## 4 Discussion  
The present findings of a randomized controlled clinical trial confirm the analgesic effectiveness of dietary supplementation based on a natural extract of _Cucunis sativus_ administered at 20 mg daily for 8 weeks in patients with articular pain due to knee OA. Pain intensity, assessed by VAS scores at the final visit as compared with baseline, as well as by weekly changes in VAS scores throughout the study period, demonstrated the superiority of _Cucunis sativus_ in comparison with a placebo to reduce the intensity of pain significantly. All patients had moderate pain intensity at the beginning of the study, which decreased to mild pain at the final visit in the two study groups, although VAS scores were significantly lower in the experimental group. Although cucumber-treated patients were not pain-free, a mean score of 1.7 indicates very little pain. In fact, subjects assigned to the experimental group experienced a very marked change in VAS pain scores, from 5.5 at baseline to 1.7 at the end of the study, which represents a 69.9% decrease as compared with VAS scores changing from 5.2 to 2.8 in the placebo group, with a 46.1% decrease. In the setting of knee OA, marked pain relief is a clinically relevant finding. Frequent switching between non-pharmacological and pharmacological alternatives, treatment discontinuation, cycling within the healthcare system and limited benefits in the long-term effectiveness of currently available medications are some of the challenges associated with existing pain management options in patients with knee OA [19, 51]. Moreover, total joint replacement is not feasible for patients with contraindications for surgery or in the presence of risk factors, such as younger age or comorbidities [52], as well as risk factors for major complications, particularly periprosthetic joint infection, after total joint surgeries [53]. Improvements observed in the VAS scores for pain intensity in the experimental group were also reflected in the overall score of the WOMAC questionnaire, as well as in the pain, stiffness and physical function subscales. Although decreases in the overall WOMAC score and in the subscales of pain and physical function were also observed among patients treated with the placebo, the magnitude of improvement was greater in the experimental group. This observation indicates the beneficial effect of dietary cucumber supplementation on quality of life. Pain and functional restrictions due to knee OA negatively impact daily living activities, social life and psychological well-being, reducing the quality of life of patients [54]. In addition, treatment satisfaction rates are related to the severity of pain, with lower pain, greater pain reduction post-medication and meeting pain management expectations as predictive factors of higher satisfaction [55, 56]. In our study, however, satisfaction with dietary supplementation was not evaluated. In a previous 6-month randomized controlled study carried out by [PERSON] et al. [46], involving supplementation with a proprietary aqueous extract of _Cucunis sativa_, at 10 mg twice a day, the percentage of change in the WOMAC score after 60 days of supplementation was 40.1%, as compared with 21.2% in controls treated with glucosamine-chondroitin (1350 mg twice daily). Similar decreases were observed in our study, with changes in the WOMAC score of 41% in the experimental group and 21.3% in the placebo group. However, decreases in the VAS score for pain intensity were 31.4% in the supplementation group and 19.8% in the glucosamine-chondroitin group, which are notably lower than 69.9% and 46.1%, respectively, found in our study. Interestingly, the consumption of the cucumber supplement for 8 weeks improved joint function, as shown by the results of dynamometry testing and the TUG test.