4. Discussion
TNF-α, Knee Injury, OA, KOA, pain, KOA pain, knee diseases, knee pain, NRS
OSTEOARTHRITIS, SPINAL DISORDER, KNEE DISEASE, SAID, PATHOLOGY
The aforementioned results showed that both dietary supplements produced beneficial effects in patients. However, NRS, KOOS and OKS scores had a statistically significant greater improvement in the treatment group, which is the one treated with the dietary supplement containing both hemp seed oil and terpenes. Therefore, this latter seems more effective in relieving KOA pain and improving specific knee function.As was said previously, hemp seed oil accounts for the increasing scores in both groups [Although less documented than BCP, myrcene has also demonstrated its anti-inflammatory properties. In a study conducted by Shamsul et al., this molecule reduced pro-inflammatory cytokines (IL-1β, IL-6, and TNF-α), immunomodulatory factors (interferon gamma (IFNγ), NF-κB and anti-inflammatory markers [interleukin-4 (IL-4), and interleukin-10 (IL-10)] [Similarly, a recent 8-week randomized double-blind placebo-controlled trial by Wang et al. reached a 2.6-points pain relief according to the Western Ontario and McMaster University (WOMAC) Osteoarthritis index using oral low molecular weight hyaluronic acid in combination with glucosamine and chondroitin on KOA in patients with mild knee pain [With regard to the functional outcomes, the ODI and SF-12 scales did not differ appreciably between the two groups, while the KOOS and OKS scales improved significantly in the treatment group. We consider this as the consequence of the fact that ODI and SF-12 are nonspecific for knee evaluation, while KOOS and OKS, as the name suggests (Knee Injury and Osteoarthritis Scale and Oxford Knee Scale), are extremely specific for the pathology we analyzed, which is KOA. Indeed, as is well known, ODI proved to be more suitable for the functional evaluation of spinal disorders [We assume that the obtained knee functional improvement is due to the fact that a pain-free joint works better. In fact, one of the first goals in the rehabilitation of knee diseases is precisely to intervene on pain in order to improve joint function and range of motion (ROM) as early as possible [Finally, the dietary supplement containing terpenes appears to have useful properties to improve KOA symptoms. It is likely that the beneficial effects of each nutraceutical component are synergistically amplified by combining them. It is important to further investigate the usefulness of nutraceutical supplements as a complementary treatment for OA because they represent a natural alternative to anti-inflammatory drugs with essentially no side effects that can be self-administered by patients [The main limitation of this study is the short duration of follow-up. For this reason, further studies are needed to monitor the durability of the benefits noted in the short term over time. Moreover, the outcome measures are self-reported by patients, but it is a mandatory condition when it is necessary to investigate joint function in the activities of daily living. Finally, there was not a placebo group, but this choice was due to the necessity of guaranteeing a treatment for all patients, since all of them suffered from significant knee pain. Nevertheless, future studies will overcome this limitation, in compliance with the necessary ethical rules.