LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

Osteoarthritis

Topical Solution for Osteoarthritis May Challenge COX-2 Inhibitors – (03-18-01)

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Topical Solution for Osteoarthritis May Challenge COX-2 Inhibitors

We are starting to see a large number of “miracle” creams for arthritis hitting the market. Remembering back to the old Ben-gay type preparations, these were purely skin irritants designed to flood the spinal cord with “touch” sensations and prevent pain transmissions for reaching the spinal cord first. New preparations have included many additional topicals ranging from glucosamine/chondroitin to capsaicin. The studies on these types of therapies, to my knowledge, are still scarce. However, the safety of many of these topicals is very good and may warrant a personal clinical trial.

(article) British biotechnology firm Provalis plans to launch its novel topical osteoarthritis solution Pennsaid in the UK this month, saying the product will compete with all nonsteroidal anti-inflammatory drugs (NSAIDs), including COX-2 inhibitors. The UK is the first market for the new product. Provalis has acquired from Canadian firm Dimethaid research the right to sell the compound in the UK and Ireland. Provalis chief executive Dr. Phil Gould told a news conference in London that Pennsaid had been approved for first-line treatment of osteoarthritis by the UK’s Medicines Control Agency and would be approved in the rest of Europe under the mutual recognition procedure. Dimethaid is seeking distributors for the other European countries and has signed a deal with Johnson & Johnson for marketing in the United States. Dimethaid’s technology uses the cell’s tubule system to deliver drugs cell-to-cell. As a result, localised conditions, such as osteoarthritis, can be treated while limiting the body’s absorption of the medication. Dr. Gould said that comparative data showed that pain relief is as least as good with Pennsaid as with the COX-2 inhibitor celecoxib and oral formulations of the NSAIDs diclofenac and naproxen.

Hip abductor activation with clinical unilateral hip osteoarthritis – (07-18-02)

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Hip abductor activation with clinical unilateral hip osteoarthritis

While this article seems blatantly obvious to those of us in manual medicine that use alot of soft tissue techniques, we apparently needed a study so others could share in the obvious. Consider a tent with one of the tethering lines pulling way too hard–of course there would be long term effects on the health and durability of the main pole. Stretching, mobilization of the hip joint, orthotics, trigger point therapy and techniques aimed at eliminating scar tissue (i.e. NMR, ART) are important components of a therapeutic approach to hip pain.

Ann Rheum Dis — Abstracts: Sims et al. 61 (8): 687

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A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee – (07-18-02)

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A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee

This study really explodes another very common procedure in mainstream medicine. Arthroscopy of the knee is very common, and yet the research to support its validity has never been done. Well, this article does some of this research and shows no benefit over placebo (the issue of a placebo surgery is an another topic entirely…). Articles like this always bring to mind the critics of chiropractic care who say what we do is not founded on research. Well, those doctors in incredibly fragile glass houses on foundations of cards should not shoot anti-aircraft missiles….

NEJM — Abstracts: Moseley et al. 347 (2): 81

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Alternative Therapies for Traditional Disease States: Osteoarthritis – (01-27-03)

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Alternative Therapies for Traditional Disease States: Osteoarthritis

This is a nice review article for some of the natural approaches to OA. However, they don’t mention MSM, which is an important sulfur donor (sulfur is needed to form cartilage).

Alternative Therapies for Traditional Disease States: Osteoarthritis – January 15, 2003 – American Family Physician

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Glucosamine Sulfate Use Delays Progression of Knee Osteoarthritis – (10-17-02)

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Glucosamine Sulfate Use Delays Progression of Knee Osteoarthritis

While this is probably not a surprise to many, I thought I would include this. For the amount of evidence supporting its safety and effectiveness, this nutrient is still not used to the full extent it should be. Interesting that there are no huge news releases from major orthopedic associations such as “glucosamine use should be expanded to include patients with these indicators…” such as we see frequently with pharmaceutical drugs such as cholesterol lowering meds.

Read entire article here

Steroid Injection Epidurals For Spinal Stenosis–Boon or Bane?

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Epidurals are handed out like candy in this country. We assume that, much like surgery and medications, that there are hordes of research studies documenting the effectiveness of this intervention.

Regular readers of the Rantings and any chiropractor out there will tell you this couldn’t be further from the truth.

Yet this doesn’t seem to stop primary care doctors from referring patients out for epidurals long before they would consider a referral to a chiropractor (data from a major insurance company in the US notes that a measly 6.6% of non-surgical spine episodes that do not begin with a chiropractor will ever be referred to one for care, and even then this is VERY late in the episode).

Possibly this lack of referral is because primary care doctors don’t think there is research supporting chiropractic care (not true).  But this doesn’t seem to halt the referral to pain management centers to perform expensive, invasive procedures with evidence actually against their use that carries a much higher risk than manipulation.

Just seems strange to me.

That’s not to say that I don’t believe epidurals have a place in medicine, because I do. I have referred non-responsive patients out for them in the past, but they are few and far between and always for leg pain that is consistent with a disc herniation.  This scenario is a far cry from what is happening in the arena of low back pain in mainstream medicine today.

I can’t tell you how many times I’ve had patients sent for epidurals for isolated low back pain with no leg pain involvement.  Ugh!!

But what about leg pain associated with spinal stenosis-a condition where advanced arthritis of the spine begins to choke off the room for the nerves going into the leg?

Just recently I had just such a case.  After the 2nd visit using Flexion-Distraction he had absolutely no response to treatment.  So on the 3rd visit I really ramped up the agressiveness of the treatment with instructions to only return for additional treatment if he noted improvement after this visit.

I was fully expecting to have a discussion about a referral to pain management for this patient.  Luckily, that last treatment broke through the barrier and he had a pretty substantial improvement.  His outcome is going to be good.

But what if it wasn’t?  What if the 3rd visit didn’t help?  I’ve had stenosis patients in the past who did not have a strong response.  They are few, but they happen.  An epidural would seem to me to be a better option than referring that patient out for a surgical consult.

At least that’s what I thought until I came across this particular article.

The premise of this study was that the use of an epidural spinal injection for spinal stenosis patients would lower the need for, or at least delay, surgery.  Boy, were they surprised.

In looking at a group of patients who had an epidural spinal injection in the first 3 months of the trial versus those who did not, there were some enlightening findings:

  1. Those who received the epidurals had a much higher preference for avoiding surgery (62% versus 33%).
  2. In those who got the epidural but ultimately ended up in surgery there was a 26-minute increase in operative time and an increased length of stay by 0.9 days.
  3. Over 4 years, there was 34% less improvement in overall quality of life (measured using the 36-Item Short Form Health Survey (SF-36) Physical Function) among the epidural patients that ended up having surgery.
  4. There was less improvement in the epidural patients (56% less on Body Pain and 64% Physical Function).
  5. Of the patients who were initially in the non-surgery group, those who had an epidural were 45% more likely to switch to the surgical group.
  6. On the only positive note, the patients who were originally in the surgery group who got the epidurals were 1/3 less likely to actually follow through with surgery.

Wow!  Talk about nullifying a hypothesis!

I think that we, as a society, need to really rethink what steroids might be doing to our ability to heal, and accept the fact that the use of steroids applied directly to sensitive spinal structures may very well be doing far more harm than good.

Just my two cents (and a lot of medical research, too…).

Fitness, fatness, activity as predictors of bone density in older persons – (12-19-02)

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Fitness, fatness, activity as predictors of bone density in older persons

This article may be surprising to some, but really fits right in with research that has been piling up in regards to exercise in our senior population. This study does not show a protective effect of light aerobic exercise on bone mass. This supports the need for weight/resistance training in all age groups. I’ve really began pushing the addition of this type of training in all my senior patients. I do find that the more exercise a patient does as they get older, the healthier, happier and less medicated they are. My favorite story I like to relay is about Jim, a patient in his upper 70′s. He relays how much weight he lifts daily in the thousands of pounds (all added up, it’s not an unrealistic number at all). He has arthritis but never feels it, no medications and is mentally as alert as any fifty year old.

Synergy Abstract

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Green Tea Inhibit Bovine, Human Cartilage & Collagen Degradation – (03-14-02)

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Green Tea Inhibit Bovine, Human Cartilage & Collagen Degradation

Add green tea to the list of chondroprotective substances. I always strongly recommend green tea as a substitute for those patients desperately looking to cut back on soda.

Nutrition.org — Abstracts: Adcocks et al. 132 (3): 341.

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