PainRelief.com Interview with: Dana Orange MD Associate Professor of Clinical Investigation The Rockefeller Institute and William H. Robinson, MD PhD James W. Raitt, M.D., Professor Medicine Immunology & Rheumatology Stanford Health Care
PainRelief.com: What is the background for this study?
Response: Periodontitis is more common in patients with rheumatoid arthritis than those without.
Of patients with rheumatoid arthritis, those with current periodontitis are less likely to receive benefit from treatment with biologic agents than those without periodontitis.
PainRelief.com Interview with: Kaitlin Carrato, M.D., Chief Resident in Interventional Radiology MedStar Georgetown University Hospital, and John B. Smirniotopoulos, M.D., Interventional Radiologist MedStar Georgetown University Hospital
PainRelief.com: What is the background for this study? What is the main indication for the RFA procedure?
Response: Roughly one in four U.S. adults have knee pain due to arthritis that interferes with their everyday lives and activities. A treatment called genicular nerve radiofrequency ablation (RFA) is a safe and effective option for reducing pain from osteoarthritis of the knee, one of the most common joints affected by osteoarthritis. Interventional radiologists perform genicular nerve RFA using image guidance to place probe needles next to nerves around the knee that send pain signals to the brain. The primary indication for this procedure is chronic pain that has not been sufficiently managed by other treatments, prescription medications, physical therapy, or for patients with persistent pain even after knee replacement.
This study examined patient demographics, prior surgical history, degree of osteoarthritis and other clinical characteristics that may affect how well RFA reduces knee pain. We measured post-procedure pain in 36 patients using the visual analog scale (VAS) and the Western Ontario McMaster Universities Osteoarthritis (WOMAC) pain scale. We then evaluated whether pain reduction levels were influenced by demographics and clinical characteristics.
PainRelief.com Interview with: Tom Arild Torstensen Department of Neurobiology, Care Sciences and Society Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden, and Holten Institute, Stockholm, Sweden
Tom Arild Torstensen
PainRelief.com: What are the main findings? Response: The results from our study (1) show that both high-dose and low-dose exercise therapy is beneficial for knee osteoarthritis. At a glance, it would be natural to think that I should choose a low-dose because it takes only 30 minutes and consists of 5 different exercises compared to the high-dose lasting 70 to 90 minutes consisting of 11 exercises. But because our study was designed as a superiority trial, meaning that even though we failed to show that high-dose treatment is superior to low-dose, our results do not imply that a low-dose exercise regimen is as beneficial as a high-dose regimen.
Both groups improved over time, but there were no benefits of high-dose therapy in most comparisons. One exception was the KOOS score function in sports and recreation, where high-dose therapy was superior at the end of treatment and the 6-month follow-up. A small benefit in QoL at 6 months was also observed. Notably, most variables numerically favored the high-dose group, albeit not in a statistically or clinically meaningful way.
PainRelief.com Interview with: Zhaohua Zhu (Alex) PhD, Associated Professor Clinical Research Center Zhujiang Hospital of Southern Medical University
PainRelief.com: What is the background for this study?
Osteoarthritis is a leading cause of pain and disability in older adults, but there are no effective drugs in preventing or reversing osteoarthritis progression.
•Metformin is the first-line pharmacologic treatment and the most commonly prescribed drug worldwide for diabetes mellitus.
•Recent experimental studies have showed that both intragastric and intraarticular metformin use can attenuate cartilage degradation and modulated pain in osteoarthritis mouse models. However, it is unclear whether metformin use is associated with reduced risk of total joint replacement in patients with type 2 diabetes mellitus.
PainRelief.com Interview with: Stephen P. Messier, Ph.D. Professor J.B. Snow Biomechanics Laboratory Department of Health and Exercise Science Worrell Professional Center Wake Forest University Winston Salem, NC 27109
Dr. Messier
PainRelief.com: What is the background for this study? What are the main findings?
Response: Some weight loss and exercise programs that have been successful in academic center-based trials have not been evaluated in community settings. The results showed that among patients with knee osteoarthritis and overweight or obesity, diet and exercise compared with an attention control led to statistically significant differences in pain, function, mobility, body weight, waist circumference, and quality of life.
PainRelief.com Interview with: Dr PANG Chun Yiu Johnson Assistant Professor School of Health Sciences Caritas Institute of Higher Education Hong Kong
Mr PANG
PainRelief.com: What is the background for this study?
Response: As a practicing physiotherapist for over 20 years in an outpatient setting at a government-based hospital, I had encountered difficult situations where patients were suffered with long-term pain that pervious treatments were ineffective or wasn’t long lasting.
Dry needling is a treatment technique that I had always been interested and practicing even during my college times. With years of practice, it has become a skill that I specialized in and received promising results from most of my patients.
However, like most techniques, it has its limitations. Microtrauma inducted by the puncturing of the needles elicit inflammatory response that activate mast cells proliferation to promote tissues healing. As a result, the effectiveness of dry needling depends on the expertise and skill of the practitioners to accurately locate the problematic structure for the insertion of needles.
The inconsistency results of studies with dry needling can be attributed to the absence of a standardized approach and inaccuracies related to needle targeting and advancement.
With that in mind, I wanted to investigate and validate a method that can enhance the accuracy of needle advancement and improve the effectiveness of dry needling. Through constantly researching evidence-based publications, coincidently I came across an article that incorporated ultrasound guidance into dry needling on treating shoulder impairments. The results were promising, both in patient’s feedback and ultrasound imaging, since the practitioner was able to clearly identify the problematic structure under ultrasound guidance. This had inspired me to further investigate the effectiveness of ultrasound-guided dry needling on different musculoskeletal conditions.
PainRelief.com Interview with: Thérése Jönsson, PT, PhD Research group, Sport Sciences Department of Health Sciences Lund University
Dr. Jönsson
PainRelief.com: What is the background for this study?
Response: Osteoarthritis (OA) is the most common joint disease and affects more than 300 million people worldwide. Exercise combined with patient education and weight control, if needed is the first-line treatment for OA. Traditionally, first-line treatment has been provided as a face-to-face intervention, requiring the patient to physically visit a primary care clinic or similar.
To increase access to healthcare for the wider community, digital health care interventions are recommended by the World Health Organization to complement traditional care. Digital care platforms have been introduced, but there is limited evidence for their efficacy compared with traditional face-to-face treatment modalities.
PainRelief.com Interview with: Professor Kim BennellFAHM Barry Distinguished Professor | NHMRC Leadership Fellow Dame Kate Campbell Fellow Centre for Health Exercise and Sports Medicine Department of Physiotherapy Melbourne School of Health Sciences The University of Melbourne, Victoria Australia
PainRelief.com: What is the background for this study?
Response:Osteoarthritis is very common, and a major contributor to disability and decreased function. Exercise is a key treatment for osteoarthritis, but many people admit to not undertaking exercise. We investigated whether a free, online 12-week unsupervised yoga program (“My Joint Yoga”) could improve pain and function in people with knee osteoarthritis. Our team worked with yoga therapists, physiotherapists and people with lived experience of osteoarthritis to design an online yoga program tailored specifically to those with knee osteoarthritis.
PainRelief.com Interview with: Beth Wallace, M.D. M.Sc Associate Investigator, Center for Clinical Management Research Staff Physician, Rheumatology VA Ann Arbor Healthcare System Assistant Professor, Division of Rheumatology University of Michigan
Dr. Wallace
PainRelief.com: What is the background for this study?
Response: Arthritis and joint pain are common among older adults. We used data from the University of Michigan National Poll on Healthy Aging to understand how a national sample of older adults experiences and manages joint pain.
PainRelief.com: What are the main findings?
Response: Seventy percent of adults aged 50-80 report that they have joint pain. Three in five have a diagnosis of arthritis, including 30% who have a diagnosis of osteoarthritis (also called “wear and tear” or “bone on bone” arthritis).
Of those with joint pain, half said that it limited their usual activities, but about three in four said that they saw arthritis and joint pain as a normal part of aging that they could manage on their own.
More than half of all adults use over-the-counter pain relievers like non-steroidal anti-inflammatory drugs (Advil, Motrin, Aleve) for joint pain. One in ten used a prescription oral steroid, like prednisone. This is important because these medications can cause or worsen health conditions common in older people, such as high blood pressure and heart disease. More than a quarter of adults who used oral steroids for joint pain did not remember discussing the risks of these medications with their health care provider.
Ninety percent of those with joint pain used non-medication treatments, like exercise, massage, and splints and braces, to manage their symptoms. Most people who used these treatments found them to be very helpful.
PainRelief.com Interview with: Mwidimi Ndosi PhD MSc BSc PGCert (Clin Ed) FHEA RN Sarah Bennet and Beth Jones Associate Professor in Rheumatology Nursing University of the West of England, Bristol Honorary Researcher University Hospitals Bristol and Weston NHS Trust
Dr.Ndosi
PainRelief.com: What is the background for this study? What are the main findings?
Response:Patient education is seen as an essential part of managing long-term conditions like inflammatory arthritis. Chronic inflammatory arthritis includes rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. We define patient education as a planned interactive learning process designed to support and enable people to manage their life with a disease and optimise their health and wellbeing.[1]
There are variations across Europe in the way patient education is delivered to people with inflammatory arthritis. In 2015, an international group of professionals and patients with inflammatory arthritis developed evidence-based recommendations for patient education [1]. This initiative was supported by the European Alliance of Associations for Rheumatology (EULAR), an organisation representing people with arthritis, health professionals in rheumatology and scientific societies of rheumatology in Europe.
In this study, we wanted to find out whether the recommendations were acceptable to patients and healthcare professionals. We also needed to know what helped people to follow these recommendations and what were barriers to putting them into practice. We surveyed health professionals in 20 countries in Europe, and 3 in Asia (India, Hong Kong and Japan) [2]
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