In The News: December 2012
Topical NSAIDs as Effective as Oral NSAIDs in Relieving Arthritis Pain
If you suffer from osteoarthritis (OA) of the knees and hands, applying topical nonsteroidal anti-inflammatory drugs (NSAIDs) can bring weeks of pain relief, according to a new review by The Cochrane Library. While oral NSAIDs are more common for managing musculoskeletal pain, reviewers wanted to examine the effectiveness of topical drugs for managing pain. Investigators evaluated 34 studies involving 7,688 adults with chronic musculoskeletal pain for a period of at least three months. Participants were organized into groups using either a topical NSAID, such as diclofenac, applied at least once daily, a placebo, or an oral NSAID. Diclofenac was found to be as effective as oral NSAIDs for arthritis in the knee or hand, and it gave more participants good pain relief compared to the placebo in studies lasting eight to 12 weeks. Reviewers clarified, however, that the use of topical formulations is limited to conditions where the pain is near the skin’s surface. “The benefit of a topical NSAID,” they explained, “is that the drug stays close to the site of application, so levels in blood and more remote tissues remain very low. This means you don’t get the gastrointestinal problems associated with oral NSAIDs.”
Value of Spinal Manipulation for Acute Lower Back Pain Questioned
Spinal manipulation (SMT), often used by chiropractors and osteopaths to improve the spine’s range of motion, is no more effective than exercise, NSAIDs, or physical therapy to treat acute lower back pain. Reviewers at The Cochrane Library studied the results of 20 randomized controlled trials representing 2,674 participants with lower back pain of less than six weeks’ duration. They concluded that SMT neither reduced pain nor sped recovery faster than treatment options such as exercise, the use of NSAID pain medications or physiotherapy. Surprisingly, the review also found no evidence to suggest that SMT was more effective than therapies known to be ineffective. One complicating factor, reviewers admitted, is the nature of acute lower back pain. Defined as lasting six weeks or less, it tends to go away on it own in almost 90 percent of all cases.
Chronic Pain Costs U.S. Nearly $635 Billion a Year
Health economists from Johns Hopkins University, writing in The Journal of Pain, report the annual cost of chronic pain in the U.S. is as high as $635 billion a year, which is more than the annual costs of cancer, heart disease, and diabetes. Researchers estimated the annual economic costs by assessing costs of health care due to pain and the indirect costs of pain from lower productivity. The sample included 20,214 individuals 18 and older to represent 210.7 million adults. The authors defined people with pain as those who have pain that limits their ability to work or who are diagnosed with joint pain or arthritis. Mean health expenditures for adults were $4,475, while prevalence estimates were 10 percent for moderate pain, 11 percent for severe pain, 33 percent for joint pain, 25 percent for arthritis, and 12 percent for functional disability. The authors noted their conclusions are conservative because the analysis did not consider the costs of pain for institutionalized and non-civilian populations, or for people under age 18.
Thigh Size in Obese Patients May Cause Hip Implants to Fail
University of Iowa researchers have determined that thigh size in obese people is a reason their hip implants are more likely to fail. In their study, the research team simulated hip dislocations and found that increased thigh girth creates hip instability in morbidly obese patients (a body mass index greater than 40). They concluded that obese patients’ thighs were so large that they pushed each other outward and forced the implant out of its socket. They also pointed to studies that showed up to a 6.9-fold higher dislocation rate for obese patients compared to normal- weight patients. Nearly 231,000 total hip replacements are performed annually in the U.S. and more than 90 percent do not require repair or replacement. But when an implant fails, it is painful, and costly. The study’s authors suggest that surgeons modify surgical procedures to minimize the chance of dislocation in obese patients and consider other designs for hip replacement implants.