Effects and Safety of Knee Wraps With Herbal Patches in Elderly Patients for the Treatment of Lom Jab Pong Haeng Khao (Knee Osteoarthritis)

Abstract

Introduction and Objectives: Lom Jab Pong Haeng Khao in Thai traditional medicine (TTM), also known as knee osteoarthritis (KOA), is a disease that causes knee pain and joint stiffness, leading to difficulty in movement. It also includes crackling sound when the knee is flexed, especially in the elderly. These symptoms thus affect the elderly’s physical and mental health. Consequently, movement limitations and an increased risk of falls may lead to depression and suffering due to chronic pain. Therefore, knee wraps with herbal patches are accepted as one of the options for treating this disease. The aim of this study was to evaluate the primary outcome regarding the effect and safety of the knee wraps with herbal patches formulated by the TTM Clinic at Khok Charoen Hospital in Lop Buri province, for relieving knee pain in elderly patients with KOA.

Methods:  This study was conducted, using a quasi-experimental research design, in a sample of elderly patients diagnosed with KOA who attended the TTM Clinic at Khok Charoen Hospital. The participants were recruited using non-probability sampling based on the following inclusion criteria: (1) age at least 60 years, (2) being diagnosed with KOA by a TTM doctor, (3) illustrating at least one of the following symptoms: knee pain, crackling when moving, and stiffness especially after waking up lasting less than 30 minutes, (4) using the services at the TTM Clinic of Khok Charoen Hospital, (5) no known allergic reactions to herbs especially Zingiber cassumunar (plai), Curcuma longa (turmeric), Citrus hystrix (kaffir lime), Piper nigrum (black pepper), and Cymbopogon citratus (lemongrass), and (6) willing to participate in the study. A total of 36 patients were allocated by non-probability sampling method and none withdrew from the study until its completion. The research initially prepared knee wraps with herbal patches containing Z. cassumunar, C. longa (turmeric), C. hystrix (kaffir lime), P. nigrum (black pepper), and C. citratus (lemongrass). All materials used in the herbal patch were well-prepared by TTM doctors; only fresh and raw herbs were selected and then kept at 4 degrees Celsius. The herbal patches were then taken to wrap the patients’ knees for 15 minutes per time, three times a week every other day for 4 weeks. The 12 times of knee wrapping were totally determined. Subsequently, the treatment was evaluated for its efficiency including pain dimension (joint pain), stiffness dimension (gelling phenomenon), and ability dimension (crepitus) using the Modified WOMAC Scale questionnaire and safety including observations for dryness, redness, irritation, and urticaria using the Visual Analog Scale (VAS) before and after treatment every week, and before and after 4-week treatment. Data analysis included frequency, percentage, mean, and standard deviation, and paired sample t-test for efficiency evaluation at a confidence level of 95 percent.

Results:  (1) Regarding primary outcomes, the mean levels of knee pain after knee wrapping with herbal patches significantly decreased from before, p–value < 0.001, at all dimensions, including levels of pain (before: 4.12 ± 1.36; after: 2.42 ± 1.04), stiffness (before: 3.62 ± 1.53; after: 2.13 ± 1.23), and function of the knee (before: 4.08 ± 1.93; after: 2.07 ± 1.46). (2) As for safety issues, there were only two patients with redness and minor allergies (5.56%) and one patient (2.78%) with irritation or minor allergy. No cases of dryness or urticaria were reported.

Discussion:  The five hot/astringent herbs in the herbal patches could expel and disperse the wind, and relieve knee pain. With their reported pharmacologic anti-inflammatory activities, they can help relieve the pain very well with low allergic reactions. Hence, the herbal patch is recognized as an alternate for KOA inflammation treatment and pain/swelling management.

Conclusion:  Knee wraps with herbal patches developed by the TTM Group at Khok Charoen Hospital are effective in reducing knee pain levels; and they are also safe for use as an alternative method for relieving the pain in KOA patients.