Do NSAIDs Accelerate Progression of Knee Osteoarthritis?

PainRelief.com Interview with:
Dr Thomas Perry PhD| Postdoctoral Research Fellow
Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research 
Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences

Dr Thomas Perry PhD| Postdoctoral Research Fellow
Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research 
Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences
Dr. Perry

PainRelief.com:  What is the background for this study?

Response: Management of knee osteoarthritis (OA) is multi-factorial and routinely involves the use pharmacological interventions; with most medications aimed at alleviating painful symptoms and improving function.

Little is known of the long-term effects of such medications on the structural progression of radiographic knee OA. Through examining the relationship between pharmacological interventions and the disease pathway, this may, in turn, identify potential areas for disease-modifying treatment development.

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Hand Arthritis: Supplement Did Not Provide Pain Relief

PainRelief.com Interview with:
Xiaoqian Liu
Clinical research fellow (Wednesday/Thursday)
Rheumatology Department| Royal North Shore Hospital
Institute of Bone and Joint Research | Sydney Medical School

hand arthritis

PainRelief.com:  What is the background for this study?

Response: Hand osteoarthritis (HOA) is a prevalent joint disease, causing symptoms in up to 10% of the general adult population worldwide. Hand pain is the most common symptom in addition to functional disability and decreased quality of life. Due to the modest effects and/or potential harms, current traditional treatment such as exercise, non-inflammatories and analgesics frequently do not meet patients’ demand. More and more people are turning to complementary and alternative medicines for pain relief.

In our previous work, we identified four dietary supplements with promising treatment effects for relieving pain which are Boswellia serrata extract, curcumin, pine bark extract and methylsulfonylmethane (MSM). The hypothesis was that combining these supplements to generate an enhanced benefit for people with HOA. The aim of the RADIANT study was to investigate the efficacy and safety of a 12-week course of this supplement combination in people with painful HOA who were confirmed with the diagnosis on their hand x-ray.

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Challenges in Providing Osteoarthritis Pain Relief

PainRelief.com Interview with:
Rebecca L Robinson
Patient Outcomes and Real-World Evidence
Eli Lilly and Company, Indianapolis, IN

PainRelief.com:  What is the background for this study?

Response: Osteoarthritis (OA) pain is unfortunately common and greatly affects patients’ quality of life. Treatment varies from patient to patient and can include nonpharmacologic therapies, over-the-counter (OTC) and prescription pain medications, as well as surgery. The combination of these treatment modalities and especially the use of acetaminophen, NSAIDs or opioids in OA patients has not been examined thoroughly. This study helps to address this gap while also demonstrating variations in treatment received by patients with different levels of pain severity. We analyzed data from the United States OA Adelphi Disease Specific Programme (DSP), which links patient and physician perspectives on the management of OA via cross-sectional surveys.

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Voltaren® Arthritis Pain Provided Meaningful Pain Relief in Knee Osteoarthritis

PainRelief.com Interview with:

Jeffrey Fudin, B.S., Pharm.D., FCCP, FASHP
Diplomate, American Academy of Pain Management
Section Editor, Pain Medicine

Dr. Fudin

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.

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Knee Osteoarthritis: Physical Therapy vs Steroid Injection for Pain Relief

MedicalResearch.com Interview with:
Dr. Gail Deyle, PT, DSc, DPT, OCS, FAAOMPT
Professor with Baylor University Graduate School 

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

Summary:

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.

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Opioids Commonly Prescribed for Pain Relief from Osteoarthritis

PainRelief.com Interview with:

Dr. Jonas Bloch Thorlund  MSc, PhD
Professor of Musculoskeletal Health
Department of Sports Science and Clinical Biomechanics &
Research Unit for General Practice (Dept. of Public Health) 
Dr. Thorlund

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.

Knee Osteoarthritis: Orthopedists Prescribing More NSAIDS and Less Lifestyle Management for Pain Relief

PainRelief.com Interview with:

Samannaaz Khoja, PT, PhD
Research Assistant Professor
Department of Physical Therapy
University of Pittsburgh School of Health and Rehabilitation Sciences

Samannaaz Khoja, PT, PhD Research Assistant Professor Department of Physical Therapy University of Pittsburgh School of Health and Rehabilitation Sciences
Dr. Khoja

PainRelief.com: What is the background for this study? 

ResponseThe 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).

Osteoarthritis: Poor Sleep Linked to More Pain

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 main findings?

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.

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Massage for Osteoarthritis of Knee Reduced Pain and Improved Physical Functioning

Adam-Perlman-

Dr. Perlman

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