Growing demand for medical cannabis as an adjunct for pain relief and reducing opioid dependence in patients with chronic osteoarthritis (OA) pain is evident in OA patients now being considered as an indication. In a preliminary cohort of chronic OA patients (N=40), they reported nearly a 50% reduction in prescribed opioid morphine equivalents and pain at 6 months even though unknown medical cannabis dosing and sample size prevented some extrapolation. Studies have determined cannabinoid receptors in OA cartilage and some studies have found CBD’s mechanism of action to involve spinal PPAR on g, but any possible effects could be mitigated by TRP channel agonists. What is lacking is the evidence base as it pertains to route of administration, dose, and long-term safety (Kitchen et al. 2025; Francis et al. 2025).
Evidence-based decision-making for cannabis dosing and routes of administration in OA.
Data to assist with opioid-sparing policies and safer prescribing of chronic pain management.
Increased access to patient-centred care and regulatory support to provide cannabinoid options.
TM and THC are traditional treatments for the management of knee OA. In a 3-week randomized trial, THC provided better relief of pain and function than oral ibuprofen and TM. However, the standardization and biochemical consequences of THC, and duration of efficacious effects, are in its infancy in larger, long-term cohorts. (Haploy et al. 2025; Kaur et al. 2025)
What are the effects of TM and THC on inflammatory markers and joint function over 12 weeks?
Without an increased risk of adverse effects, does the use of TM/THC reduce dependence on NSAID for OA patients?
What is the physiological and biomechanical basis TM/THC treatment effects?
TM/THC could be integrated more widely within low-cost, drug-free therapies.
TM/THC could be included in clinical guidelines for patients with early-stage OA.
Cultural validation of TM/THC could support integration into mainstream care and practice of Southeast Asian traditional medicine.
Haploy, Y., & Pongsaree, R. (2025, January). STUDY ON THE EFFECT OF THAI MASSAGE ON PATIENTS WITH KNEE JOINT SYMPTOMS AND KNEE STIFFNESS, AT THE THAI TRADITIONAL MEDICINE CLINIC, SUAN SUNANDHA RAJABHAT UNIVERSITY. In Proceeding National & International Conference (Vol. 17, No. 1, p. 853).
Kaur, S., Chatterjee, S., Goyal, M., Popli, A., Goyal, K., Saha, M., … & Sushma, K. C. (2025). Physiotherapeutic approaches in upper cross syndrome: A systematic review of systematic reviews. Journal of Bodywork and Movement Therapies, 42, 756-762.
Evidence indicates yoga may have beneficial effects on pain levels above and beyond, directly or indirectly improving cortisol, β-endorphin and substance P levels in patients with chronic low back pain. More specifically, among the multitude of hip flexor stretches and strategies providing a gentle spinal extension for the client with chronic low back pain, Sphinx pose is a reasonable option, making it appropriate even for older adults or individuals that are otherwise sedentary with lower back pain issues. Yet, the neurobiological pathways remain ambiguous and whether or not Sphinx pose was perceived as more effective than the other therapies has also been ambiguous (Naragatti et al., 2025; Abafita et al., 2025).
What is the effect of consistent Sphinx pose practice on the biomarker levels indicative of stress for clients with CLBP?
Is the direct biofeedback from Sphinx pose a physiologically more effective treatment at improvig pain or functional recovery than physiotherapy as a traditional cohort of patients?
Over time how does focussing on yoga techniques/sphinx pose impact long term capacity/mobility to return to work?
More individualized yoga prescriptions for clients with CLBP.
Reducing the reliance on ongoing pharmacologic intervention.
Increasing patient’s ability to return to work, and outcomes associated with musculoskeletal disorders.
Naragatti, S. A Comprehensive Review of Yoga Interventions for Chronic Low Back Pain: Efficacy, Mechanisms, and Clinical Applications.
Abafita, B. J., Singh, A., Aitken, D., Ding, C., Moonaz, S., Palmer, A. J., … & Antony, B. (2025). Yoga or Strengthening Exercise for Knee Osteoarthritis: A Randomized Clinical Trial. JAMA Network Open, 8(4), e253698-e253698.
Tai Chi is increasingly viewed as a mind-body practice that contributes to enhancing physical function, fall-related balance and mood. Trails show that there are lasting effects on pain and fear of falling, after 6 months. In OA, there is little comparative research that has studied OA and discussed other conditions such as aerobic exercise or mental health (Gau et al., 2025; Zhang et al., 2025).
What effects does Tai Chi have on depressive symptoms and self-efficacy for older adults with OA?
Does Tai Chi provide greater gains in gait and proprioception than walking and stretching?
What is the sustainability of Tai Chi effects post-intervention?
Identify Tai Chi as a first-line OA treatment strategy in geriatric care.
Reduction of fall-related injury and hospitalization.
Improvement in emotional well-being and patient compliance.
Although acupuncture improves pain and function in OA, in some cases exceeding standard care, there remain risks for serious mechanical injuries, and risk of infections that can occur in the hands of unregulated practitioners. Although its analgesic properties have been validated, its capacity to lessen opioid misuse needs stronger investigation (Majd et al., 2025; Duan et al., 2025).
Are standardized acupuncture protocols able to reduce opioid yardage in chronic pain patients?
What safety and training protocols will reduce the likelihood of adverse events when practice of acupuncture?
How does sham acupuncture compare with real acupuncture in real world pain outcomes?
Integration of safe acupuncture into pain clinics.
Development of acupuncture-assisted opioid alternative protocols.
Professionally recognized certification standards, and international safety standards.
Majd, I., Cherkin, D., & Sasagawa, M. (2025). Practical and economic challenges of implementing group auricular acupuncture treatment for chronic pain in primary care. Acupuncture in Medicine, 09645284251314188.
Duan, Y., Zhao, P., Liu, S., Wu, S., Deng, Y., Xu, Z., … & Yu, L. (2025). Patient-reported outcomes and acupuncture-related adverse events are overlooked in acupuncture randomised controlled trials: a cross-sectional meta-epidemiological study. BMJ Evidence-Based Medicine.