Jeffrey Fudin, B.S., Pharm.D., FCCP, FASHP Diplomate, American Academy of Pain Management Section Editor, Pain Medicine
PainRelief.com: What is the background for this study?
Response: Osteoarthritis (OA) affects over 14% of the United States population. As such it is important to establish effective, well-tolerated, and safe medication options. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) act locally and are strongly recommended for patients with knee osteoarthritis as a first line option prior to chronic oral NSAID use in an effort to minimize systemic exposure, as oral products, result in tremendously higher blood levels compared to their topical counterpart.
PainRelief.com: What are the main findings?
Response: Diclofenac sodium gel 1% (DSG 1%), a topical NSAID, provided better pain relief than non-drug vehicle alone for patients with knee osteoarthritis in 3 clinical trials. A post-hoc meta-analysis of these trials was conducted to determine the percentage of patients achieving a minimal clinically important improvement (MCII) in pain and other symptoms of OA to gain insight into the real world clinical impact of topical diclofenac for patients. The MCII is defined as the smallest improvement in symptoms viewed as clinically meaningful for patients. In short, the MCII represents an improvement of relevance in a clinical trial and the minimal meaningful change at an individual level.
MedicalResearch.com Interview with: Dr. Gail Deyle, PT, DSc, DPT, OCS, FAAOMPT Professor with Baylor University Graduate School
Study authors in addition to Gail Deyle are Chris Allen, Stephen Allison, Norman Gill, Benjamin
Hando, Evan Petersen, Douglas Dusenberry, and Daniel Rhon
Physical therapy is superior to glucocorticoid (steroid) injections for stiff and aching knees says Dr Gail Deyle, a physical therapist specializing in orthopaedics and manual physical therapy. A study recently published in the New England Journal of Medicine directly compared physical therapy with glucocorticoid injections to determine which was better primarily at one year but also in the short term.
The research was a collaborative effort of providers from physical therapy, orthopaedics, and rheumatology at two Army Medical Centers. Dr Deyle, who is a professor with Baylor University Graduate School, and the senior author of the study, states, our results leave no doubt that physical therapy should be strongly considered for patients with knee osteoarthritis. They will clearly benefit from a physical therapist’s hands-on treatment and decision making for exercise and activity selection.
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.
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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