The impact of osteopathic correction on the clinical course of knee osteoarthritis and the need for analgesic therapy in patients with metabolic syndrome: First results of a controlled randomized study

Abstract

Introduction . Osteoarthritis (OA) is one of the most common pathologies of the musculoskeletal system and the leading cause of chronic pain and disability in the general population. Pharmacotherapy for pain in OA is associated with serious limitations in this category of patients. It does not always provide sufficient control of symptoms and may be accompanied by side effects, which necessitates the search for additional non-pharmacological rehabilitation methods. The aim of the study : to evaluate the impact of osteopathic correction (OC) of somatic dysfunctions on pain intensity, quality of life, and average daily analgesic requirement in patients with knee osteoarthritis (KJO) and comorbid metabolic syndrome (MS) as part of comprehensive medical rehabilitation. Materials and methods . A controlled, randomized study was conducted. The study included 49 patients with KJO and MS, matched for key demographic and clinical parameters. Two groups were randomized: the study group (n=20), which received drug therapy (chondroitin sulfate and glucosamine hydrochloride, 1 000 mg/day) and a course of OC for somatic dysfunctions (one session per week for 30 days, a total of 3 sessions), and the control group (n=29), which received only the indicated drug therapy. Paracetamol was allowed on demand in both groups. Efficacy was assessed at baseline and on day 30 of observation using the WOMAC questionnaire, visual analogue scale (VAS) for pain, and recording the average daily dose of paracetamol (mg/day). Results . By day 30 of observation, both groups demonstrated comparable and statistically significant (p< 0,01) improvements in clinical parameters: a decrease in WOMAC scores (from 28,5 to 17 in the study group and from 31,5 to 21 in the control group) and VAS pain intensity (from 55 to 39 mm and from 58 to 38 mm, respectively). A key difference was identified in the dynamics of analgesic requirements: in the study group, the average daily paracetamol dose decreased by half (from 1 000 to 500 mg/day), while in the control group it remained unchanged (1 000 mg/day). Conclusion . Incorporating osteopathic correction of somatic dysfunctions into the comprehensive rehabilitation of patients with knee OA and metabolic syndrome provides clinical improvement similar to standard drug therapy, while also allowing for a statistically significant (by half) reduction in the average daily paracetamol requirement. This reduces the pharmacological burden and potential risks of drug-induced complications (hepatotoxicity and nephrotoxicity) in patients with comorbidities, for whom the safety of analgesic therapy is critical. The obtained data substantiate the advisability of using OCs as a non-pharmacological component in the management of this category of patients.