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Osteoarthritis Solutions

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“Osteoarthritis (OA) is one of most common causes of chronic pain and a major cause of reduced activity in middle aged and older patients. It is estimated to affect between 20 and 30 million Americans, but these numbers may be deceiving. Up to 85% of people older than 65 years of age have radiographic evidence of OA, and autopsy studies indicate evidence of OA in weight-bearing joints in almost all persons by the age of 45 years.  Based on these statistics, it is no wonder that it feels as if every patient being treated for chronic pain has OA as a primary or contributing factor.”  The opening paragraph of an issue preview by the editor of Practical Pain Management, Dr. Forrest Tennant (Osteoarthritis Update: 2015)

The latest issue of Practical Pain Management (Osteoarthritis: A Practical Guide To Managing Joint Pain) was all about — as you might have guessed from the title — dealing with the pain caused by Degenerative Arthritis, otherwise known as Osteoarthritis.  Because I recently wrote an article on THIS SUBJECT, my interest was piqued immediately.   Journal editor, Dr. Forrest Tennant, says that, “Although controversial, some researchers believe OA involves inflammatory mechanisms, not mechanical wear and tear.   An inflammatory component is most definitely present in most patients with painful OA. The traditional belief that OA is simply a wear-and-tear condition associated with the stress of advancing years is not tenable, but, in my opinion, the extent of the inflammatory component is unclear.”   This is essentially what I said less than a month ago — see above link — coming to the conclusion that the problem was caused by both SYSTEMIC INFLAMMATION as well as local inflammation (injury, poor biomechanics, SUBLUXATION, and chronic wear & tear).

Because the problem is “INFLAMMATORY,” the average MD treats the problem with what I call “THE BIG FIVE“.  When you click the link ant read my short post, you’ll quickly realize that “EVIDENCE-BASED MEDICINE” is not nearly as ‘evidence-based’ as you have been led to believe.  Case in point, an article by in the same issue of PPM by Dr. Elmer Pinzon (PPM Editorial Board: Tips for Treating Osteoarthritis).  After asking several of the 40 members of the journal’s editorial board, these are some of the solutions they suggested.

  • EXERCISE:  Exercise was mentioned almost ubiquitously.  They specifically mentioned swimming, STRETCHING, walking, cycling, aquatic therapy, ellipticals, Yoga, Tai Chi, and others.  I myself am a huge fan of RESISTANCE TRAINING (it does not have to be heavy), and would totally agree with the idea that exercise is beneficial for those suffering with Osteoarthritis (or even those simply wishing to prevent it).  OVERUSE was also mentioned, and for some populations is a much bigger problem than living a sedentary lifestyle.
  • PHARMACEUTICAL GRADE FISH OIL:  FISH OIL was also talked about by several individuals.  All stated that the dose needs to be between 2,500 – 2,700 daily milligrams of EPA+DHA (see the link).  DIETARY FATS greatly modulate our Inflammation levels, with most people getting somewhere between 1/30th and 1/50th of what is recommended as far as Omega-3’s are concerned. 
  • ADDING NATURAL ANTIOXIDANTS TO YOUR DIET:  OXIDATION is a huge problem in our bodies (think of it in terms of how rust affects unprotected metal).  A diet high in Antioxidants is also going to be an ANTI-INFLAMMATORY DIET; something dealt with by PPM a few years ago (not sure why this article was not mentioned today?).  Things like Garlic, Circumin, Astraxanthin, and AVOIDING SUGAR were mentioned specifically.
  • SUPPLEMENTS:  There were several mentioned, including Glucosamine, and several Vitamins.
  • COGNITIVE BEHAVIOR TREATMENT TECHNIQUES:  Although I am certainly not against these, the evidence for their efficacy is iffy at best (see link below). 
  • COPPER BRACELET:  With the advent of copper-infused clothing, this has gotten easier.  Over the years, I have seen copper bracelets (some made out of copper pipe) help some people dramatically with arthritis pain. 
  • ELECTRIC / ELECTROMAGNETIC STIMULATION:  There are many kinds of this, but one author mentioned a very specific kind, essentially telling readers that it was going to revolutionize arthritis treatment.  Who knows; it might turn out to be as beneficial as COLD LASER THERAPY.  However, I’ve been in practice far too long and heard far too many similar pitches to hold my breath.
  • HOT SHOWERS:  Pretty simple. 
  • DRINK ENOUGH WATER:  Once you realize that water is the basis for lubricating your joints, you can see why it is so important. 
  • VISCOSUPPLEMENTATION INJECTIONS:  This might be things like HA via rooster comb injections.
  • BOTOX / PRP INJECTIONS / RADIO-FREQUENCY ABLATIONS:  Although I occasionally see the first two things in this bullet point work (HERE and HERE), the third option above (RFA’s) is rarely good.  This is where the offending nerve is “burned” away by a needle heated up with radio frequencies.  It’s not permanent, and when the pain returns (the nerve grows back), it’s usually with a vengeance.
  • NSAIDS / CORTICOSTEROID INJECTIONS:   Although these were mentioned by one of the authors, it was in the context of avoiding them by doing these (mostly) non-invasive “ALTERNATIVE” sorts of treatments.

Here’s the rub.  You have the premier journal for pain doctors providing any number of natural treatment “tips” (they even had a short article in this issue touting the benefits of acupuncture).  But is this how things are really done here in America when it comes to the medical treatment of Degenerative Arthritis?  Maybe in some places, but certainly not in my area — and my guess is that it is probably not done this way in your neck of the woods either.  Another example of the CHASM that exists between the average practicing physician and medical academia.  Case in point, the article just before the one discussed above, called Treatment of Osteoarthritis.  According to the authors….

“The American College of Rheumatology (ACR) recently revised its recommendations for treatment of osteoarthritis (OA) of the hand, hip, and knee.   According to the ACR, the treatment of arthritis should include the following: Medications, Nonpharmacologic therapies, Physical or occupational therapy, Splints or joint assistive aids, Patient education and support, Weight loss, Surgery.”

Although this article certainly deals with some of the same things mentioned in the first article (not nearly as many of them), the first thing mentioned is DRUGS (medications).   Furthermore, it’s what the article spends the majority of time discussing.  And even though it’s last on the list above, surgery gets just as much space as drugs.  But how are these two pillars of Osteoarthritis treatment working out according to the “evidence”?  That’s just it — it’s not. Particularly with what we know about things like patient education (COGNITIVE THERAPY), WEIGHT LOSS, and surgery (particularly SPINAL SURGERY, which few doctors recommend any more for arthritis because it simply does not work).

For example, even though this article talks about the benefits of knee arthroscopy  (“The surgeon cleans up the knee joint by removing any debris (damaged cartilage or tissue) to prevent further joint deterioration“), is this the reality of the situation?  Firstly, we know that incidence of knee arthritis is exploding in America (HERE).  And secondly, we know beyond the shadow of a doubt that arthroscopy for knee arthritis does not work.  In fact, it actually causes arthritis (HERE).   Don’t get me wrong; I realize that many of you are between a rock and a hard place as far as the fact that your knee is totally shot, and might need replaced.  But having your knee scoped as a solution for arthritis will actually, according to peer-review, make the problem worse! 

Here is the thing you need to understand about Inflammation.  You can choose deal with it two very different ways.   Firstly, you can try and mop it up as your body creates it.  Although this approach is valid, it does not address the massive amount of Inflammation some of your bodies are producing.    This is why you should be working to dry Inflammation up at the source.  NSAIDS and CORTICOSTEROID INJECTIONS are only concerned with the former.  The only way you are going to stop Inflammation at the source is to radically change your lifestyle.  How do you do this?  THESE POSTS provide a starting point.


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