Sports Science and Clinical Biomechanics &
Unit for General Practice (Dept. of Public Health)
PainRelief.com: What is the background
for this study?
Response: Opioids are commonly prescribed to patients with knee and hip osteoarthritis (OA). But for newly diagnosed patients’ clinical guidelines recommend exercise therapy, patient education and weight loss (if needed) as first line treatment. These treatments can be supplemented or replaced with biomechanical interventions (insoles, wedges, cane use, etc.), and paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) if needed. Generally, opioids are should only be used when other treatment options are exhausted, ineffective or contraindicated. Thus, treatment with opioids shortly after OA diagnosis is considered inappropriate according to guidelines.
Samannaaz Khoja, PT, PhD Research Assistant Professor Department of Physical Therapy University of Pittsburgh School of Health and Rehabilitation Sciences
PainRelief.com: What is the background for this study?
Response: The purpose of this study was to describe and compare rates of physicians’ recommendation for physical therapy (PT), lifestyle-counseling, and pain medication for knee osteoarthritis (KOA) between 2007 and 2015. The study also aimed to identify patient, physician and practice-level factors associated with each treatment recommendation. We used survey data from the National Ambulatory Medical Care Survey, data from this survey is publicly available and is housed within the CDC. We identified 2297 knee OA related visits, which approximated to 67 (±4) million weighted physician visits between 2007 and 2015 (around 8 million visits/year).
PainRelief.com Interview with: Dr. Daniel Whibley PhD Department of Physical Medicine and Rehabilitation University of Michigan, Ann Arbor, Michigan Epidemiology Group, School of Medicine, Medical Sciences and Nutrition University of Aberdeen, Scotland, UK
PainRelief.com: What is the
background for this study? What are the
Response: Older adults with osteoarthritis commonly report symptoms of pain, fatigue and poor sleep quality. Previous research has investigated how this symptoms are cross-sectionally and longitudinally associated with each other. However, no previous studies have investigated how the quality of a night’s sleep impacts on the next day’s course of pain and fatigue in this clinical population.
We found that poor sleep quality was associated with greater pain intensity and fatigue on awakening when compared to a good night’s sleep and that, over the course of the day, the effects were sustained. Although a night of better quality sleep was associated with less pain and fatigue on awakening, these symptoms worsened more rapidly throughout the day, such that as the day progressed the effect of the previous night’s sleep became less and less important.
Director, Center for Treatment Comparison and Integrative Analysis (CTCIA) Deputy Director, Center for Complementary and Integrative Medicine (CCIM) Asst Professor of Medicine, Tufts University School of Medicine Asst Professor of Clinical & Translational Science Sackler School of Graduate Biomedical Sciences Division of Rheumatology, Tufts Medical Center Boston, MA
PainRelief.com: What is the
background for this study? What are the
Response: Though the higher rates of certain adverse events due to NSAIDs are well documented, we were curious about how soon these adverse events can begin to manifest. We were similarly interested in the efficacy trajectories of NSAIDs, because previous studies had conducted analyses of the last reported follow-up times for the drugs, but we noticed that many of the studies had only very short-term follow up ranging between 1-4 weeks which didn’t provide a more complete picture of the therapeutic effect over time.
The key findings of our study are that the widely used NSAIDs are very effective for short-term pain relief but their efficacy wanes over a period of 12 weeks. The adverse events though mild in nature start appearing within 4 weeks of treatment.
PainRelief.com Interview with: Robert E. Sorge, PhD | Associate Professor College of Arts and Sciences Department of Psychology Director | PAIN Collective UAB | The University of Alabama at Birmingham
PainRelief.com:What is the
background for this study? What are the main findings?
Response: Our work
in animals has shown that a poor-quality diet (high in refined carbohydrates)
leads to widespread inflammation, activated immune cells and prolongs recovery
from an injury. We have also shown that diet can reverse these effects.
Therefore, we wanted to see whether we could reduce pain in people with knee osteroarthritis
just by changing their diet.
that carbohydrates can lead to inflammation and oxidative stress, so we wanted
to know whether reducing them would reduce pain or whether pain could be
reduced by just losing weight – the knee is a weight-bearing joint, after all.
We found that weight loss did not predict pain relief, but that the
participants following a low-carb diet showed reduced daily pain, reported less
pain interference in daily activities and had less pain when we evoked pain in
their knees. The reduction in evoked pain was related to changes in oxidative
Ours is a small study, but we believe that it is important to let people know that a change of diet can have a significant impact on their daily pain. Diets are modifiable and have no negative side effects – something not true of most pain-relieving medications.
PainRelief.com Interview with:
Adam Perlman, MD, MPH
Program Director, Leadership Program in Integrative Healthcare
Duke Integrative Medicine
PainRelief.com: What is the background for this study? What are the main findings?
Response: Current treatment options for knee osteoarthritis have limited effectiveness and potentially adverse side effects. Massage may offer a safe and effective complement to the management of knee osteoarthritis.
We investigated the effect of whole-body massage on knee osteoarthritis, compared to active control (light-touch), and usual care. Participants received 8 weeks of massage, light-touch or usual care and then were randomly assigned to maintenance every other week massage, light-touch or continuation of their usual care. At the end of 8 weeks, massage significantly improved symptoms, including pain, stiffness and physical function, while the other groups did not. At 52 weeks, every other week massage maintained the improvements, however the other groups also improved. Continue reading →
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