Benefits and Limitations of Non-traditional Approaches
A study on glucosamine and chondroitin showed that it had no effect on the symptoms and signs of chronic knee pain as compared to placebo. However, pooled results from a review show other interesting findings. Glucosamine and chondroitin preparations are as safe as a placebo and might be effective in relieving pain in patients with osteoarthritis of the knee when compared to a placebo. Misuse of this data may lead to false conclusion that non-traditional therapies have a placebo effect and are medically ineffective. The knee pain doctors also noted that many non-traditional treatments are not well researched and the patient may end up as a test subject. An example would be microcurrent therapy for knee pain. In animal studies, it has been shown to moderate arthritis, but human studies on knee pain are lacking.
Effectiveness in Pain Management
With regards to the duration of treatment for knee pain patients in Singapore, it is expected that the effects of acupuncture will last longer than that of the NSAID, with or without being more sessions of acupuncture than the recommended course time for the NSAID. This will be weighed in future studies on the duration and therefore cost-effectiveness of the acupuncture in comparison to the medication.
Another study on 570 patients compared acupuncture with counseling in addition to the best care in general practice for patients with chronic back pain, failed to demonstrate specific effects from acupuncture. However, the recent National Institute of Health and Clinical Excellence (NICE) guidelines for management of low back pain and sciatica recommend offering a course of acupuncture needling because it is more effective than no treatment and is a cost-effective treatment for patients whose symptoms have not improved with other therapies. This is a general endorsement of the effectiveness of acupuncture for pain management.
The effectiveness of traditional NSAID medication and that of acupuncture were compared by a study published in 2004. The randomized controlled trial on 88 patients tested the efficacy of acupuncture against diclofenac, a traditional NSAID, and a fake acupuncture. The study concluded that in the short term, acupuncture was almost twice as effective as both diclofenac and fake acupuncture, and therefore more superior to the NSAID. It was also shown that there were no adverse events from the acupuncture, making it a favorable therapy. The limitation to this trial was a small sample size and a short trial period, therefore it’s not possible to determine the comparative duration of the effects or the long and short-term cost-effectiveness.
Potential Side Effects
Hormonal treatments also carry side effects in women and children, which may come from inadvertent exposure. Topical treatments are attractive due to the smaller risk of systemic side effects. Anti-inflammatory and opioid-based creams are available, but their efficacy and safety profile has not been fully established. Hormone replacement gels may carry the same risks as injectable forms. High doses of the formulation used by men have been associated with inadvertent virilization of women and children who have come into contact with the gel.
Anabolic steroid and testosterone abuse is associated with a whole host of side effects, the majority of which are dose-dependent. High doses of anabolic steroids may cause damage to soft tissue structures, such as ligaments and tendons. This is of particular concern in patients with painful osteoarthritis. Changes in mood and behavior are well documented with anabolic steroid abuse. This may be detrimental to the athlete who is trying to return to play, and it may also have negative effects on family and employment.
Potential side effects of glucosamine or chondroitin include diarrhea, indigestion, and abdominal pain. Others have suggested that patients may be at an increased risk for insulin resistance, and patients with shellfish allergies should avoid use of these compounds. Although the individual side effects may be mild, it is of extreme importance to consider the overall safety profile of these compounds in the knee pain population.
Integration with Conventional Treatments
From a conventional medical point of view, how a particular modality of alternative therapy integrates potentially with a conventional treatment may depend on whether the treatment is symptom-oriented or trying to affect a cure. It is likely that patients using alternative therapies for chronic degenerative conditions will continue with some form of the alternative therapy with the intent to alleviate symptoms, try to slow down progression of the condition, and improve their quality of life. An example would be a patient with degenerative meniscus or cartilage changes opting to have acupuncture for pain relief and later to prevent further damage in view of postponing or avoiding surgery. Alternative therapies are less likely to be used for a severe acute injury, e.g. fracture, ligament rupture, or post-surgery, given the nature of those conditions the treatment is usually designed to rehabilitate back to full function.
In terms of incorporating alternative therapies with conventional treatments, all interviewees shared that it is occasionally suggested to the patient. Dr. TCM mentioned that after he prescribes a series of herbs to a patient suffering from rheumatoid arthritis, he may send the patient back to the rheumatologist to cut down on the steroids if the herbs have been effective in controlling the condition. Massage therapists and chiropractors sometimes refer patients to physiotherapists. Dr. KK shared a recent experience where the anaesthetist persuaded his patient to go for epidural for her chronic pain in view of postponing the knee operation. The patient had tried various alternative therapies and is now considering acupuncture next to the epidural to stretch the duration of impending surgery. How the patient actually chooses to combine conventional and alternative treatments will depend on the nature of his condition, level of pain or dysfunction, personal philosophy, and financial resources.
Choosing the Right Knee Pain Doctor in Singapore
With advances in the internet and communication technology, it is increasingly easy to find patient reviews and testimonials of healthcare providers in Singapore. Patient reviews can be found on search engines, forums, and social media. Many clinics in Singapore have set up Facebook Pages and other social media accounts for the public to follow and comment on. A doctor’s ability to communicate and explain complex medical conditions and treatment options is an important skill, and a favorable review may be an indication of this. However, it is important to remember that there are many factors which may influence a patient’s opinion of a doctor, and a few good or bad reviews may not be an accurate reflection of the doctor.
A well-qualified doctor may or may not have a lot of experience. Some newly qualified doctors are very up to date with the latest research and treatments for knee pain. It is often best to ask the doctor questions about your condition and the treatment options. You may also wish to discuss the treatment plan with the doctor to get an idea of what to expect from the treatment. A doctor with more experience is more likely to accurately diagnose your condition and recommend an appropriate treatment. However, some older doctors may not be up to date with the latest research and treatments for knee pain.
It is important to ensure that the doctor you are considering seeing has the appropriate training and qualifications. Knee pain can be caused by a number of different conditions, and it is important to see a knee pain doctor Singapore who can accurately diagnose the condition and recommend the most appropriate treatment. For example, a recent study found that 50% of the time, primary care physicians incorrectly diagnose medial meniscal tears. In this case, seeing a Family Physician in Singapore with a postgraduate diploma in orthopedics or a specialist in Orthopedic Surgery would be more appropriate.
Qualifications and Experience
Different people will place different emphasis on the importance of a particular doctor’s qualification and experience. This will be partly dependent upon the severity of their knee pain and the potential long-term prognosis. Usually people with chronic knee pain or a more serious knee injury, such as a torn ligament, will attach more importance to this factor. In general, it is probably usually a good idea to find the most qualified and experienced knee doctor that you can. However, it is not always easy to measure a doctor’s ability in this way. An experienced doctor with an excellent reputation may not always have the most impressive looking qualifications. Conversely, there may be young orthopaedic specialists with the most up-to-date knowledge on knee treatments, but have yet to gain significant experience. A doctor’s experience and skills may also be more important for certain types of knee injury. For example, someone with a complex knee fracture requiring surgery would prefer an orthopaedic surgeon who has done many similar operations and is highly skilled in internal fixation.
To find a good knee pain doctor in Singapore usually involves a number of different things for different people. Everyone will have something different that they will consider important. Usually, the first port-of-call will be a personal family doctor. He will be in a good position to recommend you to a specialist, whatever your condition. After discussing your symptoms and potential causes, your GP might refer you to an orthopaedic specialist. The orthopaedic doctor will be able to optimally diagnose your knee pain and direct you to a treatment plan. This plan may involve a number of different treatments, including medications, injections, physical therapy, surgery or alternative therapy. If your knee pain is chronic, you may consider seeing an orthopaedic specialist who specializes in treating the whole knee joint.
Patient Reviews and Testimonials
Mixed reviews could suggest that some patients utilizing CAM are satisfied but others do not gain the relief they expected. This means that it is important for patients to carefully scrutinize the feedback to assess if it is an accurate representation of the therapy they seek. In general, knee pain patients will be viewing patient reviews and testimonials as a way to quickly gauge both the compatibility and expected success of a doctor and his treatments with their own condition.
Some popular sentiments regarding complementary medicines are “I was recommended glucosamine and chondroitin, but it didn’t work for me” or “The injection in my knee really helped, I’m glad I tried that before surgery”. These are both important insights for prospective patients who are considering the same treatments. Unfortunately, sometimes the feedback is more ambiguous or unconvincing. One survey found that one of the top factors in seeking CAM was persuasive advice from a provider, yet online ratings of general information providers and even specific treatment efficacy in the case of knee pain are best described as mixed.
Google and even Facebook reviews have become a convenient place for many consumers to rate and critique every service available on the market. Knee treatments are no exception, and these platforms are popular for patients to leave public feedback on the knee pain doctors that have tried to help them. Testimonials and reviews available on the clinic’s website are an additional resource that may provide both qualitative and quantitative ratings of that doctor’s services. Many patients are motivated to leave feedback because they feel strongly about the service they received, either in a positive or negative way.
Availability and Accessibility
When seeking alternative therapies for knee pain, particularly in a non-traditional setting, it may be difficult to initially find available qualified therapists and physicians. Although there are several certified practitioners in areas around the world, the number of physicians practicing traditional Chinese medicine, or other alternative treatments, is significantly lower than those of physicians who practice Western medicine. I have found this to be the case in Singapore in particular. There are a number of physicians and therapists who are trained in Western medicine techniques in Australia, America, and the UK. However, in the event that I decided to visit my family in Singapore, it may be difficult for me to find a qualified practitioner, particularly at short notice. This was reinforced by David, a TCM practitioner, who said that sometimes it is difficult for patients to locate a TCM physician when they are relatively unknown in the community or do not advertise their services. With all practitioners aware, newer graduates may find it difficult to immediately establish themselves in the community and gain a strong client base. This culminates in a lack of availability and accessibility of the right practitioner at the right time. This is critical when considering current evidence on treatment utilization for knee pain patients. Treatment is continually sought if the condition is chronic or if the patient is dissatisfied with their current level of pain and/or disability. This means that it is essential for a variety of treatment options. The patient must have access to an option to change treatments if the current one being used is unsatisfactory. This makes availability and accessibility a key issue in finding the right practitioner.
