Ask the Doctors September 2003 Issue

Ask Dr. Marks: 09/03

I’ve heard a lot about pain patches recently. Are they effective, addictive, expensive?

Pain patches are very effective at delivering narcotic pain relievers. The patches are placed on an area of clean skin and produce a narcotic concentration gradient that transports the narcotic through the skin into the blood stream. The narcotic, usually Fentanyl, is released over a period of three days instead of the few hours of pain relief achieved by pills.

Pain patches are quite effective in relieving chronic pain, such as cancer pain. They should not be used for mild to moderate pain and are rarely used for arthritis pain.

Over a period of time, the use of any narcotic—whether through a pill, injection or transdermal patch—can become addictive. Compared to other types of analgesics, pain patches are expensive, and they must be used under a doctor’s supervision.

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How often and how vigorously do I have to exercise during the week to see benefits for my arthritis?

The goal of exercise is to promote range of motion of the arthritic joint and strengthen surrounding muscles. Arthritis pain often causes muscles adjacent to the affected joint, which act as joint stabilizers and shock absorbers, to atrophy because of lack of use. Improving muscular strength often leads to the reduction of arthritis symptoms.

To be effective, an exercise program should be conducted on a regular basis. I recommend to my patients that they set aside a specific time each day for exercise, usually in the morning after a warm shower.

Arthritis-friendly exercises include swimming, bicycling and strengthening movements. How vigorously these exercises are performed depends on the severity of the arthritis and your overall condition. The minimum frequency for exercise to be beneficial for arthritis is three times a week. There are usually exercise programs available in the community to promote joint health for older individuals. However, the key to any exercise program is consistency.

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What are the signs of knee arthritis? How is it diagnosed, and how is it treated?

Joint pain, stiffness and swelling are the symptoms of arthritis of the knee. The pain is usually worse when weight bearing and can be relieved by rest. Joint stiffness is greatest the first thing in the morning. After a shower or exercise, stiffness usually subsides. Swelling of the joint, if it occurs, is more frequent later in the day

Arthritis of the knee is diagnosed primarily by weight-bearing X-rays. In osteoarthritis, there is a narrowing of the joint space (the apparent “gap” between the femur and the tibia) and the formation of osteophytes (“spurs”).

Treatment varies depending on the severity of the arthritis. Mild to moderate arthritis is treated with pain relievers such as Tylenol and anti-inflammatory drugs. In addition to medication, exercise can help to alleviate symptoms. As the arthritis progresses, injections of steroids into the joint may be necessary to suppress symptoms. If medications fail to relieve the severity of pain, the most effective treatment is a total knee replacement.