LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

Osteoarthritis

Glucosamine Sulfate May Promote Development of Insulin Resistance – (05-20-00)

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Glucosamine Sulfate May Promote Development of Insulin Resistance

This was a small study, but this will definitely require further studies. Many people continue to take high levels of GS once they have noticed a response. Many times the dosage can be tapered down to much less than the original dosage. If more patients followed this guideline, the risk for increased insulin resistance may turn out to be less. A research study presented at the annual Experimental Biology scientific meetings in San Diego, California, cautioned that consumption of the popular dietary supplement glucosamine sulfate may actually increase the risk of developing insulin resistance and may worsen control of diabetes in patients with this disease. Glucosamine sulfate is widely used to relieve the pain of osteoarthritis and other chronic joint conditions.

18 US Women Per Day Die From Common Drug: 3 Scary Stats

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For those of you into math, that’s about 550 deaths per month, or more than a Boeing 747 could hold.  Imagine the heat on the FAA if one was dropping out of the sky monthly.  Would you fly?

For those of you following the Rantings, you can begin to guess that it is prescription opioids I’m talking about.  Not just OxyContin and morphine, but also Percocet and Vicodin.  They are handed out like candy in urgent care and the ER and concern has been raised to the equivalent of a Homeland Security threat level RED.  Earlier this year, the FDA reached out to providers asking them to increase their training in the prescribing of this dangerous class of drugs.

If the FDA has to politely ask providers to better understand the use of these drugs (this IS, after all, the regulatory agency tasked with protecting the public), one has to assume that the education required to prescribe these drugs may be lacking.

Scary.  And profoundly upsetting because I am, after all, a chiropractor.  I can’t count how many times over the years that a patient came in for a problem that was resolved in a visit or two, and yet had been given opioids after an urgent care or ER visit.  Completely avoidable had the patient been steered towards chiropractic treatment.  We remain a profession at the red-headed-stepchild level and yet hold the answers to many of the ills in medicine today.

With that intro, we need to move on to this particular article, which highlights just how dangerous this class of drugs has become.  Researchers looked at opioid deaths from 1999 to 2010 in women.  Here’s what they found:

  1. Nearly 48,000 women died of prescription painkiller overdoses  between 1999 and 2010.
  2. Deaths from prescription painkiller overdoses increased over 400%, compared to 265% in men.
  3. For every woman who dies of a prescription painkiller overdose, 30 go to the ER for misuse or abuse.

Despite these numbers, I still have patients coming into my office every week who have been given prescriptions for this class of drugs.  Much like the decades long delay that occurred to get pediatricians to stop giving antibiotics for ear infections, these statistics seem to be falling on deaf ears.

The next time a provider wants to given you a prescription of Percocet or Vicodin for some type of new-onset musculoskeletal disorder (neck pain, shoulder pain, low back pain…) but does NOT recommend seeing a chiropractor, maybe it’s time to find a new provider that keeps your best interests in mind.

 

Long-term effects of glucosamine sulphate on osteoarthritis progression – (01-27-01)

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Long-term effects of glucosamine sulphate on osteoarthritis progression

Not that these results are Earth-shattering, but it’s nice to see them published in one of the major medical journals. Glucosamine and chondrotin sulfate have been used for a long time now with natural practioners. It is very effective, very inexpensive (when compared with almost any NSAID and especially the new COX-2 inhibitors) and has little incidence of side effects. There has been some concern with GS affecting insulin sensitivity, but the evidence is not strong to date. Combine GS or CS with manipulative therapy, an exercise routine, an anti-inflammatory diet and avoidance of food allergies to round out a natural approach to osteoarthritis.

Lancet 2001; 357: 251-56 Treatment of osteoarthritis is usually limited to short-term symptom control. We assessed the effects of the specific drug glucosamine sulphate on the long-term progression of osteoarthritis joint structure changes and symptoms. We did a randomised, double-blind placebo controlled trial, in which 212 patients with knee osteoarthritis were randomly assigned 1500 mg sulphate oral glucosamine or placebo once daily for 3 years. Weightbearing, anteroposterior radiographs of each knee in full extension were taken at enrolment and after 1 and 3 years. Mean joint-space width of the medial compartment of the tibiofemoral joint was assessed by digital image analysis, whereas minimum joint-space width–ie, at the narrowest point–was measured by visual inspection with a magnifying lens. Symptoms were scored by the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index. The 106 patients on placebo had a progressive joint-space narrowing, with a mean joint-space loss after 3 years of -0·31 mm (95% CI -0·48 to -0·13). There was no significant joint-space loss in the 106 patients on glucosamine sulphate: -0·06 mm (-0·22 to 0·09). Similar results were reported with minimum joint-space narrowing. As assessed by WOMAC scores, symptoms worsened slightly in patients on placebo compared with the improvement observed after treatment with glucosamine sulphate. There were no differences in safety or reasons for early withdrawal between the treatment and placebo groups. The long-term combined structure-modifying and symptom-modifying effects of gluosamine sulphate suggest that it could be a disease modifying agent in osteoarthritis.

 

Glucosamine Sulfate vs Ibuprofen for TMJ Osteoarthritis – (07-02-01)

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Glucosamine Sulfate vs Ibuprofen for TMJ Osteoarthritis

TMJ is really quite a common secondary complaint seen in many chiropractic offices. The good news is that a vast majority of these cases resolve very well with a combination of trigger point therapy to the muscles of mastication as well as the posterior cervical muscles, cervical manipulation and home stretching. It is nice to have another tool to use for those patients that do not respond adequately to manual therapies for this joint.

Evaluation of Glucosamine Sulfate Compared to Ibuprofen for the Treatment of Temporomandibular Joint Osteoarthritis: A Rando

Read entire article here

Markers of bone, cartilage, and synovial tissue w/ knee osteoarthritis – (06-21-01)

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Markers of bone, cartilage, and synovial tissue w/ knee osteoarthritis

More and more, a new theory of osteoarthritis is emerging–one which views OA as a systemic condition affecting the nutrition of the joints surfaces themselves. This could drastically change the way we treat OA. Current Western therapies focus only on the reduction of overall inflammation in an attempt to control pain in the joint and does absolutely nothing to affect the nutrition of the joint surfaces themselves. Besides nutritional therapies to support health cartilage function, chiropractic physicians for years have known that manipulation increases the exchange of fluids out of and into the avascular joint surfaces.

Ann Rheum Dis — Abstracts: Garnero et al. 60 (6): 619

Read entire article here

Static postural sway, proprioception with knee osteoarthritis – (06-07-01)

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Static postural sway, proprioception with knee osteoarthritis

This article reveals that, in patients with knee OA they have reduced ability to balance themselves. This is the classic case where manipulative therapy shines–the adjustment actually works by firing off proprioceptors surrounding the joint–sort of a “breaking the cobwebs free” concept. Research has shown that these receptors surrounding the joint send a burst during the manipulation–thereby waking up the joint and restoring or improving joint proprioception.

Ann Rheum Dis — Abstracts: Hassan et al. 60 (6): 612

Read entire article here

Efficacy of intra-articular sodium hyaluronate in knee osteoarthritis – (05-20-03)

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Efficacy of intra-articular sodium hyaluronate in knee osteoarthritis

I still believe that this type of therapy and also future advances in cartilage transplants do hold strong hopes for the future of many advanced cases of OA. Patients in my office who have had the procedure done have had mixed results. I do think that advances in the makeup of the injection will lead to better results in the future. Hyaluronic acid the water-holding component of cartilage that keeps it springy and resilient.

SpringerLink: Clinical Rheumatology – Abstract Volume 22 Issue 2 (2003) pp 112-117

Read entire article here

Trends in Surgery for Lumbar Spinal Stenosis

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Technically, “stenosis” is shrinking of an opening.  When we refer to “spinal stenosis” this means a shrinking of the openings of the spinal column where your nerves run through it.

There are two flavors: lateral recess stenosis and central canal stenosis. In lateral recess stenosis, the nerves exiting the spinal cord are affected, usually resulting in pain down one leg, most often aggravated by standing or walking.

In central recess stenosis, the column where the spinal cord runs through is compromised, more often resulting in cramping, pain, numbness and tingling in both legs (numbness and tingling starting in the feet and moving up over time), again aggravated by standing or walking.

Lumbar spinal stenosis (occurring in the lumbar region, as opposed to the cervical, or neck, region) is a slowly progressive condition associated with arthritis of the spine. Over time, the enlargement of the bones in the region of the openings where the nerves exit essentially chokes off the healthy function of the nerves or spinal cord.

However, there are also ligaments that get thickened and hard over time that also contribute to the shrinking of the opening, most notably the ligamentum flavum. These ligaments, I believe, can be stretched and loosened up to help with the symptoms of lumbar spinal stenosis.

In my experience, back strengthening exercises for spinal stenosis don’t seem to really help all that much. Spinal epidural injections have not been shown to help in the long run either, and may increase the need for surgery later on.

Flexibility is a definitely plus, so yoga and specific stretches for the lumbar spine can be good. I am a very big fan of inversion tables for this condition as well (you can read about this more in a older blog article by clicking here).

In our office, we have been very successful using a technique called the Cox Flexion-Distraction technique. While we don’t fix everyone, the vast majority of patients do well with this treatment, especially when combined with a home inversion table and yoga.

But what about surgery? Is surgery for lumbar spinal stenosis a good idea?

I guess that depends.

There are different procedures that have been used for lumbar spinal stenosis. They range from “simple” decompressive laminectomies to complicated fusions. As always, simple is the best approach and, in general, the patients who I know who had this procedure done years ago seemed to do well. Complicated fusions, on the other hand, are a toss up.

Here’s the kicker: the outcomes are usually equivalent while the complications are far greater with the more complicated surgeries. That being said, fusions are likely a better option for those patients who also have instability present (usually from a condition called spondylisthesis) or patients with a higher curvature scoliosis of the spine.

One other little tidbit—there was a huge push for a period of time to use an artificial compound mixed in with bone, called bone morphogenetic protein – BMP, for spinal fusions. The problem is that the bone grew too fast and couldn’t be controlled, leaving a much higher complication rate. Luckily, the company that made BMP did a great job of paying off doctors to promote its use and hiding the concerns.

So, with this in mind, you would think that most of the surgeries done for lumbar spinal stenosis should NOT be fusions, right?

This particular study gives us some enlightening answers. Researchers looked at the data from 2004-2009. They looked at 3 situations:

  1. Lumbar spinal stenosis without any other factors
  2. Lumbar spinal stenosis with spondylolisthesis
  3. Lumbar spinal stenosis scoliosis

Surgical treatment was then divided into 3 groups:

  1. Decompression only (laminectomy, discectomy)-the “simple” option.
  2. Simple fusion (1–2 disc levels, single approach.
  3. Complex fusion (>2 disc levels or a combined front and back approach).

Here’s what the researchers found:

  1. The rate of decompressions dropped from 58.5% to 49.2%.
  2. The rate of simple fusions increased from 21.5% to 31.2%.
  3. The use of a compound called BMP more than doubled from 14.5% to 33.0% of all fusions.
  4. The use of interbody devices increased from 28.5% to 45.1%.
  5. In 2009, 26.2% of patients with stenosis without instability had a fusion procedure.

The bottom line is that, in a period of 5 years, while the numbers of procedures did not increase greatly, there was a shift from simpler surgeries that were cheaper with less complications, to more complicated procedures that were far more expensive and used a compound that was known to further increase complication rates.

No wonder our healthcare system is going broke.

If you have stenosis, I would STRONGLY recommend that you find a chiropractor that does Flexion Distraction, buy a home traction unit and get a 2nd and 3rd opinion on whether you really need that surgery.