Research: What types of treatments do osteoarthritis patients want?
The people we see at our clinic are typically people who have been suffering from chronic pain for many, many years. Their joints pop, grind, crack and are generally considered to be “noisy.” They have a long medical history of prescription anti-inflammatory medications use, stronger prescription anti-inflammatory medications, painkillers, physical therapy, massage therapy, chiropractic care, cortisone shots, nerve blocks, and finally a surgical recommendation. Some patients have even had the surgery and they continue to suffer from chronic pain issues and they start the cycle of treatments over again.
Why does this happen to them and millions of people just like them? The answer: These treatments do not actually fix the root cause of the patient’s problem.
Let’s start with a 2022 paper in the journal Rheumatology reviews (7). In this collaborative opinion from international researchers a review is offered on the current conservative care treatment options for knee osteoarthritis. “Osteoarthritis is the most prevalent type of arthritis worldwide, resulting in pain and often chronic disability and a significant burden on healthcare systems globally. Non-steroidal anti-inflammatory drugs (NSAIDs), analgesics, intra-articular corticosteroid injections are of little value in the long term, and opioids may have ominous consequences. Radiotherapy (low dose radiation) of knee osteoarthritis has no added value. Physical therapy, exercises, weight loss, and lifestyle modifications may give pain relief, improve physical functioning and quality of life. However, none of them has articular cartilage regenerating potential.”
Let’s focus on that last sentence. “None of them has articular cartilage regenerating potential.”
I don’t go to the doctor because nothing can help me and I will just have to live with
Some patients spend years with painful osteoarthritis without seeking a doctor or doctors guided and suggested medical treatments. This would include the times of acute flare up when they are experiencing persistent severe pain and disability. Then why do patients seek or not seek medical care? Researchers in the British Medical Journal (1) sought to investigate and answer this question.
The research team received responses to a self-complete questionnaire from 863 people age 50 and over (55% female; average age 70 years, range: 58 years old to 93 years old).
The most important determinants of the patient’s decision to consult the doctor for joint pain were:
- the extent to which pain disrupted everyday life 31%
- what the patient thought the doctor would say to them – the possibility that nothing could be done and that the patient would just have to live with it 24%
Anticipating that the doctor will regard joint pain as ‘part of the normal aging process that one just has to accept’ is a strong disincentive to seeking help, potentially outweighing other aspects of quality of care.
Alongside the recognition and management of disrupted function, an important goal of each primary care consultation for osteoarthritis should be to avoid imparting or reinforcing this perception.
When patients did seek treatment, what did they find most effective?
An October 2021 paper in the Archives of rheumatology (2) surveyed patients whose complaints included mostly knee pain, lumbar pain, and cervical spine – neck pain. Prior to the survey treatment modalities which were prescribed to patients were:
- Oral drugs (79.7%)
- Topical drugs (73.8%),
- Home-based exercise program (62.6%), and
- physical therapy (outpatient) (61.3%).
However, based on their own personal needs, patients preferred:
- out patient physical therapy program (45.9%),
- oral drugs (33.1%),
According to the researchers: “the treatment preferences of our patient group were mostly drugs, outpatient and inpatient physical therapy programs, and home-based exercises depending on the reasons such as previous benefit from treatment, long-term effects, easily access to treatment, and concerns about side effects.”
The standard medical treatment for osteoarthritis involves the use of non-steroidal anti-inflammatory drugs (NSAIDS). Unfortunately, however, it has been recently shown that these medications may promote further deterioration of the joint. Therefore, although these medications may be helpful in reducing pain, they may not be beneficial in the long run. At the minimum, everyone would concur that they do nothing to help the repair process of the soft tissue injury.
Over the past several years additional information has accumulated in regards to the use of glucosamine, chondroitin sulfate, and collagen II. These products are available without a prescription from health practitioners or the local health food stores. They have been shown to be effective in pill form or via injection. Glucosamine can be extremely helpful in reducing pain from osteoarthritis and can also help prevent further deterioration of the joint.
Another useful medicine for joint pain is Capsaicin. This is available either as a generic or proprietary cream (known as Zostrix). When applied to a painful joint on a regular basis, joint-related pain and muscle spasms are decreased to a significant degree. Side effects, other than warmth, are very rare. These creams literally work to decrease the amount of pain chemicals that are present in the tissues surrounding the joint.
A November 2022 paper published in the journal Osteoarthritis Cartilage (3) assessed the effectiveness of vitamin D supplementation on knee osteoarthritis in 236 patients over 45 years old and had knee pain. The researchers found that compared to the control group, vitamin D supplementation did not make a significant difference in pain or function.
There is a lot of recent research coming out of China on the use of glucosamine in the treatment of osteoarthritis.
A July 2022 study (4) found “the clinical efficacy of chondroitin combined with glucosamine in the treatment of knee osteoarthritis was significantly higher than that of conventional therapy (conservative care treatment or that of chondroitin or glucosamine alone).” Patients showed patients had positive results for joint pain, tenderness, swelling, and dysfunction.”
In July 2022, Pakistani researchers (5) found that “Manual therapy and resistance exercise training are effective in the management of knee osteoarthritis, however, glucosamine and chondroitin sulfate supplementation for 4 weeks showed no additional benefits.”
Irenka and Cymbalta
A May 2022 paper in the journal Arthritis & rheumatology (6) tested the effectiveness of Irenka and Cymbalta (duloxetine drugs typically prescribed for major depressive disorder, anxiety, diabetic peripheral neuropathy, and chronic musculoskeletal pain) in patients with chronic pain from osteoarthritis.
- 132 patients were randomized into treatment groups. A total of 66 patients were randomized to receive duloxetine in addition to usual care, and 66 patients did not receive duloxetine but had conventional care. Duloxetine was gradually discontinued after 3 months when patients experienced no effect and/or when patients had intolerable side effects.
Usual care was education, lifestyle advice, diet, physiotherapy, and analgesics. Intraarticular injection of glucocorticoids and referral to secondary care were also allowed. The researchers found: “no (added benefical) effect of duloxetine added to usual care compared to usual care alone in patients with chronic knee or hip osteoarthritis pain.”
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