Exercise Helps Manage Hip Arthritis Pain

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(Reuters Health) – Water- or land-based exercise should provide some short-term benefit in pain management for hip osteoarthritis, though there are few well-designed trials testing it, according to a new review.

Americans develop three million new cases of osteoarthritis each year. Most vulnerable are those who are older, obese, have previous joint injuries, overuse, weak muscles or genetic risk factors.

“It is nice to finally have some hip-specific data, as hip and knee osteoarthritis are often grouped together and it is almost certain that there are differences between these groups of patients, as well as differences in those with multiple joint osteoarthritis,” said Dr. Amanda E. Nelson of the Thurston Arthritis Research Center at the University of North Carolina Medical Center in Chapel Hill, who was not part of the new study.

“However, the studies are still small and heterogeneous, and larger, longer-term studies of more specific interventions are certainly needed to provide more specific recommendations,” she said.

The review only considered pain, not joint function, which may also improve with physical activity, Nelson told Reuters Health by email.

The researchers, lead by Kay M. Crossley of La Trobe University in Bundoora, Australia, reviewed 19 studies of water-based or land-based exercise therapy or manual therapy for hip pain, 10 of which were designed specifically for hip osteoarthritis.

Four studies found short-term benefits, up to three months later, with water-based exercise compared to minimal pain management. Six found similar benefit for land-based exercise therapy in the short term, but there was no evidence for benefit in the medium or long term, up to one year after therapy.

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Manual therapy, which includes joint manipulation, active stretching and massage, did not appear to provide additional benefit on its own or in combination with exercise, the researchers reported in the British Journal of Sports Medicine.

That’s not encouraging, said Dr. Kim Bennell of The University of Melbourne in Australia, who was also not part of the review. “However, the number of studies is relatively small and there was a lot of variation in the methods of the studies, so further research is needed in this area to confirm the results.”

Most doctors do not recommend exercise therapy, relying instead on pain-relieving drugs for osteoarthritis, despite agreement across guidelines and organizations that non-drug approaches are worthwhile, Nelson said.

“There are numerous potential barriers to recommendation and treatment including access to care, financial concerns, and the burden of managing multiple medical conditions in a short visit with a provider, among others,” she said. “Therefore, although the guidelines are in agreement, it is likely that the majority of patients are not receiving this recommendation from their providers, and that even fewer actually follow through on the recommendation if given.”

The 19 studies in the review all tested different type, frequency and duration of exercise, so the best sort of exercise, how much and how often to do it, remains to be determined, she said.

It would appear that a 12-week program with exercises generally including strengthening and range of motion three times per week is beneficial, Bennell told Reuters Health by email.

“Based on the overall body of work in physical activity, though, any regular physical activity is likely to be beneficial to most patients,” Nelson said. “It is safe to say that most adults do not get enough physical activity, and that this is even more of an issue among those with osteoarthritis.”

SOURCE: http://bit.ly/1Z1OiCu British Journal of Sports Medicine, online November 26, 2015.

Original Article HERE

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Researchers Find A Simple Daily Practice Can Control Pain Better Than A Placebo

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An article from our friends at A Plus:

A true example of mind over matter.

Meditation has shown that the human mind is a powerful thing. Through focused thought, humans have been able to improve their concentration, promote mental well-being, and encourage various aspects of physical health as well.

Some of these assertions, however, have been dismissed as a placebo effect rather than actually being effective. A new study by researchers at Wake Forest Baptist Medical Center in Winston-Salem, N.C., has put this to the test by pitting mindfulness meditation against a placebo. The results unequivocally showed that meditation came out on top for pain management. The results were published in The Journal of Neuroscience.

The placebo effect is a fascinating — though little-understood — phenomenon in which a person can actually improve their condition as long as they think they’re getting treatment. Pseudomedications that have no active ingredients are given to subjects who believe they’re taking an actual drug. Once they believe that they are supposed to feel better, some actually see an improvement in their symptoms.

“We were completely surprised by the findings,” lead researcher Fadel Zeidan explained in a statement. “While we thought that there would be some overlap in brain regions between meditation and placebo, the findings from this study provide novel and objective evidence that mindfulness meditation reduces pain in a unique fashion.”

Participants in the study were separated into four groups: mindfulness meditation, placebo meditation, placebo topical cream, and the control, which did not receive treatment. Mindfulness meditation is characterized by sitting still and focusing exclusively on one’s breathing. Though it is difficult to only think about breathing at first, it becomes easier with practice. In this study, this meditation was performed four times a day for 20 minutes per session.

Next, each of the participants was subjected to a painful stimulus (in this case, a probe heated to 120 degrees Fahrenheit) and asked to rate their pain. In order to keep the results from being completely subjective, brain scans were done using an MRI.

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Interestingly, those who practiced mindfulness meditation experienced more than double the pain relief compared to those who used the placebo ointment, and the decrease of emotional response to the pain was nearly tripled as well.

“This study is the first to show that mindfulness meditation is mechanistically distinct and produces pain relief above and beyond the analgesic effects seen with either placebo cream or sham meditation,” Zeidan continued.

The results of this study are very interesting and a testament to not only the prowess of the human brain, but also how much we have left to learn about how these processes work.

The researchers acknowledge that one of the limitations on the study is that all of the participants are ordinarily pain-free. Hopefully future studies will explore how meditation compares to placebo for those who suffer from chronic pain.

Original Article HERE