Pain Management

In The News: November 2019

Having osteoarthritis has been linked to an increased risk for heart disease. But the reasons for the connection are not known. Results of a study published in Arthritis & Rheumatology (August 2019) suggest that use of non-steroidal anti-inflammatory drugs (NSAIDs) may be, at least partly, to blame. Researchers analyzed data from Canadian health databases on 7,743 people with osteoarthritis and compared them to 23,229 people of similar age without osteoarthritis. Those with osteoarthritis had a 42% higher risk for heart failure, a 17% higher risk for coronary heart disease, and a 14% higher risk for stroke. The researchers reported that about 41% of the total effect on increased heart disease risk was attributable to current use of NSAIDs. This was an observational study, and the authors acknowledge that prospective studies (which compare people randomly assigned to different groups) are needed to confirm the findings.
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Ask The Doctors: November 2019

A: The short answer to your question is no. But that doesn't mean there's nothing you can do about it. Osteoarthritis is caused by the degeneration of cartilage, and it cannot be reversed. Where two bones meet to form a joint the ends of the bones are covered with cartilage, which is a tough slippery material that allows the bones to glide smoothly over each other. At the most mobile joints (called synovial joints), which are the hips, knees, shoulders, elbows, wrists, fingers, ankles and toes, the cushioning cartilage can wear down. The reasons are not known, but it is partly a function of aging. Close to 50% of Americans ages 65 and over have arthritis.
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Joint Pain From Cancer Treatment

Aromatase inhibitors are used mainly in two situations. First, a woman newly diagnosed with a breast cancer tumor of a specific size who has undergone surgery will be given an aromatase inhibitor to take for five years, and possibly up to 10 years, to prevent the cancer from coming back. "This is someone who doesn't have cancer right now," says Dr. LeGrand. "It's given for prevention."
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Gout Drugs Are Underused

Uric acid is a waste product of natural processes in the body. It is eliminated through the gastrointestinal tract and kidneys. If not enough uric acid is removed, it can accumulate in the blood. Once levels exceed 6.8 milligrams per deciliter (mg/dL), uric acid can leave the bloodstream and settle in joints, tendons and under the skin.
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Conquer Fear of Falling

To strengthen the calf muscles and small muscles of the ankles and feet, try this simple exercise: Stand up tall and rise straight up on your toes. Try to stay stable for three seconds. Have your hands hovering over a surface (close but not touching) for safety. Work up to doing this 20 times. Eventually, try doing this on one foot. Start with five repetitions.
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Relief for Nagging Hip Pain

A short course of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) or naproxen (Aleve), can be used as long as there are no reasons not to take them. NSAIDs should be used cautiously in certain people, including those with a history of stomach ulcers, kidney disease, heart disease or stroke. Talk to your doctor to ensure you are taking the drugs safely. Your doctor also may prescribe a stronger NSAID.
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Adults Need Vaccines Too

Anyone can get the flu. It usually lasts about a week and often requires bed rest for a few days. Some people are at high risk for developing flu-related complications, such as pneumonia. They include children, older adults and people with some chronic diseases (including rheumatoid arthritis and psoriatic arthritis). During the 2017-2018 flu season, close to 1 million people were hospitalized for the flu, and there were 79,400 deaths from the flu.
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Download The Full October 2019 Issue PDF

NSAIDs are effective because they block an enzyme called cyclooxygenase (COX), which exists in two forms-COX-1 and COX-2. These enzymes make chemicals called prostaglandins, which contribute to inflammation in the body.
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Use NSAIDs Cautiously

COX-2 inhibitors were developed to avoid the stomach problems that can occur with traditional NSAIDs. The COX-1 enzyme protects the stomach lining from corrosive effects of stomach acid, so it was thought that inhibiting just COX-2 would be easier on the stomach. But COX-2 also has a protective effect. The risk for stomach issues is about 50% lower with COX-2 inhibitors than with nonselectiveNSAIDs.
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In The News: October 2019

People with osteoarthritis in the knee or hip may be at increased risk for heart disease, according to a study published in the journal Osteoarthritis and Cartilage (June 2019). The researchers studied 469,177 residents of southern Sweden who were 45 to 84 years old in 2003. They analyzed health data from 2004 to 2014. Overall, 15,901 of the residents had osteoarthritis in the knee, hip, hand or other joints. For most causes of death, the researchers found no difference in risk between people with osteoarthritis and those without it. However, people with osteoarthritis in the hip or knee were almost 20% more likely than the general population to die of heart disease. Most deaths were from ischemic heart disease (from clogged arteries) and heart failure. The risk increased with duration of osteoarthritis. The increase is thought to be due to mobility problems and lack of physical activity among people suffering with painful joints. The study highlights the need to find pain-free ways to stay active.
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Don’t Ignore Ball-of-Foot Pain

The plantar plate is a fibrous structure underneath the foot that supports and stabilizes the joints between the toe bones and the bones of the foot. (These are the metatarsophalangeal joints [MPJ].) The plantar plate, which is made of collagen, consists of bands that provide attachments for ligaments that go to each toe and that go between toes. These keep toes straight (preventing them from drifting up) and also in alignment (preventing the toes from separating).
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Should You Get a Partial Knee Replacement?

Osteoarthritis results from the deterioration of cartilage in joints. Cartilage is the tough material that covers the ends of bones, providing a smooth gliding surface. In the knee joint, where the thigh bone (femur) meets the shinbone (tibia), there are three places where bones make contact. One of them is on the inside (nearest the opposite knee, referred to as medial) and one is on the outside (farthest from the opposite knee, referred to as lateral). The kneecap (patella) is the third point of contact.
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