treatment

Are Supplements an Effective Joint Pain Relief Option?

/ Thomas Cohn, MD

Joint PainCritical review of articles is essential to understanding whether or not the conclusion is accurate.  A recent New York Times article cited a study that researched whether Vitamin D and Calcium help relieve joint pain.  The conclusion was that these supplements do not help.

Unfortunately, this conclusion is misleading. Vitamin D and Calcium are used primarily to promote healthy bones and prevent osteoporosis. Joint health is a completely different issue

The question of whether supplements such as Glucosamine, chondroitin and fish oil help with joint pain is unclear. Multiple studies have been done on these compounds and the results have been mixed on whether they actually do anything.  Many people find these compounds to be very helpful.  It is fairly clear that they are not harmful.  Take these as directed on the bottle, and they might help, a 3-month trial would be reasonable and decide on your own.

Medications that Reduce Joint Pain

So if these supplements do not help reduce joint pain, what are some pain management options? There are numerous ways to combat joint pain. Medications that have FDA approval for joint pain include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen
  • Analgesics like acetaminophen
  • Steroids like prednisone
  • Injections like hyaluronic acid

Some of these are now available without a prescription.  NSAIDs act by interrupting compounds in the body that cause inflammation and thus joint pain.  Prednisone is a corticosteroid, a very powerful prescription level medication that decreases inflammation, but can cause significant other problems when not used cautiously.  Analgesics block the transmission of pain signals to the brain or their perception.  As noted, these medications all may have significant side affects and can cause other more severe medical problems besides helping with joint pain.

Other Joint Pain Treatment Options

A lot of joint pain is caused by slow deterioration of the joints as we age. Maintaining a healthy lifestyle is one of the best ways to prevent joint pain. Here are a few specific ways to maintain a healthy lifestyle and prevent joint deterioration:

  • Eating appropriately
  • Exercising regularly
  • Keeping muscles strong, and the body moving
  • Proper body mechanics while doing activities
  • Not over stressing the body

To maintain bone health, taking Vitamin D and Calcium has been proven to be healthful.  However, joint health is a different issue entirely. When reading research, sometimes it is necessary to understand more background information to be able to determine if the conclusions make any sense.  Just because someone did a study does not make it correct.

 

Source:

http://well.blogs.nytimes.com/2013/08/21/supplements-fail-to-relieve-joint-pain-in-study/?_r=1

Low Back Pain – A Common Problem, often Mistreated

/ Thomas Cohn, MD

low back pain minnesotaLow back pain is a very common issue – 85% of the population will experience back pain at some point in their lives. However, back pain is often treated improperly and as a result, it has become a costly problem in American society.  A lack of understanding of back pain, its causes, and usual treatment, leads to costly management.

Acute Low Back Pain

Acute low back pain is pain that has been present less than 3 months.  Most back pain can be treated conservatively.  Only rarely is back pain a serious medical emergency.  There are many structures in the back that cause pain, including:

  • Vertebral discs
  • Bones
  • Joints
  • Nerves
  • Muscles

All of these can cause pain.  Fortunately, most pain is caused by muscle strains and irritation of joints, discs or nerves.  Initially all of these are treated the same, with ice and heat, minimal rest, stretching, and then muscle strengthening of the core.

Medications should be kept simple – use Tylenol or anti-inflammatories like naproxen to manage the pain.  If pain is more severe, see a primary care physician for referral to a Physical therapist.  Very short-term use of narcotic pain medicine is useful if other medications cannot be taken but these are not advised for more than several weeks.

If Back Pain Persists

If back pain persists for more than a month, despite basic management, you should seek out an expert in low back pain.  The best medical doctors to evaluate and treat this type of pain are board certified physicians in Physical Medicine and Rehabilitation.  These physicians are experts in the musculoskeletal and nervous system.  They can guide a person through a detailed exam and diagnosis and more advanced treatments.

Surgery, MRIs, & CT Scans

Back pain is rarely a medical emergency.  If a patient has had cancer and has new onset of back pain, aggressive evaluation is necessary to determine if cancer is affecting the region.  Low back pain with loss of control of the bowels, or loss of muscle function in the legs is the other case when aggressive evaluation is necessary.

Back pain is usually relatively benign.  Most pain will resolve within weeks with conservative treatment.  Only in rare cases (such as cancer) should MRI or CT scans be obtained.

Surgery should only be considered if nerves are compromised, or bowel or bladder control is lost due to the spine being injured.

Osteoarthritis of the Knee – Treatment Options

/ Thomas Cohn, MD

osteoarthritis of the kneeEarlier this week, we discussed the signs and symptoms of osteoarthritis in the knee. Today we will further investigate this condition by discussing the treatment options for osteoarthritis.

Treatment of osteoarthritis of the knee includes a wide range of options, starting with lifestyle modifications, medications, and progressing to surgical management. 

Always start simple. Change starts with the individual and is not magical.  The most common first step is to lose excess weight so you are not stressing the joints.  Change the type of activity you are doing from high impact to low impact exercise. Go from jogging to cycling and swimming, or try an elliptical. Walking is always a good alternative as well.  Exercise maintains range of motion, flexibility, and health. Add in strengthening and function may also improve. 

Medication Management

Medication management is the next level of care. Having a physician involved in this level is beneficial to prevent negative side affects.  Natural substances you can take include:

  • A combination of glucosamine and chondroitin. These are natural substances found in joints. If taken orally they are supposed to promote normal joint health.  Scientific studies are mixed on whether they are truly helpful, but they rarely if ever would be harmful, if early in the disease, it may be worthwhile.
  • Fish oil. This can help with joint lubrication.

Prescription level medication starts with acetaminophen, to aspirin and anti-inflammatories, to steroids and injectable compounds.  Acetaminophen is only an analgesic and it treats pain.  Aspirin and ibufrophen or naproxen, are a class of medications known as nonsteroidal anti-inflammatory drugs (NSAIDs), and can treat pain and swelling.  These medications are stronger, may be taken orally and may be available as crèmes, but have many side affects and should be used with caution.  Skin preparations however are very safe and may be extremely helpful.

Corticosteroids are very powerful anti-inflammatory hormones, and sometimes on a limited basis orally or as injections can be helpful in controlling pain and swelling for long periods of time.  Lastly, viscosupplementation with injectable hyaluronic acid compounds is used to improve joint fluid production for periods of 3-6 months.

Surgical Options

End stage knee osteoarthritis can be treated surgically.  Orthopedic surgeons can do several things from cleaning up and removing damaged tissue in the joint arthroscopically when appropriate, to replacing the knee joint.  Surgical intervention is a consideration when the damage is severe, not responding to more conservative options, and otherwise when the patient is healthy enough to undergo surgery.

Osteoarthritis will occur eventually in all of us as we age.  The key to control degeneration is to maintain good health habits.  Keep your weight under control, excess weight will stress out your joints.  Exercise, this will keep everything moving, and maintain your strength.  Work with your doctor if more advanced treatments are needed.