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Medical Forum / Diseases and Disorders / Arthritis / February 2005What you can do: pain management
http://tinyurl.com/6s32a http://www.telegraph.co.uk As drugs used to ease osteoarthritis are withdrawn, what should sufferers do? Christine Doyle reports ------snip---------- Now, some specialists predict a new era with a greater emphasis on prevention through lifestyle changes and a simpler approach to treatment. Take regular exercise, lose weight and take paracetamol as the first line of treatment rather than NSAIDs, is the advice of Michael Doherty, professor of rheumatology at the City Hospital, Nottingham. With epidemiologist Dr Ken Muir, Prof Doherty is currently leading a £400,000 ARC clinical trial of 400 obese people to discover whether exercise and slimming will reduce their knee pain. Unsupervised exercise in 800 people with arthritic knee pain led to a substantial fall in pain and disability over two years, according to an NHS-sponsored trial. Prof Doherty advocates advice from nurses and doctors about simple changes that could make a big difference. He also says doctors need better education. "Many lack both the training and confidence to deal effectively with the many arthritic conditions they see on a daily basis." In the January issue of ARC's magazine, Paul Dieppe, Medical Research Council professor at Bristol University, says: "Worldwide sales of the new NSAIDs are colossal, in excess of £20 billion a year." He is critical of drug companies and the drug regulatory agencies. "They should be under a legal obligation to reveal data on all side-effects." Of all the forms of arthritis, osteoarthritis is the commonest cause of misery. Although paracetamol is a mild painkiller, it can be taken at the recommended dose of up to eight 500mg tablets a day without causing liver damage. If pain is really severe, the next step is a form which contains codeine, a stronger painkiller. Marilyn Brown, 58, a solicitor, says. "I have moderate osteoarthitis which waxes and wanes. I decided against the new generation of drugs and have stuck with paracetamol, regular exercise and a herbal remedy, called Tabritis. I have occasional sessions of acupuncture for my knees, and take glucosamine. I am doing really well. I think there is a lot that people can do for themselves." The power of new shoes and exercise Keep moving: regular exercise is critical for supple joints. Hard training or marathon running, however, is not always a good idea. Athletes and professional footballers who place huge demands on their joints at an early age are more prone to arthritic damage. Try to walk, swim or cycle for at least 30 minutes a day. Gradually build up speed. Add in daily stretching and strengthening exercises. Unwind your spine: the spine is prone to arthritic degeneration. At least 10 times a day, consciously unwind your spine from a slump, tuck in your stomach and draw yourself up to your full height - it could be two inches more than usual. Maintain the pose for 30 seconds. Take up yoga or join a pilates class. Keep trim: maintain the weight range appropriate for your height and frame. Even being moderately overweight, especially in those over 40, will add to inherited or acquired risks of decrepit joints. The extra pounds bear down through your hips, knees, ankles and feet. Eat your omegas: a healthy, balanced diet both prevents and slows down osteoarthritis. Follow a low-fat, low-sugar diet with plenty of colourful fruit and vegetables, such as carrots, broccoli and beetroot. Eat more oily fish and poultry than red meat. Mackerel, sardines, salmon, tuna and other oily fish contain omega-3, an essential fatty acid that helps control inflammation. Omega-6, mostly found in plant seed oils, such as evening primrose and sunflower seeds, also helps. "One of the most exciting recent discoveries is that these oils help some people with arthritis," says the ARC. "The benefits might be small, but they could be cumulative over time." Food flare-ups: there are many claims for exclusion diet miracle cures - but very little hard evidence. Anecdotally, however, some people link a flare-up of symptoms with dairy products, wheat and plants in the nightshade family, including potatoes, tomatoes and aubergines. Others believe that they react to spinach and grapefruit. Go shoe-shopping: buy the best-fitting shoes you can afford, especially if your joints are starting to creak. "Many trainers have excellent shock-absorbing qualities," says Prof Dieppe. "Some ordinary shoes are well-cushioned, but we need more manufacturers to take up the challenge of producing well-fitting, well-designed shoes. There would be plenty of customers." Supplementary evidence: "I have taken glucosamine for five years and I no longer feel my hips are seizing up," says Sally Herbert, 50. "I walk and cycle and take the supplement to keep my joints youthful." Once controversial, glucosamine, which is derived from shellfish, is rapidly moving into the mainstream. New studies, to be published soon, are expected to confirm that it reduces the need for hip and knee replacements. Cod liver oil, the war-time staple, is a favourite with ballet dancers. Until feet, which have 26 bones and more than 200 interacting muscles, ligaments and joints, start to suffer, they are often ignored, says the ARC, which supported research showing that cod liver oil slows the destruction of joint cartilage in patients with osteoarthritis. Complementary techniques: many people swear by Chinese acupuncture to prevent their knees losing their spring. This belief is backed by recent research showing that acupuncture reduces the pain of osteoarthritis and improves mobility. Magnetic bracelets, which cost between £30 and £50, are the latest technique to gain scientific approval. A study among almost 200 patients in Devon found a significant fall in arthritic pain up to 12 weeks later. Massage, aromatherapy and relaxation techniques can also help to ease pain. > Magnetic bracelets, which cost between ?30 and ?50, > are the latest technique to gain scientific approval. By the Emu-Ironman Secret Scientific Association? > > Magnetic bracelets, which cost between £30 and £50, > > are the latest technique to gain scientific approval. > > By the Emu-Ironman Secret Scientific Association? Heh~ There really *was* a study that showed some efficacy. But you won't catch me buying one. I'm holding out for the 'diamonds' study. http://tinyurl.com/4ymd9 www.reuters.com Zee some good ideas debbie m. http://www.angelfire.com/ga2/angels1/ > http://tinyurl.com/6s32a > http://www.telegraph.co.uk [quoted text clipped - 110 lines] > significant fall in arthritic pain up to 12 weeks later. Massage, > aromatherapy and relaxation techniques can also help to ease pain. > http://tinyurl.com/6s32a > http://www.telegraph.co.uk [quoted text clipped - 110 lines] > significant fall in arthritic pain up to 12 weeks later. Massage, > aromatherapy and relaxation techniques can also help to ease pain. Thankfully, there is now also the option of taking Limbrel. At His service, Andrew -- Andrew B. Chung, MD/PhD Board-Certified Cardiologist ** Suggested Reading: (1) http://makeashorterlink.com/?L26062048 (2) http://makeashorterlink.com/?O2F325D1A (3) http://makeashorterlink.com/?X1C62661A (4) http://makeashorterlink.com/?U1E13130A (5) http://makeashorterlink.com/?K6F72510A (6) http://makeashorterlink.com/?I24E5151A (7) http://makeashorterlink.com/?I22222129 My sincerest thanks to you ZEE for introducing us to this publication. It is not only informative, up-to-date, but goes even beyond. I agree lifestyle changes are the wave of the future and also in the "now" for those of us who already have the bloody affliction, I think we will be forced to make significant changes in habits. I, too, take Glucosamine with Condroitin, Omega 3s, eat only fish and no other meat of any kind and haven't for the last 11 years. I am into 32 oz of green tea a day, preferably gunpowder green tea. I have been forced to live in my motorhome rather than my real house which is on top of a mountain in the midst of 300 acres of woods that are entirely infested with the deer ticks causing Lyme's. The house is, of course for sale. So, it is hard to find much space to exercise in a motor home and my husband has purchased a small building which will be my workout room which will house a home gym that will allow me to work with weights as I have done successfully in the past. The room serves a dual purpose as we will use it for our recording studio for our music. The interior of the building is almost done and within 2 weeks, it will be finished. I do not need to lose any weight but I do need to tone up. I am reverting back to fresh salads for lunch and healthy food at night which will include steamed veggies. I am just determined to get the best of all the approaches. It will be my main focus to do whatever is necessary to avoid knee surgery again and ultimately avoid knee replacements. By the way, what is paracetamol exactly? Does it compare to any drug approved in the US? I've not heard of it before. Again, thank you for the intro to the publication and the reminder that there are many alternatives. ziajade Paracetamol is acetominephen. One common North American brand is Tylenol. I think you have the major hurdles cleared for your workout: attitude and determination to succeed. It doesn't hurt that your gym setting sounds magnificent and therapeutic. Zee > My sincerest thanks to you ZEE for introducing us to this publication. > It is not only informative, up-to-date, but goes even beyond. I agree [quoted text clipped - 30 lines] > > ziajade hi. my husband suffers from osteoarthritis and is a window cleaner by trade. He feels little pain during the day when he is working but as soon as he stops, his pain is almost unbearable. Does anyone have any advice on how to reduce this pain? He already takes co-codimol and ibuprofen. Thanks. > Paracetamol is acetominephen. One common North American brand is > Tylenol. I think you have the major hurdles cleared for your workout: [quoted text clipped - 48 lines] > > > > ziajade > hi. my husband suffers from osteoarthritis and is a window cleaner by > trade. He feels little pain during the day when he is working but as > soon as he stops, his pain is almost unbearable. Does anyone have any > advice on how to reduce this pain? He already takes co-codimol and > ibuprofen. Would suggest he inform his doctor(s) who will likely refer him to a rheumatologist. > Thanks. You are welcome. All praises belong to my heavenly Father, Whom I love with all my heart, soul, mind and strength :-) At His service, Andrew -- Andrew B. Chung, MD/PhD Board-Certified Cardiologist ** Suggested Reading: (1) http://makeashorterlink.com/?L26062048 (2) http://makeashorterlink.com/?O2F325D1A (3) http://makeashorterlink.com/?X1C62661A (4) http://makeashorterlink.com/?U1E13130A (5) http://makeashorterlink.com/?K6F72510A (6) http://makeashorterlink.com/?I24E5151A (7) http://makeashorterlink.com/?I22222129 n Fri, 11 Feb 2005 07:47:39 -0500, "Andrew B. Chung, MD/PhD" <andrew@heartmdphd.com> wrote: >> hi. my husband suffers from osteoarthritis and is a window cleaner by >> trade. He feels little pain during the day when he is working but as >> soon as he stops, his pain is almost unbearable. Does anyone have any >> advice on how to reduce this pain? He already takes co-codimol and >> ibuprofen. Its typical that he will stiffen up after work when he is relaxing. Usually, first thing in the morning is the worst time. I take co-codamol too but can't have any anti-inflammatories like ibuprofen. Tramadol relieves pain but a lot of people don't like it. It can make you feel a bit high. There is another drug called (in the UK) Arthrotec. He could ask his doctor for that. I take 3000 mgs of Omega 3 fish oil every day and am convinced it has made a difference. > hi. my husband suffers from osteoarthritis and is a window cleaner by > trade. He feels little pain during the day when he is working but as > soon as he stops, his pain is almost unbearable. Does anyone have any > advice on how to reduce this pain? He already takes co-codimol and Hi here are a couple of posts from the past. Glucosamine Has a Disease-Modifying Effect on Osteoarthritis CME News Author: Laurie Barclay, MD March 17, 2004 - Glucosamine has a disease-modifying effect on osteoarthritis, according to the results of two three-year randomized studies published in the March/April issue of Menopause. "The management of knee osteoarthritis, recognized as responsible for consistent pain and disability, is a major social and economic target in health management," write Olivier Bruyere, MSc, from the WHO Collaborating Center for Public Health Aspect of Osteoarticular Disorders in Liege, Belgium, and colleagues. "For a few years, glucosamine sulfate has been considered a potential disease-modifying drug for osteoarthritis." This study was a preplanned combination of two three-year, randomized, placebo-controlled, prospective, independent trials investigating the effects of glucosamine sulfate on symptoms and joint structure in osteoarthritis. Of 414 subjects enrolled, 319 were postmenopausal women. Demographics and disease characteristics were similar at baseline in the glucosamine sulfate and placebo groups, both in the overall study population and in the subgroup of postmenopausal women. After three years, postmenopausal women who received placebo had joint space narrowing on standing anteroposterior knee radiographs, but those who received glucosamine did not. Joint space change was +0.003 mm (95% confidence interval [CI], -0.09 to 0.11) in the glucosamine group and -0.33 mm (95% CI, -0.44 to -0.22) in the placebo group (P < .0001). The glucosamine sulfate group also improved in the Western Ontario and McMaster Universities Osteoarthritis Index function scale (WOMAC) reflecting symptoms (-14.1%; 95% CI, -22.2 to -5.9), while there was a trend for worsening in the placebo group (5.4%; 95% CI, -4.9 to 15.7; P = .003 between groups). A potential study limitation is that symptom relief might improve joint space narrowing as seen on standing knee x-rays, but the authors found only a poor relationship between symptom relief and prevention of joint space narrowing. They also found a significant difference in joint space preservation between patients receiving placebo or glucosamine when considering only those patients with symptomatic improvement. "This analysis, focusing on a large cohort of postmenopausal women, demonstrated for the first time that a pharmacological intervention for osteoarthritis has a disease-modifying effect in this particular population, the most frequently affected by knee osteoarthritis," the authors write. "Glucosamine sulfate, therefore, is the first agent that meets the current requirements to be classified as a symptom- and structure-modifying drug in women with knee osteoarthritis." Visit my website: http://www.mzuschlag.com Crikeys - I hope this doesn't wake up you know who LOL!!! Glucosamine is Associated with Improved Osteoarthritis Outcomes Gillian A. Hawker1, Michal Abrahamowicz2, Roxane du Berger3, Annette Wilkins4, Elizabeth Badley4. 1Women's College Campus of SWCHSC, Toronto, ON, Canada; 2Department of Epidemiology and Biostatisitics, McGill University, Montreal, PQ, Canada; 3Division of Clinical Epidemiology, The Montreal General Hospital, Montreal, PQ, Canada; 4Arthritis Community Research & Evaluation Unit, UHN, Toronto, ON, Canada Purpose: To prospectively examine the effect of osteoarthritis (OA) therapies on changes in OA pain and disability. Methods: A prior study ('96-'98) established a population cohort of 2,411 individuals aged 55+ years with disabling hip/knee arthritis (baseline). In '99, the cohort was invited to participate in a 5-year follow-up study. Information was collected at baseline and annually: age, sex, education, income, living circumstances, self-reported comorbidity, use of therapies (NSAIDs, pain killers, steroid injection, glucosamine, walking aids and devices), hip/knee joint replacement, visits to arthritis health care professionals, and OA pain and disability (WOMAC). Three mixed regression models were used estimate associations between current use of different therapies and repeated measurements of the WOMAC, adjusting for sociodemographics, comorbidity and concurrent use of other therapies. Model 1 assessed if individuals currently on a therapy have better WOMAC scores across the repeated assessments than those not using the therapy. Model 2 adjusted additionally for baseline WOMAC values while Model 3 adjusted for the prior year WOMAC value to investigate if change from last year is associated with recent use of the therapy. Results: 1,376 patients contributed a total of 4,119 assessments. Baseline mean age was 72 years; 72% were female. The proportion using glucosamine increased from 9% to 17% during the follow-up period. Adjusting for sociodemographics and concurrent use of other therapies, current glucosamine use was associated with lower WOMAC scores in all models. Across the repeated assessments, individuals taking glucosamine had a mean WOMAC score 1.8 points lower than individuals with the same characteristics and treatments who were not taking this therapy (95% CI: 0.5 to 3.0, p=0.005). This effect remained significant after adjusting for baseline and final year WOMAC scores, which were on average lower by 1.5 (95% CI: 0.3 to 2.7, p=0.014) and 1.1 (95% CI: 0 to 2.3, p=0.05), respectively. No other therapy showed any association with improved outcomes. Other significant predictors of lower WOMAC scores at follow-up were: younger age, higher education and income, and male gender. Males had, on average, WOMAC scores 4 points lower than women with the same sociodemographics and treatments (mean 4 points lower; 95% CI: 2.6 to 5.4, p<0.0001). Conclusion: Of the therapies considered, only glucosamine was associated with an improvement in OA pain and disability providing support for the benefits of this therapy in OA. The absence of an effect with other therapies is likely due to confounding by indication, which is less likely to impact non-physician-prescribed glucosamine use.Crikeys - I hope this doesn't wake up you know who LOL!!! Glucosamine is Associated with Improved Osteoarthritis Outcomes Gillian A. Hawker1, Michal Abrahamowicz2, Roxane du Berger3, Annette Wilkins4, Elizabeth Badley4. 1Women's College Campus of SWCHSC, Toronto, ON, Canada; 2Department of Epidemiology and Biostatisitics, McGill University, Montreal, PQ, Canada; 3Division of Clinical Epidemiology, The Montreal General Hospital, Montreal, PQ, Canada; 4Arthritis Community Research & Evaluation Unit, UHN, Toronto, ON, Canada Purpose: To prospectively examine the effect of osteoarthritis (OA) therapies on changes in OA pain and disability. Methods: A prior study ('96-'98) established a population cohort of 2,411 individuals aged 55+ years with disabling hip/knee arthritis (baseline). In '99, the cohort was invited to participate in a 5-year follow-up study. Information was collected at baseline and annually: age, sex, education, income, living circumstances, self-reported comorbidity, use of therapies (NSAIDs, pain killers, steroid injection, glucosamine, walking aids and devices), hip/knee joint replacement, visits to arthritis health care professionals, and OA pain and disability (WOMAC). Three mixed regression models were used estimate associations between current use of different therapies and repeated measurements of the WOMAC, adjusting for sociodemographics, comorbidity and concurrent use of other therapies. Model 1 assessed if individuals currently on a therapy have better WOMAC scores across the repeated assessments than those not using the therapy. Model 2 adjusted additionally for baseline WOMAC values while Model 3 adjusted for the prior year WOMAC value to investigate if change from last year is associated with recent use of the therapy. Results: 1,376 patients contributed a total of 4,119 assessments. Baseline mean age was 72 years; 72% were female. The proportion using glucosamine increased from 9% to 17% during the follow-up period. Adjusting for sociodemographics and concurrent use of other therapies, current glucosamine use was associated with lower WOMAC scores in all models. Across the repeated assessments, individuals taking glucosamine had a mean WOMAC score 1.8 points lower than individuals with the same characteristics and treatments who were not taking this therapy (95% CI: 0.5 to 3.0, p=0.005). This effect remained significant after adjusting for baseline and final year WOMAC scores, which were on average lower by 1.5 (95% CI: 0.3 to 2.7, p=0.014) and 1.1 (95% CI: 0 to 2.3, p=0.05), respectively. No other therapy showed any association with improved outcomes. Other significant predictors of lower WOMAC scores at follow-up were: younger age, higher education and income, and male gender. Males had, on average, WOMAC scores 4 points lower than women with the same sociodemographics and treatments (mean 4 points lower; 95% CI: 2.6 to 5.4, p<0.0001). Conclusion: Of the therapies considered, only glucosamine was associated with an improvement in OA pain and disability providing support for the benefits of this therapy in OA. The absence of an effect with other therapies is likely due to confounding by indication, which is less likely to impact non-physician-prescribed glucosamine use. And add this site http://home.gci.net/~cushman4/oa-gcs.htm Have you seen an RD [rheumatologist] yet? You might have a form of arthritis which will have limited help from G/C and better help from some other form of treatment. Duckie The smallest but a great site where a person can learn a great deal Harv He should use his pain medication pro-actively: take it one hour before activity. He should use ice and heat, alternately, and should get to a physical therapist to show him how to do this effectively, and receive possible other treatmentsand pain management education.. Some medications can cause the type of pain you describe, with heightened pain 6-12 hours after activity and not resolving as soon as it should, or ever. If your husband is taking a statin medication to lower his cholesterol, consider that the pain may be caused by his medication. http://www.annals.org/cgi/content/full/138/12/1008-a http://www.annals.org/cgi/reprint/138/12/1008-a.pdf Zee Rheumy's are ok for pain management to a certain point, you then can ask, and most Rheumy's are amenable to a referral to a pain clinic. Bruce > hi. my husband suffers from osteoarthritis and is a window cleaner by > trade. He feels little pain during the day when he is working but as [quoted text clipped - 53 lines] >> > >> > ziajade |
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