Osteoarthritis - Ask Dr. P - The Pain Doc

Depression Can Make Knee Pain Worse – Study

by Pain Doc | Mar 25, 2011 | Uncategorized

A recent study in The Journal of Bone and Joint Surgery showed that people who had mild to moderate knee osteoarthritis and were depressed rated their pain as severe, the level which others in the study who had x-ray documented advanced osteoarthritis reported.

I’ve always believed that there is a “mind-body” connection, and this is yet another study that supports this. The thoughts that you allow to enter your mind can have a definite effect on your physiology, whether it be blood pressure, heart rate, respiration rate, digestion, strength, immune response, or pain. Check out this cancer treatment center’s use of visual and music therapy to help with treatment.

Jon T. Giles, MD, an assistant professor of medicine at Columbia University and rheumatologist at New York Presbyterian Hospital in New York City, says this study adds further weight to the existing medical literature highlighting the effect of psychosocial issues on pain responses.

“Painful sensations are relayed through the brain in a very complex way, and can be modulated up or down,” he says. With stress, poor sleep, anxiety and depression, which are known to influence pain levels, “stimuli feel more painful than they would in someone without the adverse psychosocial factors. This probably explains in part why the largest effect of depression in the study was seen in those without much OA to see on X-rays.”

The study recommends that patients fitting this profile get psychiatric evaluation and treatment, including anti-depressant drugs, in order to help alleviate their pain.

The study does not outright say that only “clinical” depression can make pain worse. If you have pain, persistent negative thoughts are more likely to make it appear worse than it actually is. Remember, the perception of pain is a complex neurological pathway that is not entirely understood.

I can sympathize with those experiencing chronic pain– it can be a terrible cycle, where the pain itself can push the patient to negative thoughts and depression, embedding it further and further into the body’s central nervous system. Speaking as a human being, and not just a health care provider, I can offer the following suggestions to break the cycle. And I’m sure it’s not all new, but worth repeating here:

1. Don’t hang around negative people. Their negative energy will bring you down. Instead, hang around those with “positive buoyancy,” the ones who can lift you up emotionally. Most small children fit in this group.

2. Similar to #1, avoid negative stimuli in your environment– crime shows, news, reality TV, newspaper headliners, internet news, etc.

3. Find something to keep your mind occupied; something that requires active brain usage (not passive, like watching TV). Social activities that involve interacting and working with other people is a good choice; especially if it is for a good cause. Arts and crafts is another good choice.

4. Get a pet. There’s nothing like a dog who exhibits unconditional, total loyalty to you.

5. Eat only those foods that nourish the body. The nutrient dense foods that occur naturally; i.e. plants and animals are the best for a body experiencing pain: fruits, green leaf plants, sardines, lean meat, nuts. Definitely avoid cigarette smoke, alcohol, corn syrup, sugar, and food preservatives.

6. Get out in the sun. Take of your shirt, expose your trunk to the sun several times throughout the day.

7. Stay active, as much as your pain will allow. Tai chi and yoga are good if your body can’t handle the forces of running , jumping, and lifting weights. Walking briskly is good, too.

8. Get fresh air. Drive to your nearest nature preserve, far enough away from the city and suburbs and get some negative ions (the only good, negative thing if you’re in pain!) and clean oxygen in your lungs.

Knee Pain, Roosters and Osteoarthritis?

by Pain Doc | Mar 22, 2011 | Knee Pain

Osteoarthritis occurs when the cartilage lining the articulating (contacting) surfaces of a joint gets damaged or wears out, exposing nerve endings inside and leading to inflammation. Since a joint is a precision, biological mechanism the slightest change in any of its components will eventually lead to breakdown, much like car engine.

As the cartilage thins, bone on bone contact occurs. Since bone is living tissue, it will respond to this irritation by forming osteophytes, better known as bone spurs. The osteophytes compound the problem by disrupting proper joint movement and irritating surrounding ligaments. And to make matters worse, the joint fluid, called synovial fluid gradually loses its ability to cushion the joint. Synovial fluid to a joint is like motor oil to a car engine’s cylinder: it enables “near frictionless” movement. It forms a thin, lubricating buffer between the ends of the two bones that make up a joint; for example in the knee, the tibia (lower leg) and femur (upper leg).

The knee is perhaps the most common joint to experience osteoarthritis. It is a large, primary weight bearing joint that takes a lot of punishment in the course of a day. Basic activities like walking, running, going up stairs, stepping down from a curb, exercising, and sports really put the knees to task. Those who have advanced osteoarthritis in the knees realize how important they are to a normal life.

I ran across this treatment for knee osteoarthritis that involves a single injection that can last for six months. It is called Synvisc-One, and it’s made from the combs of roosters. Apparently, the substance found in rooster combs is similar in biochemical make up to that of synovial fluid. If you’ve ever pressed or bent a rooster’s comb, you can see why– it is soft, cushiony, and rebounds quickly to its original shape.

synvisc injection into the knee joint

The procedure is a relatively quick outpatient procedure. After filling out the necessary forms to ensure you have no contraindications, especially any known allergies to birds, the doctor injects the Synvisc into your knee joint using a large caliber needle. There, it occupies the capsular space just like motor oil occupies a car engine’s cylinder. The substance cushions the knee joint surfaces (distal femur-proximal tibia articulation) and lubricates the space to minimize abrasion of these surfaces.

Synvisc is indicated for the treatment of pain in osteoarthritis (OA) of the knee in patients who have failed to respond adequately to conservative non-pharmacologic therapy and simple analgesics, e.g., acetaminophen. It can be an option for total knee replacement for some people.

The drawback is that you have to keep getting them. But for those who have severe osteoarthritis in both knees and can’t afford or do not desire knee replacement surgery, six months of less pain is a pretty big deal. As with all forms of treatment options, a lot of it is personal choice. Not everyone’s situation is the same.

Check out our Self Treatment for Knee Pain video for non-drug, non-surgical therapies to manage osteoarthritis of the knee.

Can You Grow Cartilage By Eating Certain Foods or Supplements?

by Pain Doc | Feb 21, 2011 | Uncategorized

Cartilage, specifically, hyaline cartilage is the tissue that lines the articular (contacting) surfaces of bones. If the cartilage deteriorates it can lead to pain and inflammation in the weight bearing joints, mostly the knees and hips, as nerve endings in the joint get exposed to abrasive action. This can force the sufferer to elect for knee or hip replacement surgery, as well as artificial disc surgery. Smaller joints such as in the fingers can be affected as well.

Cartilage is made by special cells called chondroblasts. These cells make the extracellular matrix of cartilage, comprised of Type II collagen and ground substance, which is comprised of proteoglycans and elastin. Another important constituent is hyaluronic acid, which improves the resiliency and hydration of cartilage. Without going into too much detail, a proteoglycan is a protein molecule with a chain of sugar molecules attached called glycosaminoglycans, or GAGs. The two GAGs that are best known to the public are glucosamine sulfate and chondroitin sulfate, the key ingredients in most cartilage and bone supplements. Glucosamine sulfate is the one found in the exoskeletons of shellfish, as well as some fungi.

Persons suffering from the various forms of arthritis such as osteoarthritis and rheumatoid arthritis have cartilage tissue that is undergoing inflammation and degradation, either mechanical in nature or auto-immune.

Collagen is a group of naturally occurring proteins found mostly in animal connective tissues– tendons, ligaments, and skin. What makes collagen useful in cartilage is its ability to withstand pressure and return to its original shape (deform and rebound). This is what is necessary in joints of the human body, which are subjected to forces multiple times throughout the day. The simple act of sitting or standing places enormous pressure on the joint surfaces of the feet, knee, hip and lower back. Using one’s hands to type or grip things places pressure on the smaller joints of the fingers and wrists.

So, if your have thinning cartilage in your knees, can you grow it back simply by taking glucosamine sulfate and chondroitin supplements? Unfortunately, the latest research on their ability to reduce joint pain show minimal improvement. Why is this?

It’s because that, just because you give the body supplements through your diet, it doesn’t guarantee that your body will do things you want it to do with these nutrients. They could be going somewhere else besides you joint, which is more likely the case.

The harsh reality regarding all muscle and connective tissue building dietary supplements such as collagen, bone broth, protein powder, etc. is that they get broken down in your GI tract into their amino acid constituents, and need to be reassembled. But as mentioned, your body will not reassemble them into the desired tissue 100%. These proteins may go to your skin, hair, nails, or may be made into an enzyme or cell receptor. In other words, the amino acids in those glucosamine sulfates pills may wind up forming new hair, not cartilage.

That being said, if you hope to build cartilage through your diet, it may be more effective to eat the actual cartilage. At least it consists of the actual amino acid sequences in the proper percentage the body uses to build cartilage..

Consider consuming bone broth soup regularly if you are suffering from achey joints; or do so as a preventative measure. Most butcher shops in the grocery store will have large joints of beef or pork, usually the hips, knees and spine. And they are cheap, usually less than $2.00 a pound. They will saw them in small pieces for you if you request. What’s great about them is that they still have tendons and cartilage pieces attached. Get a large pot, add a gallon of water and bring to boil; lower temperature and boil for two hours. The broth will be rich in nutrients that your body can use to help regenerate damaged cartilage.

For preventive measures to protect the health of your joint cartilage, remember to:

do functional exercises regularly to improve whole-body muscle & joint responsiveness
avoid sitting for too long at your work
avoid activities that require repetitive trauma to the joints such as long distance running
avoid ingesting toxins like cigarette smoke, alcohol, and highly processed food
get enough daily rest to allow your body to regenerate
drink filtered water (not distilled)
get enough sun exposure for Vitamin D synthesis

How to Tell if Your Pain is from Arthritis

by Pain Doc | Aug 28, 2010 | Arthritis, Bone Pain, Hand and Wrist Pain

Image via Wikipedia

If you have deep, achy pain in a joint that doesn’t go away with time it’s likely some form of arthritis. Lower back pain can be arthritic in nature (as opposed to muscle) if it behaves similarly– deep, achy, doesn’t seem to ever go away entirely; and you have a history of repetitive, physical impact to your body such as construction workers/ laborers, martial art practitioners and gymnasts. However, with rheumatoid arthritis (explained below) no history of trauma is necessary.

Most people associate arthritis with the elderly. But did you know it can affect younger people as well?

The word arthritis translates to “joint inflammation.” There are several forms of arthritis, the two most common types being rheumatoid arthritis and osteoarthritis.

Image via Wikipedia

Rheumatoid arthritis (RA) is an auto-immune disorder, where the body’s white blood cells attack the synovium of synovial joints. Synovium is the inner lining of a synovial joint— encased (capsular) joints like in the spine, hips, knees and shoulders. The synovium produces synovial fluid, which lubricates the inner surfaces of the joint as it moves.

People suffering from rheumatoid arthritis will have bouts of severe joint swelling, redness, heat and pain. RA is typically bilateral; meaning, for the extremities it strikes both sides, not just one. It is an awful condition that can can severely impact mobility. Those with rheumatoid arthritis in the knuckles of the hand will have difficulty gripping things and doing fine dexterity movements such as writing and buttoning a shirt. Areas commonly affected by rheumatoid arthritis are the hands, spine, and feet.

Currently, drugs are the only medical treatment for RA including non-steroidal anti-inflammatories– NSAIDS (aspirin, Motrin, Tylenol, Ibuprofen), corticosteroids and immunosuppressives.

Palliative care to manage pain levels include acupuncture, yoga, and chiropractic. Cannabis (medical marijuana) is a popular choice for many sufferers.

Osteoarthritis (OA) is described as joint pain and inflammation from wear and tear of the cartilage. It is usually found in people who have suffered repeated joint trauma, like football and basketball players. Marathon runners can develop it in the knees and hips as well. OA is found in the weight bearing joints of the feet, ankle, knees, hips, lower spine and neck.

When repeated trauma impacts a weight bearing joint, over time it creates tiny fissures in the cartilage, which thins the cartilage and exposes the bone underneath. From there, the bone forms bone spurs called osteophytes. Radiologists describe these changes (disc degeneration plus osteophytes) as spondylosis of the joint.

Both types of joints can be painful, with RA being more acutely painful. The symptoms are pain, joint stiffness and reduced range of motion.

MAKING BONE BROTH SOUP FOR ARTHRITIS PAIN:

In both cases, eating a low-inflammation diet will be helpful: reduce sugar intake including high fructose corn syrup; limit carbohydrates to 150 grams per day; emphasize protein and fat, especially fish with high Omega 3 content; nut oils (walnut, almond, Brazil nuts), virgin olive oil, and raw plants (green leafy salads, lightly steamed vegetables). Raw milk and butter from grass fed cows, and coconut oil are also good for an anti-inflammatory diet.

Eating bone broth soup every day will give your body the constituents for rebuilding cartilage: Visit your local butcher and ask for the large beef and pork joints. They can saw these in little pieces in the back and give them to you in a bag; they price them pretty cheap; too!

You’d be amazed as to how cow/ pig knee and hip joints look very much like a human’s. If you want to understand the anatomy of these joints, this is a great way to do it. You will see and feel the smoothness of the cartilage on the femur head. You’ll see the anterior and posterior cruciate ligaments (ACLs and PCLs). You will see the patella, fat pad; and collateral ligaments, condyles and meniscus. Make sure to eat all of these parts in addition to drinking the broth to get all the proteins needed to rebuild tendons, ligaments and cartilage.

MAKING THE BROTH:

Add a couple of pieces of joints into a tall pot; fill half-way with water; add salt. For extra bone-building strength add some eggshells (from cracked RAW eggs– You want the inner shell membrane to be intact; with boiled eggs the nutrient-rich membrane sticks to the egg). Bring to a strong boil; reduce heat to low and cook for 60 minutes. Steep out the eggshells, and drink the soup. Eat any pieces of tendon stuck to the bones, and eat the bone marrow as well. You can add spinach to the soup the last minute of boiling for more variety. (chicken and turkey carcasses and whole fish bones work well, too).

The calcium and cartilage nutrients you get from this bone broth can help your joints feel better.

HOME THERAPY FOR ARTHRITIS

Arthritis pain comes from inflammation and stimulation of pain receptors in damaged cartilage by the inflammation and also by physical abrasion.

Pulsed electromagnetic field therapy (Pulsed EMF or PEMF) can help by energizing the affected cells. The electromagnetic field produced by PEMF machines are similar to the naturally-occurring fields produced by the biological activity of your cells; adding an external source helps those cells function better. The few cells that exist in the cartilage and ligaments and tendons have more energy to synthesize matrix and collagen which goes towards joint rebuilding. Use in conjunction with red light therapy for maximum effect. Red light at around 660 nm wavelength initiates photobiomodulation, which also gives cells more energy to function, much like photosynthesis in plants.

For temporary relief, heat works best with chronic pain and stiffness. An infrared heat lamp is a good choice, as it is easy to set up and penetrates all the way down to the affected tissue, unlike a hot pack which only heats the skin. Heating is not advised for rheumatoid arthritis when it is in a flare-up, hot and acute phase.

As far as medical care, joint replacement is a more drastic option but can effectively reduce pain while preserving some joint functionality. There are also experimental procedures that involve culturing cartilage cells in a lab and injecting them into the joint space, hoping that they will bond to existing cartilage and thicken, but results are mixed at this point.

If you don’t have arthritis, do things that will help prevent you for getting it. Build up your joint strength with the diet mentioned above, and avoid repetitious trauma to the weight bearing joints (activities that involve jumping and landing on a hard surface). Strengthen surrounding ligaments of your knee and hip joints with exercises like weightless squats, knee bends, and simple uphill hiking.

Your joints are the most neglected part of your body; we often take them for granted. But when one is injured or develops arthritis, you will realize very quickly how important they are to your happiness and well-being. Don’t wait until it is too late; strengthening and nurturing your joints should be a definite part of your fitness routine.