Combination of Curcuminoid With Acupressure for Inflammation and Pain in the Elderly With Osteoarthritis Genu

Osteoarthritis, Knee Clinical Trial

Official title:

Effect of Combination of Curcuminoid Standardized Turmeric Extract With Acupressure on Inflammatory Markers, Endorphins and Quality of Life in Elderly People With Osteoarthritis Genu

Clinical Trial Details — Status: Enrolling by invitation

Administrative data

• NCT number: NCT06105840
• Other study ID #: KE/FK/0674/EC/2023
• Status: Enrolling by invitation
• Phase: Phase 1/Phase 2
• Start date: August 27, 2023
• Est. completion date: October 31, 2023

Study information

• Verified date: October 2023
• Source: Gadjah Mada University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The goal of this clinical trial is to to investigate the efficacy of acupressure and standardized curcuminoids from turmeric extract to inflammatory markers, endorphin hormones in the blood and quality of life in elderly patient with Osteoarthritis Genu.

The main questions it aims to answer are:

1. Is there any effect combination of acupressure and standardized curcuminoids from turmeric extract to inflammatory markers in elderly patients with Osteoarthritis Genu?

2. Is there any effect combination of acupressure and standardized curcuminoids from turmeric extract to endorphin hormones in the blood in elderly patients with Osteoarthritis Genu?

3. Is there an effect combination of acupressure and standardized curcuminoids from turmeric extract to quality of life in elderly patients with Osteoarthritis Genu?

Participants in the intervention group received 2 treatments, namely acupressure at points that provide osteoarthritis-specific comfort and standardized curcuminoids from turmeric extract capsules. Participant in the control group alo would receive 2 treatments, an active placebo (starch capsules and sham acupressure).

Researchers will compare interventional group and sham group to see efficacy the combination therapy

Description:

Background. One of the degeneration processes that occurs in the elderly is the musculoskeletal system. These deteriorations include bone loss and a decrease in joint fluid volume which is exacerbated by bearing the weight of the body. Pain in Osteoarthritis patients affects many areas of quality of life such as physical function, emotional behavior, and mental health. Osteoarthritis-related pain is a major factor in poor quality of life. The most common pharmacological treatment to control pain is the use of non-steroidal anti-inflammatory drugs (NSAIDs), but these drugs carry the risk of causing side effects. Limitations associated with pharmacologic treatment result in patients choosing commonly available alternative therapies for pain management. Popular alternative therapies include herbal therapy, therapeutic touch, relaxation techniques, music therapy, acupuncture, and acupressure. This alternative therapy, unlike the use of drugs, does not produce dangerous side effects.

Research on the effectiveness of herbal therapy on inflammatory osteoarthritis patients was conducted in Indonesia in 2009 on 80 sufferers with the result that administration of turmeric rhizome extract curcuminoids significantly suppressed the activity of synovial fluid monocytes to secrete Cyclooxygenase-2 (COX-2) and Reactive Oxygen Intermediate (ROI), reduced leukocyte numbers and fluid Malondialdehyde (MDA) levels. synovia and reduces Osteoarthritis (OA) joint pain, with an ability that is not significantly different compared to diclofenac sodium therapy 3x25 mg per day. Furthermore, the development of herbal therapy for Osteoathritis continued with research which proved that the combination of ginger, ginger, soybean and shrimp shell extracts provided significant results in reducing joint pain, stiffness and physical disability which were evaluated based on the Western Ontario and McMaster values. Universities Osteoarthritis Index (WOMAC) and did not show a significant difference when compared with meloxicam.

Research that has been carried out to evaluate the effectiveness of acupressure therapy for the pain of Osteoarthritis patients was also carried out in several countries, including by study on 40 Osteoarthritis patients who were divided into two groups (intervention and control). In the intervention group, acupressure therapy was given for 5 days with a duration of 30 minutes each time. The results showed that the average pain score in the intervention group decreased significantly from 5.89 at the beginning of the study to 4.11 at the end of the study, while the pain score did not change substantially in the control group. These findings remained consistent after adjusting for age, weight, and pretreatment covariates. This study supports the evidence that Acupressure therapy provides an effective option for short-term knee pain relief in patients with knee Osteoarthritis. In line with the results, there was research which was conducted on 51 elderly with osteoarthritis divided into 3 groups (acupressure intervention, placebo and control). This study revealed that respondents who received acupressure therapy for 3-4 weeks with the duration of each therapy being 10-15 minutes, showed a significant reduction in the total WOMAC index, pain and physical dysfunction.

So far, there has been no research combining standardized curcuminoid turmeric extract therapy with acupressure for inflammation and pain in osteoarthritis patients. More clinical trials with appropriate methodology are needed to confirm the effectiveness of standardized turmeric extract, curcuminoids and acupressure to treat physical problems in osteoarthritis patients.

Study Design/Methods. The research will be carried out by design Randomized Controlled Trials (RCT). Respondents will be divided randomly into 2 groups, namely treatment and control. The treatment group will receive interventions, namely herbal therapy and acupressure therapy, while the control group will receive active placebo (capsules containing starch and acupressure massage at points that are not to provide comfort for knee pain). In this study, a double blind technique was used , that is, the subjects and researchers did not know which respondents were in the treatment group and which respondents were in the control group.

Data Analysis Plan

1. Analysis Descriptive Data obtained done tabulation in accordance with general data grouping and special data results measurement variable pre-test and post-test research . Data analysis will used For get description general from each variable . Data processing uses distribution frequency , reading data distribution (mean, mode, median, etc deviation )

2. Analysis Inferential For know difference effectiveness on second group , researcher use Test the Difference with using the Independent T-Test and Wilcoxon Sign Rank Test. Analysis done on difference all over variable before And after done intervention on second group

Recruitment information / eligibility

• Status: Enrolling by invitation
• Enrollment: 70
• Est. completion date: October 31, 2023
• Est. primary completion date: October 31, 2023
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 60 Years and older

Eligibility

The inclusion criteria in this study are:

1. Clinical diagnosis of osteoarthritis which confirmed by physical examination and x-rays

2. Experience pain with a Numeric Rating scale of 1-7

3. Must be able to swallow capsules

4. Must be able to carry out mobility without assistance or with minimal assistance

The exclusion criteria in this study are:

1. Parkinson's disease

2. Dementia disease

3. Psychosis disease

4. New bone fractures

5. Joint dislocations

6. Cancer

7. Rheumatic diseases other than osteoarthritis (rheumatoid arthritis)

8. Undergoing joint replacement therapy.

9. Analgesic dependent disease

Related Conditions & MeSH terms

• Osteoarthritis
• Osteoarthritis, Knee

Intervention

Procedure:
• Acupressure and Standardized Curcuminoid from Turmeric Extract
capsules containing curcuminoid from Tumeric Extract three times a day for 3 weeks and acupressure massage at points provide comfort for knee pain twice a week for 3 weeks
• Sham Acupressure and Placebo
capsules containing starch three times a day for 3 weeks and acupressure massage at points that are not to provide comfort for knee pain twice a week for 3 weeks

Locations

Country	Name	City	State
Indonesia	Padukuhan Tanjungsari Kelurahan Sukoharjo Ngaglik	Sleman	Yogyakarta

Sponsors (1)

Lead Sponsor	Collaborator
Gadjah Mada University

Country where clinical trial is conducted

Indonesia, 

References & Publications (17)

Adamczak A, Ozarowski M, Karpinski TM. Curcumin, a Natural Antimicrobial Agent with Strain-Specific Activity. Pharmaceuticals (Basel). 2020 Jul 16;13(7):153. doi: 10.3390/ph13070153. — View Citation

Alinaghizadeh M, Hawkins J, Abbassian A, Seif Barghi T, Ayati MH, Alizadeh Vaghasloo M. Effect of Persian acupressure (Ghamz) on Patients with Knee Osteoarthritis: A Single-Blinded Parallel Clinical Trial. Pain Manag Nurs. 2021 Dec;22(6):820-827. doi: 10. — View Citation

Cheung DST, Yeung WF, Suen LK, Chong TC, Ho YS, Yu BY, Chan LY, Chen HY, Lao LX. Self-administered acupressure for knee osteoarthritis in middle-aged and older adults: a pilot randomized controlled trial. Acupunct Med. 2020 Apr;38(2):75-85. doi: 10.1177/0 — View Citation

Gomes TPO, Souza JIN, Somerlate LC, Mendonca VA, Lima NM, Carli GP, Castro SBR, de Jesus A S Andrade T, Dias JVL, Oliveira MAL, Alves CCS, Carli AP. Miconia albicans and Curcuma longa herbal medicines positively modulate joint pain, function and inflammat — View Citation

Guo D, Ma S, Zhao Y, Dong J, Guo B, Li X. Self-administered acupressure and exercise for patients with osteoarthritis: A randomized controlled trial. Clin Rehabil. 2022 Mar;36(3):350-358. doi: 10.1177/02692155211049155. Epub 2021 Oct 18. — View Citation

Ho KK, Kwok AW, Chau WW, Xia SM, Wang YL, Cheng JC. A randomized controlled trial on the effect of focal thermal therapy at acupressure points treating osteoarthritis of the knee. J Orthop Surg Res. 2021 Apr 27;16(1):282. doi: 10.1186/s13018-021-02398-2. — View Citation

Kare SK, Vinay V, Maresz K, Prisk V, Vik H. Tamarindus indica Seed Extract-Based Botanical Compositions Alleviate Knee Pain and Improve Joint Function in Mild-to-Moderate Osteoarthritis: A Randomized, Double-Blind, Placebo-Controlled Clinical Study. Evid — View Citation

Kertia N, Asdie AH, Rochmah W, Marsetyawan. Ability of curcuminoid compared to diclofenac sodium in reducing the secretion of cycloxygenase-2 enzyme by synovial fluid's monocytes of patients with osteoarthritis. Acta Med Indones. 2012 Apr;44(2):105-13. — View Citation

Lee WJ, Park H. Effects of auricular acupressure on sleep and pain in elderly people who have osteoarthritis and live in nursing homes: A randomized, single-blind, placebo-controlled trial. Explore (NY). 2023 Mar-Apr;19(2):214-222. doi: 10.1016/j.explore. — View Citation

Li LW, Harris RE, Tsodikov A, Struble L, Murphy SL. Self-Acupressure for Older Adults With Symptomatic Knee Osteoarthritis: A Randomized Controlled Trial. Arthritis Care Res (Hoboken). 2018 Feb;70(2):221-229. doi: 10.1002/acr.23262. Epub 2017 Dec 29. — View Citation

Madhu K, Chanda K, Saji MJ. Safety and efficacy of Curcuma longa extract in the treatment of painful knee osteoarthritis: a randomized placebo-controlled trial. Inflammopharmacology. 2013 Apr;21(2):129-36. doi: 10.1007/s10787-012-0163-3. Epub 2012 Dec 16. — View Citation

Pinsornsak P, Niempoog S. The efficacy of Curcuma Longa L. extract as an adjuvant therapy in primary knee osteoarthritis: a randomized control trial. J Med Assoc Thai. 2012 Jan;95 Suppl 1:S51-8. — View Citation

Rahimnia AR, Panahi Y, Alishiri G, Sharafi M, Sahebkar A. Impact of Supplementation with Curcuminoids on Systemic Inflammation in Patients with Knee Osteoarthritis: Findings from a Randomized Double-Blind Placebo-Controlled Trial. Drug Res (Stuttg). 2015 — View Citation

Raj JP, Venkatachalam S, Racha P, Bhaskaran S, Amaravati RS. Effect of Turmacin supplementation on joint discomfort and functional outcome among healthy participants - A randomized placebo-controlled trial. Complement Ther Med. 2020 Sep;53:102522. doi: 10 — View Citation

Sorour AS, Ayoub AS, Abd El Aziz EM. Effectiveness of acupressure versus isometric exercise on pain, stiffness, and physical function in knee osteoarthritis female patients. J Adv Res. 2014 Mar;5(2):193-200. doi: 10.1016/j.jare.2013.02.003. Epub 2013 Apr — View Citation

Srivastava S, Saksena AK, Khattri S, Kumar S, Dagur RS. Curcuma longa extract reduces inflammatory and oxidative stress biomarkers in osteoarthritis of knee: a four-month, double-blind, randomized, placebo-controlled trial. Inflammopharmacology. 2016 Dec; — View Citation

Wan Y, Sun W, Yang J, Ren J, Kou Q. The comparison of curcuminoid formulations or its combination with conventional therapies versus conventional therapies alone for knee osteoarthritis. Clin Rheumatol. 2022 Jul;41(7):2153-2169. doi: 10.1007/s10067-022-06 — View Citation

* Note: There are 17 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Inflammation Marker	Inflammation markers are carried out by measuring Leukocyte Number, NLR, Blood Sediment Rate and COX-2 hormone. Outcome measurements will be carried out a complete blood test using a Hematology Analyzer. Leukocyte numbers measured in microliter (mcL). Neutrophil-Lymphocyte Count Ratio can be calculated from the number of neutrophils (cells) and lymphocytes (cells). Neutrophils and lymphocytes will be combined to report Neutrophil-Lymphocyte Count Ratio in %. Blood Sediment Rate is a measurement of the difference in the decrease in height of red blood cells in a test tube (mm) divided by the time (hours) required for all of them to settle to the bottom of the test tube. There will be combined to report Blood Sediment Rate in mm/hr. The COX-2 hormone examination was carried out using the Enzyme Linked Immunosorbent Assay (ELISA). The amount of COX-2 Hormone in the blood in nanograms and blood sample volume in milliliters will be combined to report secretion of COX-2 in ng/mL	Outcome measurements will be carried out before starting therapy and after 3 weeks of therapy
Primary	Endorphin Hormones	Secretion of endorphin hormones Endorphins, in this case beta endorphin, are hormones released by the pituitary gland in response to stress or pain, which are also secreted in blood plasma. Endorphin hormone examination is carried out using the Enzyme Linked Immunosorbent Assay (ELISA) method on blood plasma. The amount of Endorphin Hormone in the blood in nanograms and the blood sample volume in milliliters will be combined to report secretion of COX-2 in ng/mL	Outcome measurements will be carried out before starting therapy and after 3 weeks of therapy

External Links

•   Acujoint, a highly efficient formulation with natural bioactive compounds, exerts potent anti-arthritis effects in human osteoarthritis - A pilot randomized double blind clinical study compared to combination of glucosamine and chondroitin
•   Adjunctive effects of acupressure therapy on pain and quality of life in patients with knee osteoarthritis: an interventional study.
•   Effectiveness of knee acupressure along with herbal knee poultice for knee osteoarthritis treatment: A pilot pre-post clinical study.
•   Effects of auricular acupressure on joint pain, range of motion, and sleep in the elderly with knee osteoarthritis
•   The effect of acupressure therapy on pain, stiffness and physical functioning of knees among older adults diagnosed with osteoarthritis: A pilot randomized control trial.