
• Regarding electroacupuncture, a study showed that two weeks of repeated applications of transcutaneous electrical nerve stimulation at 2 Hz, 100 Hz or 2/100 Hz produced similar treatment effects for people suffering from OA knee.
Because knee OA cannot be reversed or cured, the treatment goals for elderly patients with include maintaining mobility, decreasing pain, monitoring overall health, providing post-operative healing in the event of joint replacement surgery and social support.
A study from 2007 titled “Depression, Social Support, and Quality of Life in Older Adults with Osteoarthritis” showed that social support appeared to play an important role in moderating the effects of pain, functional limitation and depression on these subjects’ quality of life.
Ted Ray, licensed acupuncturist and herbalist, is owner of Peninsula Acupuncture in Mountain View. For more information, call 564-9002 or visit peninsulaacupuncture.com