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]
Felix Gonzalez, M.D. Assistant professor, Division of Musculoskeletal Imaging Department of Radiology and Imaging Scienc Emory University School of Medicine Atlanta, Georgia
Dr. Gonzalez
PainRelief.com: What is the background for this study? What are the main findings?
Response: Total knee arthroplasty is a common procedure performed worldwide for the treatment of symptomatic knee arthritis. Unfortunately, approximately 20% of those patients develop chronic pain after the surgical intervention in the setting of no complications such as infection or hardware loosening. The reason for this is not known at this point although theories exist.
The new study focused on 21 patients who were experiencing persistent chronic pain after total knee replacement, without underlying hardware complications. The patients had all failed conservative care. They filled out clinically validated questionnaires to assess pain severity, stiffness, functional activities of daily living and use of pain medication before and after the procedure. Follow-up outcome scores were collected up to one year after the C-RFA procedure.
In the end, the study found, patients with knee arthritis reported an 70% drop in their pain ratings approximately, on average.
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
Prof. Bennell
PainRelief.com: What is the background for this study?
Response: Osteoarthritis is a common chronic painful joint condition with no cure that often leads to costly joint replacement surgery. Treatments are needed that can not only reduce symptoms but also slow structural progression of the disease in order to reduce the burden of knee OA. There are no approved disease-modifying treatments available at present.
Platelet-rich plasma (PRP) injections have become a widely used treatment for knee osteoarthritis (OA) in recent years despite the fact that the evidence to support their effects is limited and not of high quality. For this reason, clinical guidelines currently do not recommend PRP for the management of knee osteoarthritis.
To address this gap in knowledge, our study aimed to compare the effectiveness of PRP injections to reduce knee pain and slow loss of medial tibial cartilage volume over a 12-month period. We did this by conducting a clinical trial of 288 people with mild to moderate knee OA. The study included a placebo group where participants were injected with saline into the knee. Participants and the injecting doctors were blind as to whether PRP or saline was injected into the knee.
PainRelief.com Interview with: Stuart L. Silverman MD FACP FACR Clinical Professor of Medicine, Cedars-Sinai Medical Center and UCLA School of Medicine Medical Director, OMC Clinical Research Center Beverly Hills, CA 90211
Dr. Silverman
PainRelief.com: What is the background for this study?
Response: As a practicing rheumatologist, I am aware that prior studies have shown variation in medical care, pain management and treatment with opioids by race and social economic status. Suboptimal treatment of pain in patients with osteoarthritis (OA) may also disproportionately burden racial minorities and Medicaid recipients.
Studies have shown that African Americans are nearly 1.5 times as likely to have symptomatic knee OA than White patients even when adjusting for other factors. Similarly, they also have a higher prevalence of symptomatic and radiographic hip OA. Analyses of Medicare data has shown evidence of persistent racial disparities for joint arthroplasty usage and surgical outcomes.
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