I find myself regularly referring to the passage of time, especially in regards to its effects on the human body. Not surprisingly, illness and ill health are usually the subject of discussion. As many will attest, the passage of time inexorably leads to the development of joint pain, and more specifically osteoarthritis. It is one of defeated resignation that , disability, and deformity should all be expected and accepted. Or, I have no idea how to get some relief.
Osteoarthritis is the most common type of arthritis found in the United States and is also the most common joint disease in adults worldwide. Many joint-related structures can be affected, including intra-articular (intra-articular) and extra-articular tissues. Therefore, it can affect bones, cartilage, muscles, nerves, and other structures. Pain, disability, and deformity are common complications of this disease.
Traditionally, the therapeutic focus has been on end-stage osteoarthritis through joint replacement or fusion surgery, but these efforts have yielded no effective results. Nor does it change the course of the disease. Primary health care has generally been unconcerned with benign joint pain and overwhelmed with more pressing problems. It would be much easier to prescribe anti-inflammatory drugs for another busy day, but patients have been inadequately maintained for years on these potentially harmful palliatives. When it does, it can lead to surgery, associated costs, and potential disability and complications.
Many have commented that our approach to managing joint pain in elderly patients is inadequate, inefficient and wasteful. is not changed. We respond to symptoms by relieving them, but we do not cure disease. But gradually, very slowly, the tide is turning. Many in the healthcare industry recognize that our approach is inadequate and believe more proactive measures are needed. Yes, there is a new paradigm: from mitigation to prevention.
Nonpharmacologic treatments are becoming recognized as a more effective long-term approach to management, including patient education and provision of self-management strategies, weight loss advice, strengthening and physical therapy programs. Particularly effective, but not commonly used, assessment of biomechanical problems can be addressed with orthoses and foot orthoses. Naturally, in the case of knee problems, foot braces are often beneficial, as poor foot alignment can be expected to put greater physical stress on the joints.
Current guidelines actually recommend various orthopedic measures to reduce pain, as well as intra-articular corticosteroids. Incidentally, a recent study found no significant difference between synthetic synovial fluid injections and corticosteroids in terms of pain relief and functional improvement in osteoarthritis.
Exercise offers an effective, safe, low-tech, low-cost treatment that reaches the majority of patients who need it when they need it. Muscles are the most easily manipulated tissue by us and exercise therapy improves muscle function, joint pain, stability and function. However, less than half of patients with joint disease receive exercise advice and only a minority benefit from effective rehabilitation therapy. There are effectively no resources available.
more than this “on the horizon” Regenerative medicine is an exciting new approach to treating musculoskeletal pain. The term includes a variety of techniques aimed primarily at promoting healing through the action of stem cells. Pain relief is a clear benefit of stimulating tissue repair. From applying small bursts of powerful sound waves (shock wave therapy) to injecting specific blood cells from your own blood (PRP), many new methods have been discovered and are now available, often with great benefits. While much research is needed and these technologies are not yet as precisely defined as many over-the-counter drugs, they have the potential to change medical practice. It offers better options for people struggling with the consequences of the condition.
The majority of the public, including patients and even medical professionals, seem to view osteoarthritis as an inevitable consequence of life. . It seems logical that this is not only incurable, but virtually untreatable. However, research has shown that exercise with proper braces and support can help maintain function and reduce pain. Our attitude towards this mundane situation is one that must be overcome, and education is the cornerstone of this effort. There are better options, but you’ll have to look for them.
Dr. Conway McLean, DABFAS, FAPWHc has offices in L’Anse and Marquette. He is a doctor who specializes in treating lower extremity, ankle and foot problems.