Effects of Nigella Sativa Oil on Pain Intensity and Physical Functions in Patients With Knee Osteoarthritis
Condition: Knee Osteoarthritis
MeSH terms: Osteoarthritis; Osteoarthritis, Knee; Pain
Study type: Interventional

Summary: 
      Purpose: The study was conducted to determine the effect of 1 ml of nigella sativa oil
      applied for 2 minutes three times a day for 21 days on pain severity and physical functions
      in patients with knee osteoarthritis (OA).

      Design and methods: This randomized controlled study was conducted with patients diagnosed
      with knee OA and admitted to the physical therapy outpatient clinic of a public hospital in
      Turkey between February 15, 2021 and March 31, 2021. A total of 75 patients were included in
      the study, and 25 of them were assigned to the nigella sativa oil group, 25 to the naproxen
      and lidocaine gel group, and 25 to the massage group. Research data were collected using the
      "Patient Information Form", "Western Ontario and McMaster Universities Osteoarthritis Index
      (Western Ontario and McMaster Universities Osteoarthritis Index = WOMAC)" and knee joint
      range measurements were made. For 21 days, both knees were massaged for 2 minutes 3 times a
      day, 1 ml of nigella sativa oil was applied to the patients in the nigella sativa oil group,
      1 ml of naproxen and lidocaine gel was applied to the patients in the naproxen and lidocaine
      gel group, and 1 ml of liquid vaseline was applied to the patients in the massage group.
    

Detailed description: 
      Osteoarthritis (OA); It is a chronic degenerative joint disease that is frequently seen in
      all societies due to many factors such as age, gender, genetics, osteoporosis, high activity
      level, diet, obesity and occupation, negatively affecting the quality of life and causing
      problems such as joint pain and limitation of movement in the affected joint. Articular
      cartilage, subchondral bone, synovial membrane and periarticular muscles as well as all joint
      structures are affected by this disease. According to the Health Research data conducted by
      the Turkish Statistical Institute in 2019, it was determined that 14.6% of women over the age
      of 15, 7.6% of men and 11.2% of the general total had arthritis problems in Turkey. The World
      Health Organization estimates that 18% of women over the age of 60 and 9.6% of men worldwide
      experience OA symptoms, 80% of them develop limitation of movement due to pain and loss of
      function, and 25% are unable to perform activities of daily living. OA, whose incidence and
      prevalence increases with aging in particular, affects the knee, waist, neck, hip and hand at
      a high rate, while it affects the shoulder and ankle at a low rate. Common complaints; joint
      pain, stiffness, edema on the joint, a feeling of being stuck with the movement of the joint,
      and decreased range of motion. It is stated that the condition that most affects the patient
      is pain and psychological changes related to the disease.

      Since current medical treatment approaches cannot prevent tissue degeneration in OA, relief
      of pain and improvement of joint functions are at the forefront of treatment. In this
      respect, integrative approaches consisting of pharmacological, non-pharmacological and
      surgical or a combination of these are used in the treatment.

      In pharmacological treatment, starting with paracetamol according to the severity of the pain
      and increasing the severity of pain, non-steroidal anti-inflammatory drugs (NSAIDs), COX-2
      inhibitors, and topical drugs are switched. In addition, in some selected cases,
      intra-articular steroid and hyaluronic acid injections and centrally acting analgesic drugs
      are also preferred. However, it is stated that these drugs should be used with caution in
      terms of their efficacy and side effects, and gastrointestinal and renal side effects are
      more common in long-term use of NSAIDs, especially in elderly individuals.

      Rest, regular aerobics, muscle strengthening and range of motion exercises, aquatic exercise,
      transcutaneous electrical nerve stimulation, crutches, walker, cane, corset, elastic bandage,
      insoles and appropriate shoes use, weight loss as well as joint protection of the patient and
      coping with the disease. Education about methods constitutes non-pharmacological treatment.
      In surgical treatment, osteotomy, arthroscopy and, as a last resort, arthroplasty are
      performed in patients with persistent pain whose activities of daily living are severely
      restricted. In the Consensus Report of the Turkish Rheumatism Research and Combat Association
      (2012), evidence-based recommendations for the treatment of knee OA; It is stated that
      integrative treatments can be used in addition to pharmacological and non-pharmacological
      treatments, provided that they are monitored in terms of their effects and side effects. In
      the literature, it has been observed that integrative treatments such as massage therapy,
      herbal treatments, balneotherapy, acupuncture, and Tai chi are effective for OA.

      It is stated that among the integrated treatments, especially herbal medicines have been used
      in articular diseases for 2000 years and they do not have any side effects, and in recent
      years, medicinal plants have become a new source of medicine due to many side effects of
      synthetic drugs. One of these medicinal herbal remedies is nigella sativa oil, which belongs
      to the Ranunculaceae family, commonly known as black cumin in traditional medicine. The
      active nutraceutical ingredient of the oil is thymoquinone. Nigella sativa oil is rich in
      unsaturated fatty acids such as oleic acid and can relieve pain by inhibiting the activity of
      the cyclooxygenase enzyme, as well as showing anti-inflammatory, antidiabetic,
      anticonvulsant, anticancer, anti-aging, immunomodulator, antimicrobial, spasmolytic,
      bronchodilator, hepatoprotective, renoprotective, gastroprotective and antioxidant effects.
      is also indicated.

      A limited number of studies have been found in the literature indicating that nigella sativa
      oil reduces pain and improves physical function in patients with OA. Therefore, in this
      study, it was aimed to examine the effect of 1 ml of nigella sativa oil applied with massage
      for 2 minutes three times a day for 21 days on pain severity and physical functions in
      patients with knee OA and to contribute to the literature.
    

Intervention name(s): Nigella sativa oil; Naproxen and lidocaine gel; Massage
Intervention type(s): Biological; Biological; Biological
Intervention description(s): 1 ml of nigella sativa oil was applied to both knee areas of the nigella sativa oil group by massaging for 2 minutes three times a day for 21 days.; 1 ml of Naproxen and lidocaine gel was applied to both knee areas of the Naproxen and lidocaine gel group by massaging for 2 minutes three times a day for 21 days.; 1 ml of vaseline was applied to both knee areas of the massage group by massaging for 2 minutes three times a day for 21 days.
Intervention MeSH terms: Naproxen; Lidocaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Nursing; Osteoarthritis; Nigella sativa; Pain; Massage