Your physician will feel around the knee to determine precisely where it hurts. Does it hurt in the area of the kneecap? Does it hurt in the area of the meniscus? Although it may not be possible to pinpoint the precise trouble spot, this examination can give your doctor some idea of where the problem may lie.Sometimes the pain may be isolated to one spot; sometimes it may seem to roam all over the knee. When the physician says, “Where does it hurt?” in about 20 percent of all cases, a patient with kneecap symptoms will specifically point to the patella. However, 20 percent will point to the left side of the knee, 20 percent will point to the right side, 20 percent will complain of pain in the back of the knee, and 20 percent will say that they have pain everywhere. This is not surprising: pain is often referred, that is, an injury in one location may hurt in another. In the case of the knee joint, the closeness of the anatomy makes it even more difficult to precisely pinpoint the location of the pain, but an experienced specialist can often narrow down the possibilities.*11\185\2*

Feeling that you have emotional support can also help you feel better. A recent observational study found that people with rheumatoid arthritis who have supportive marriages and close personal social relationships tended to experience less severe pain than those whose spouses were critical or uninterested or those who had few close friends.
You can also count on yourself for help. Two of the most positive things you can do for yourself are to learn about your disease and take an active role in your own treatment. Several studies, including one randomized trial, have shown that a program of health education to assist with self-management actually reduces pain. In addition, evidence shows that education can reduce health-care costs and produce benefits that last for as long as 4 years.
You can pursue this information in a number of ways: Ask your doctor for information. If you have a computer, you can seek information on the Internet and participate in newsgroups and message boards that focus on your disease. Continue to read books on your illness (like this one!) and magazines that report new findings in health. The more control you take over your own health, it seems, the better you are likely to feel.
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Acupuncture is a traditional treatment that has been used in Asia for more than 2,000 years. Researchers have conducted a few double-blind placebo-controlled trials on the use of acupuncture to treat osteoarthritis, and two of these were reviewed in an article in the Annals of Internal Medicine. Neither study, however, is evidence that acupuncture is effective.
One double-blind trial observed 40 participants with osteoarthritis. The active treatment group received acupuncture at traditional points. The placebo treatment consisted of inserting needles at random points. Treatment was done once a week for 8 weeks. Two physicians who did not know which participants had received which treatments evaluated the results.
Both groups improved to some extent, as would be expected due to the placebo effect. However, the results did not show any difference in outcome between the real acupuncture and the fake acupuncture groups.
Another study compared acupuncture with no treatment. Two groups of 16 participants each received either 20 minutes of acupuncture twice a week for 3 weeks, or no treatment at all. Everyone was evaluated after 9 weeks. Those receiving treatment reported a 23% decrease in pain, compared to a 12% worsening of pain in the untreated group. While this is a very significant result, it is impossible to tell if acupuncture was really beneficial on its own, or if the improvement was a placebo effect from having needles inserted, or simply from receiving attention.
One problem with acupuncture studies is that most of them tend to use a predetermined set of points for the treatment of all participants. True acupuncture, however, is much more sophisticated and individualized to the symptoms of each individual. For this reason, such limited studies cannot fully assess the power of this traditional art.
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