4/6/10 Many people who develop knee pain from osteoarthritis (OA) get good relief from simple lifestyle changes like getting more exercise and from over-the-counter treatments like knee braces and shoe inserts, according to the results of a new study.
But many people with arthritis also start taking pain medications without any guidance from a doctor or pharmacist, a decision that may lead them to over-the-counter drugs that could aggravate common conditions like heart disease, hypertension and stomach ulcers.
“I think it’s really good that people felt empowered to do things on their own. The scary thing is when they start to do the medication part on their own without advice,” says lead author Carlo Marra, PhD, a pharmacist and a research scientist at the Arthritis Research Center of Canada in Vancouver.
For this study, which was published in the April issue of Arthritis Care & Research, pharmacists at 27 locations in Canada recruited customers who’d complained of knee problems in the past year. They gave them a screening questionnaire and based on those answers, identified 190 people who had knee OA but had never been diagnosed with it. These participants were mostly overweight or obese white women with an average age of 63 years. Researchers assessed these patients at the beginning of the study and again one, three and six months after diagnosis.
When they first joined the study, less than half of the participants were doing any sort of exercise, but after six months, nearly three-quarters said they were routinely exercising and 80 percent said it made them feel better.
Additionally, by the end of the study, about one-third had begun using knee braces, shoe inserts, knee tape and acupuncture and 75 percent said those remedies made a difference, and nearly all reported seeing a doctor to talk about their knee pain.
Experts said they were surprised to see that more than 50 percent of participants started treatment – whether exercise, activity aids or medicines – on their own.
“My first impression of the study is that it really proves that patients are smarter than we give them credit for,” says Neeru Jayanthi, MD, director of Sports Medicine at Loyola University Health System, in Chicago, who was not involved in the research. “What we are finding here is patients are directing themselves to increase their own quality of life and they have been relatively successful.”
But researchers stressed that going it alone might not always be a good idea, particularly when it comes to taking medications.
During the study, 52 percent of study participants started some sort of pain medication, 36 percent took natural medicine supplements and 66 percent took a combination of both. About half used nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Motrin) or naproxen (Alleve) and about a quarter tried acetaminophen (Tylenol).
Researchers say they were troubled to learn that more patients starting using NSAIDs before trying acetaminophen, which the American College of Rheumatology recommends as the first line of therapy for OA, because when used as directed, it associated with fewer side effects that NSAIDs.
“Acetaminophen is much safer,” Marra says. “People with knee OA tend to be older and might have hypertension or heart failure, which might be exacerbated by NSAIDs. NSAIDs also have impact on gastrointestinal safety. They can lead to ulcers. Acetaminophen doesn’t have those problems and about half who take it respond to it,” he adds.
When it came to natural supplements, 60 percent of participants took glucosamine and 40 percent used both glucosamine and chondroitin. Marra says these results point out a need for doctors to educate patients about these medications.
“You want people to maximize the benefit they’ll get from the money they spend,” Marra says. “[Glucosamine and chondroitin] are safe, but they aren’t necessarily effective in clinical trials.”
At the end of the six-month-study, only 50 percent said they were feeling benefits from the pain medicine and natural supplements, far fewer than reported relief from non-drug interventions like exercise. Marra says this indicates that lifestyle changes may be more effective than medication alone.
“If they are overweight they should lose weight. That’s one of the more effective things to do. They should exercise and work with someone to find a plan that suits their needs and lifestyle. There are a lot of things they can do to self manage their disease and hopefully prevent future complications,” Marra says.
Marra says while people might have been engaging in good habits at the study’s end, it’s unclear how long that would continue since researchers only followed them for six months.
“Sadly I think these things are hard to sustain over time. I would suspect that these things aren’t as sustained as we would like them to be. So that would require more effort on behalf of the patients,” Marra says.
Dr. Jayanthi, of Loyola University, says he also has some questions about how recruitment for study participants was done.
“I would have loved to see how they diagnosed with nothing but a symptom survey. Because out of the people they talked to, 190 out of 194 had arthritis. I have X-rays and other things so I am a little skeptical about the recruitment and selection bias,” Dr. Jayanthi says.
He also says there is some inherent bias in the participants, which were mostly white woman. “I don’t want people to think that only white women and obese people get arthritis. That’s not necessarily the normal distribution of arthritis in our country,” Dr. Jayanthi says.
But he says it doesn’t surprise him that people took charge of their own treatment. He just hopes that somewhere down the road they reach out to a doctor or medical professional for support.
“The disease process doesn’t improve with time,” Dr. Jayanthi says. “At some point, it will be too much to handle on their own. So it’s important to remember to have a reliable relationship with a health-care provider.”
I was told that I have arthritis in both knees.
I had hylagan injections, and they did help but did not completely take away all of the pain.
What helped me the most was pool exercises that I was doing as a part of my physical therapy.
After working out in the swimming pool for months, I do not have near the amount of pain as I had before that. This even helped pain that I was having in my SI joint.
Simple stretching exercises can be of big help for your body as on this website link.
http://exercise.about.com/od/flexibilityworkouts/tp/officestretches.htm
1. Find an indoor pool near you -the temperature should be ABOVE 90 degrees. I attend twice a week- and do my AI CHI exercises- which are gentle stretching movements. Even in winter. Try to find a place where the therapists are used to taking care of disabled people, as they know HOW to do it and the pool usually has a lift to assist those who can't walk into the pool. I attend a place that has live in disabled children and young adults and it is WONDERFUL ! If you can't find such a place- call a rehab hospital and ask about a WARM water pool. Most YMCAs pools are NOT warm enough. Low 80s is NOT good for Arthritis !
2. No matter what your income level is -you are ENTITLED to the BEST medical care- and do NOT let anyone tell you differently !
Check out those doctors carefully- and remember YOU have to live with the results- they do NOT. Be your own best avocate ! Bring someone you trust with you to the initial evaluation to ask question and listen and help you to evaluate the doctor.
Good luck and God bless you.
Suzanne
I am having my 3rd synvisc shot tomorrow in both knees. I hope that it is successful for me. I am told that it will take 6 weeks to see a difference. I am keeping my fingers crossed
the shots did not work for me. Af the 6th shot and I had to wait a week then he told me there was nothing else they could do for me. I walk around in pain everyday.
The hospital is 350 miles from my home, so I'm trying to find out about any programs or such so my husband can have lodging near me so I won't be alone. Our youngest daughter lives about 70 miles away, so at least she'll visit me once or twice. I hope they let me go right home when I'm released from the hospital, to avoid even more motel bills. I'm just praying that all of the details will work out & my questions answered at my eval, & I can get more info about my choices, resources, etc. If anyone has any information or suggestions of what more I might do or try, please let me know! ... Gina
2 yrs ago i fell broke my filmur, big bone, in leg. now i have oa, ra. pain is
un bearable at times, had one corisone shot help for a while, take pain meds,plus tyanol dr, said i need a knee
replacement, been putting it off long as possible, i try walking but pains gets worse, my knee bends at 20%
will a knee job let my knee bend more?
god bless
have a great summer
I am a 53 year old 300+ male with (MIXED CONNECTIVE DEGENERATIVE TISSUE DISEASE) I have to take 43 pills a day just to function with bone on bone on the right knee and oa in the left and both handes. I also have neropathy bad in both feet and half way up my shin.Itook high dose of prednizone for years I no longer take that now i am on methotrexate it has done wonders on keepiing me active. but by having to take all the other meds including high dose of nerotinand morphine sulfate I am always tierd. I have tried everything to lose weight but it won't budge. I just wantto be able to walk farther then 2 blocks and rid my bike with my grandkids. They keep me going I have been raising them for 10 years now and the oldest just turned 13. My greatest help is my faith and my grandkids I try to wake up every morining with a song on my lips anf a good attitude.
keep the faith
MNM
I am trying to save the money to have my pool solarized this winter so I can swim year round. I live in Az so it will be doable. I also have a hot tub which is wonderful when that "FMS Bear climbs on my back". In eed to loose weight and now I am off Cymbalta I hope to accomplish it, that stuff put 40 lbs on me.
Don't give up do a little at a time, but do something. I am 53 and I do not want to go on disability but keep going as long as God lets me
God Bless
Tonie
It is a catch 22. Ineed to move around and walk but the pain can be pretty bad at times.
I have had injections and they seem to help for now.
I do not want to have knee replacemants yet.
I am 61 and retired and need to get fit to travel on our motorcycle with my husband.
Angel
Know exactly what you're going through. I'm a 69 yr old guy with OA CA and titanium from my right hip to my patella. In addition my lumbar spine is toast with all five discs playing tunes on my spine.
I am surprised that your Dr suggests that you not walk or at least exercise your joints. PT is a good form of staying fit. I have also through my bone Dr used a fairly new injections of a drug called SYNVISC. Great results for me. Hope this may give you some ideas. GOOD LUCK AND BE WELL !!!
i am trying again to loose this weight, i am 61 female and have ra and osteo.
walking also is so helpful, at this point i have herniated disk's pressing on a nerve, which is causing me more pain when i walk, please help with some ideas to help, the dr's. at this point do not want me to walk, for i used to walk alot and felt great, however it was before i developed this disk problem in my back and especially now in my lower back and pressing on a nerve.
so all in all i have more then two problems here to deal with.
i just want to be pain free, and my aim is to get back to my walking .
also upmost to loose weight.
i will never give up to get to were my goal is , to do my walking again and to loose weight.
thanking you in advance,
regards to all, faye lazear
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