Osteoarthritis of the Knee – Signs & Symptoms

July 15, 2013September 27, 2016 / Thomas Cohn, MD

As we age, many of us develop knee pain. One of the most common knee conditions is Osteoarthritis – slow degeneration of the cartilage of the knee.

Symptoms of Osteoarthritis

The symptoms of osteoarthritis are:

Gradual onset of stiffness in the joint, especially after sitting for a period of time or lying down
Difficulty bending and straightening the knee
Swelling and pain when first moving the knees, sitting, or kneeling
In more severe cases, the size of the knee may become larger

As we get older, joints in the body age and deteriorate. This starts as early as our twenties, and is more common when we are past forty. Historically, the body was designed to get us to between age forty and fifty. Prior to the onset of modern medicine roughly 150 years ago, disease, trauma, and natural conditions like heart problems killed us by age fifty. So as we age, there is increasing wear from normal use and trauma on our joints including our knees. Weight also often increases as we age and further stresses weight bearing joints.

Factors & Signs

Factors that contribute to osteoarthritis development are:

Age
Trauma
Weight
Genetic tendency (some families may be more prone to its occurrence)

In the doctor’s office, when we examine a knee with osteoarthritis, we usually see a large knee, maybe slightly swollen but not warm, and stiff to move. Plain X-rays will reveal a large joint, often with narrowing of the joint space especially on the inside aspect, and the joint surfaces may appear to be irregular from deterioration.

Read our follow up blog on the treatment options for Osteoarthritis.

Top 4 Causes of Back Pain

July 10, 2013October 30, 2015 / Thomas Cohn, MD

The human spine consists of roughly 30 bones, known as vertebrae that are stacked on top of each other. In between each of these vertebrae are discs – bits of cartilage that prevent the bones from rubbing against one another. When something disrupts the organization of the spine, it often results in back pain.

Many people suffer from back pain, but it’s often difficult to pinpoint what exactly is causing the pain. Here are four of the most common causes of back pain:

Injuries to the muscles, and ligaments. This can include injuries from sports, car accidents, or simple slip and fall accidents. Jarring your back in an unnatural way can result in move the vertebrae or discs out of their place, resulting in chronic back pain.
Herniated Disc. This is also known as a slipped disc. It happens when a spinal disc expands and presses against the nerves in the spinal column.
Degenerative Changes. Over time all areas of the body gradually break down. The spine is no exception. As a person ages their bones generally weaken, and the spinal discs can weaken or shrink (causing vertebrae to rub against each other).
Pinched Nerve. When discs bulge or shift, they can press against or pinch nerves, resulting in sometimes extreme pain.

You don’t have to live out your life just dealing with back pain. There are numerous treatment options available that can help you get back on the road to a pain free life.

How the Body Feels Pain

July 8, 2013September 27, 2016 / Thomas Cohn, MD

Pain is a complex issue. Acute pain is usually related to one of the following:

Tissue damage
Perceived damage
Injury

Chronic pain can be associated with chronic damage or a short circuit in the transmission of pain signals. Treatment of pain depends on the cause. In acute pain, if you treat the cause the pain will normally go away. However when pain becomes chronic, treatment often does not take away all the symptoms.

Pain Signals & Sensory Stimuli

Chronic pain is generally defined as pain lasting longer than 3 to 6 months. Often, it outlasts the initial injury. In some ways it becomes independent of the initial stimulus or cause. Damage may be ongoing, and there may be a chronic inflammatory response, all causing ongoing sensory stimuli, which are subsequently linked in the spine and brain, to the perception of pain. Often, non-painful sensory signals then become linked to nerves that previously transmitted pain signals. Normal signals then become perceived as pain.

All sensory signals are processed in the brain at some level. The brain has an incredible ability to determine the importance of each signal and then form a response. Depending on the circumstance, the brain can ignore the same signal that would be horrific pain. For example, we all have heard about soldiers in war who have been shot, but continue fighting with no loss of focus. Therefore, the real key player in all responses to pain signals is the brain and its interpretation of the signals.

Blocking Pain Signals

The key to treatment of pain then is altering the brain’s ability or desire to interpret sensory signals as pain. Blocking signals can be done anywhere along the path from the sensory receptor including:

The peripheral nerve to the spinal cord
Along the spinal cord pathways
In the brain itself

Although pain can be treated in multiple ways, all treatments try to prevent transmission and interpretation of sensory signals that are perceived as pain. There is no magic bullet and no one treatment alone that will work for everyone.

The simple reason why there are so many treatments for pain is that there are so many ways to alter signals that are perceived as pain. Medications have been designed to affect sensory impulses at a variety of locations from the skin and periphery to the spine and brain. Furthermore, there are a variety of techniques from proper movement, to acupuncture, to psychological training that can effectively treat pain.

Do Opioids Reduce Inflammation in Chronic Pain Patients?

July 3, 2013September 27, 2016 / Thomas Cohn, MD

A recent preliminary study found that inflammation in patients with chronic pain is persistent despite long-term opioid treatment.

The study was carried out by Forest Tennant, MD, director of the Veract Intractable Pain Clinic in West Covina. Dr. Tennant examined 40 patients from July 2012-October 2012. All of these patients had been receiving heavy doses of opioids to treat their chronic pain for the past 10 years.

While many patients reported improved levels of depression and function, 20% of those surveyed still had high levels of inflammation markers. Further, a number of patients had abnormally high hormone levels.

Dr. Cohn Comments

Opioids are used to treat all types of pain, but they do not treat inflammation. If a chronic condition causes pain, such as osteoarthritis, treating this with opioids will not change the inflammation that is occurring. The pain may be better with the opioids, but the disease is not being modified and one should expect to see inflammatory markers.

Chronic pain is defined as pain lasting longer than 3-6 months. Pain can be caused by any number of factors, and is a response to ongoing stimulation of pain receptors in the body. It is not very surprising that if we monitor blood borne markers, we can find elevations in those that are indicators of inflammation.

Osteoarthritis is a chronic degenerative joint disease. If it is painful, there is likely active destruction of tissue, and the joint may be warm and swollen. Osteoarthritis of the knees is very common, and we all know many older adults who complain of painful, swollen knees. Furthermore, the most common treatments are nonsteroidal anti-inflammatory drugs, like Motrin and Aleve.

Low back pain has many causes, such as:

Inflammation of nerves causing radiculopathy
Degeneration of the facet joints

First line treatments are meant to reduce inflammation. This is done sometimes by oral steroids, or long-acting steroid epidural injections. Steroids treat inflammation directly, and finding inflammatory markers when someone has low back pain is not surprising.

If a person has chronic pain, a good pain physician will recognize the causes of the condition. Treating the cause of pain with interventions that modify the disease is the best strategy. Treat the disease, and the disease markers will improve. Opioids are often a Band-Aid – they help in the short term but fail to address the underlying condition.

Related Sources:

MedpageToday

Low Back Pain: Signs & Symptoms of a Bad Disc

July 1, 2013September 27, 2016 / Thomas Cohn, MD

Low back pain from a bad disc is very common. By the age of 30, discs often begin to show signs of wear. By age 40 disc pain is normal.

The human body was initially built to last roughly 40 to 50 years. Up until about the mid 1800’s, most people would die by this age due to:

Trauma
Infections
Disease
Heart problems

Since that time, science and medicine has developed tremendously, and we have improved our longevity well into the 70’s and 80’s for many people. The problem as we live longer, is that we are out living the natural life expectancy and durability of many of our body parts. We are wearing out the spine, the disks, bones, joints and sometimes the nerves. As we age, our body parts age, become damaged, and cause us pain.

Signs you have a Bad Disc in your Back

The first sign that you have a bad back disc is often radicular pain – that is pain that starts in the back and radiates into the buttock or leg, either one or both sides. Sometimes it starts after moving wrong, bending and twisting, or lifting something too heavy. People who suffer from this often don’t know exactly what happened. They simply notice annoying, ongoing pain from the back into the leg.

Having low back pain and a bad disk is not unusual. A bad disk does not mean that you need surgery. However, having ongoing back pain means that you need to do more maintenance to keep going. Just like having an older car, an aging body needs more work on a regular basis to keep running. If you ignore everything, it will stop working well. But unlike an old car, you cannot just go to the local mechanic to keep things running. To keep the back well tuned, you need the advice of an expert and you need to invest in your own health.

Spinal Disc Treatment Options

Most back disc problems can be treated conservatively, without surgery. Treatment ranges from simple to aggressive based on what works and what is wrong. Surgical treatment should be reserved mostly for discs causing neurologic damage including weak muscles in the legs and loss of control of the bowel or bladder. This is rare though – less than 2% of all disk problems need surgery.

If the low back pain is radicular and has not responded to simple treatment in 4-6 weeks, it is time to find a Physical Medicine doctor who specializes in pain. These are experts in diagnosis and treatment of these problems. They can start simple, from medications and therapy, and move to the most complex solutions if necessary. Interventionalists are pain doctors who may also do injections to diagnosis specific problems and perform complex procedures that treat the pain without surgery. Often these doctors can determine if the pain may be coming from several different sources, and how to treat each of the specific problems so that life is not a pain.