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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Nine Things To Know About Stem Cell Treatments

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Many clinics offering stem cell treatments make claims that are not supported by a current understanding of science.

Disclaimer: This article was originally published on The International Society for Stem Cell Research’s (ISSCR) Website

Stem cells have tremendous promise to help us understand and treat a range of diseases, injuries and other health-related conditions. Their potential is evident in the use of blood stem cells to treat diseases of the blood, a therapy that has saved the lives of thousands of children with leukemia; and can be seen in the use of stem cells for tissue grafts to treat diseases or injury to the bone, skin and surface of the eye. Important clinical trials involving stem cells are underway for many other conditions and researchers continue to explore new avenues using stem cells in medicine.

There is still a lot to learn about stem cells, however, and their current applications as treatments are sometimes exaggerated by the media and other parties who do not fully understand the science and current limitations, and also by “clinics” looking to capitalize on the hype by selling treatments to chronically ill or seriously injured patients. The information on this page is intended to help you understand both the potential and the limitations of stem cells at this point in time, and to help you spot some of the misinformation that is widely circulated by clinics offering unproven treatments.

It is important to discuss these Nine Things to Know and any research or information you gather with your primary care physician and other trusted members of your healthcare team in deciding what is right for you.

1. Currently, very few stem cell treatments have been proven safe and effective

The list of diseases for which stem cell treatments have been shown to be beneficial is still very short. The best-defined and most extensively used stem cell treatment is hematopoietic (or blood) stem cell transplantation, for example, bone marrow transplantation, to treat certain blood and immune system disorders or to rebuild the blood system after treatments for some kinds of cancer.

Some bone, skin and corneal (eye) injuries and diseases can be treated by grafting or implanting tissues, and the healing process relies on stem cells within this implanted tissue. These procedures are widely accepted as safe and effective by the medical community. All other applications of stem cells are yet to be proven in clinical trials and should be considered highly experimental.

Beware of stem cell treatments offered without regulatory approval or outside the confines of a legitimate and registered clinical trial.

2. There is something to lose when you try an unproven treatment

When there is no existing or effective treatment for a disease or condition, it is easy to understand why you may feel there is nothing to lose from trying something new, even if it isn’t proven. Unfortunately, most of the unproven stem cell treatments for sale throughout the world carry very little promise of actual benefit and very real risks:

  • Complications may create new short- and long-term health problems, and/or may make your condition or symptoms more difficult to manage
  • Receipt of one unproven or experimental treatment may make you ineligible for future clinical trials or treatment options
  • Out-of-pocket expenses could be enormous. In addition to treatment costs, there may be accommodation charges or other fees. In most cases, insurance companies and government health programs do not cover the cost of experimental treatments
  • If travel is involved, there are additional considerations, including time away from friends and family

Before you decide whether to pursue an unproven or experimental treatment, carefully assess the treatment you are considering. Weigh the risks and potential benefits. Get input from your loved ones and from your healthcare team; they may provide insight you haven’t thought of.

Unproven treatments present serious health, personal and financial considerations. Consider what might be lost and discuss these risks with your family and healthcare providers.

3. Different types of stem cells serve different purposes in the body

Different types of stem cells come from different places in your body and have different functions. Learn more about various types of stem cells here.

Scientists are exploring the different roles tissue-specific stem cells might play in healing, with the understanding that these stem cells have specific and limited capabilities. Without manipulation in the lab, tissue-specific stem cells can only generate the other cell types found in the tissues where they live. For example, the blood-forming (hematopoietic) stem cells found in bone marrow regenerate the cells in blood, while neural stem cells in the brain make brain cells. A hematopoietic stem cell won’t spontaneously make a brain cell and vice versa. Thus, it is unlikely that a single cell type can be used to treat a multitude of unrelated diseases involving different tissues or organs.

Be wary of clinics offering treatments with stem cells originating from a part of your body unrelated to your disease or condition.

4. The same stem cell treatment is unlikely to work for different diseases or conditions

Because stem cells that are specific to certain tissues cannot make cells found in other tissues without careful manipulation in the lab, it is very unlikely that the same stem cell treatment will work for diseases affecting different tissues and organs within the body.

Scientists have learned to make certain specialized cell types through a multi-step processes using pluripotent stem cells, that is embryonic stem cells or induced pluripotent stem (iPS) cells. These cells have the potential to form all the different cell types in the body and offer an exciting opportunity to develop new treatment strategies. Embryonic stem cells and iPS cells, however, are not good candidates to be used directly as treatments, as they require careful instruction to become the specific cells needed to regenerate diseased or damaged tissue. If not properly directed, these stem cells may overgrow and cause tumors when injected into the patient.

View clinics that offer the same cell treatment for a wide variety of conditions or diseases with extreme caution. Be wary of claims that stem cells will somehow just know where to go and what to do to treat a specific condition.

5. The science behind a disease should match the science behind the treatment

The more you know about the causes and effects of your disease, the better armed you are to identify your best treatment options. If you have a certain type of blood cancer, for example, transplantation with blood-forming stem cells makes sense, as the treatment requires those specific cells to do exactly what they are designed to do. If you have diabetes, receiving a blood-forming stem cell treatment doesn’t make sense, because the problem is in the pancreas rather than in the blood itself. Without significant and careful manipulation in the lab, tissue-specific stem cells do not generate cell types found outside of their home tissues.

Your best protection against clinics selling unproven stem cell treatments is an understanding of the science behind your disease, injury or condition.

6. Cells from your own body are not automatically safe when used in treatments

In theory, your immune system would not attack your own cells if they were used in a transplant. The use of a patient’s own cells is called an autologous transplant. However, the processes by which the cells were acquired, grown and then reintroduced into the body would carry risks. Here are just a few known risks of autologous stem cell treatments:

  • Any time cells are removed from your body, there is a risk they may be contaminated with viruses, bacteria or other pathogens that could cause disease when reintroduced
  • Manipulation of cells by a clinic may interfere with their normal function, including those that control cell growth
  • How and where the cells are put back into your body matters, and some clinics inject cells into places where they are not normally present and do not belong

Every medical procedure carries risk; be wary of clinics that gloss over or minimize the risks associated with their treatments.

7. Patient testimonials and other marketing provided by clinics may be misleading

It can be hard to tell the difference between doctors conducting responsible clinical trials and clinics selling unproven treatments. One common differentiator is the way a treatment is marketed. Most specialized doctors receive patient referrals, while clinics selling stem cell treatments tend to market directly to patients, often through persuasive language on the Internet, Facebook and in newspaper advertisements.

Clinics peddling unproven stem cell treatments frequently overstate the benefits of their offerings and use patient testimonials to support their claims. These testimonials can be intentionally or unintentionally misleading. For example, a person may feel better immediately after receiving a treatment, but the perceived or actual improvement may be due to other factors, such as an intense belief that the treatment will work, auxiliary treatments accompanying the main treatment, healthy lifestyle changes adapted in conjunction with the treatment and natural fluctuations in the disease or condition. These factors are complex and difficult to measure objectively outside the boundaries of carefully designed clinical trials. Learn more about why we need to perform clinical trials here.

Beware of clinics that use persuasive language, including patient testimonials, on the Internet, Facebook and newspapers, to market their treatments, instead of science-based evidence.

8. An experimental treatment offered for sale is not the same as a clinical trial

The fact that a procedure is experimental does not automatically mean that it is part of a research study or clinical trial. Responsible clinical trials share several important features:

  • They build upon their own preclinical data, lab-based research on cells, tissues and animals, that indicates the treatment being tested is likely to be safe and effective
  • Oversight by an independent medical ethics committee to protect participants’ rights
  • Conformity to regulatory requirements, including a listing in a recognized clinical trial registry
  • A structure designed to answer specific questions about a new treatment or a new way of using current treatments (results are usually compared with a control group of patients who do not receive the experimental treatment)
  • The cost of the new treatment and monitoring is not covered by the participant

Responsibly-conducted clinical trials are critical to the development of new treatments. Learn more about clinical trials here.

Beware of expensive treatments that have not passed successfully through clinical trials.

9. The process by which science becomes medicine is designed to minimize harm and maximize effectiveness

There is a lengthy, multi-step process involved in responsibly translating science into safe and effective medical treatments. During this process, scientists may discover that an approach that seemed promising in the lab, does not work in animals, or that an approach that worked in animals, does not work in humans. They may discover that a treatment effectively addresses symptoms of a disease or injury in humans, but that it carries unacceptable risks. Scientists carefully review and replicate their work, and invite their peers to do the same. This process by which science becomes medicine is often long, but it is designed to minimize patient harm and to maximize the likelihood of effectiveness. Learn more about how science becomes medicine here.

Beware of clinics that circumvent the accepted process by which science becomes medicine.

‘Like an orchestra’: Pain management moving toward holistic approach

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Logan resident Dawn Carter’s life changed in January 2015 following an accidental fall down a flight of stairs.

Originally diagnosed with just a concussion, complications from the injury now cause Carter to experience chronic nerve pain and migraines, in addition to seizures and memory loss.

“There is really nothing (my doctors) can do about my pain,” Carter said. “It hurts so bad (that) I feel like an electric eel is swimming throughout my body. It mainly starts in my wrist and works up my arms, up to my shoulders and down to my back.”

According to data gathered by the Institute of Medicine of the National Academies, 100 million Americans suffer from chronic pain conditions, affecting more people than coronary heart disease, diabetes and cancer combined.

Fortunately, treatment options for both chronic and acute forms of pain have evolved from the over-simplified, pharmaceutical heavy days of the 1970s, said Dr. Brian Richardson, who specializes in pain management at Logan’s Southwest Spine and Pain Center.

As pain management evolves, so too does the form it takes. The new standard of care in pain management is that of the holistic approach, or the treatment of a patient’s pain with the combined help of general practitioners, physical therapists and psychologists.

“The way I like to describe treatment to my patients is that it’s like an orchestra,” Richardson said. “Say you’re watching “Les Miserables” live onstage, but the only instrument in the score is a trombone. Alone, that might not be very pleasant. But if you’ve got cellos, violins, saxophones and clarinets, it’s going to sound a lot better and be a much more pleasant experience. It’s the same concept with pain management. Now, we’re using multiple tools to help diagnose, address and fix a problem.”

The physical, mental, social approach

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Physical therapist Swen Sandberg, who has been rehabilitating outpatients through Intermountain Healthcare at Logan Regional Hospital since 2013, said pain management has been working towards the “biopsychosocial” model of treatment over the past few years.

Often abbreviated as BPS, the approach gives equal weight to the physical, mental and social aspects of any given disease.

Sandberg said research studies have shown the effectiveness of the BPS style, with patients showing better recovery results when cared for holistically instead of by a single entity. The results are shifting the way pain management is being approached and introducing an increase in collaboration between medical professionals.

Sandberg predicted that within 10 years, insurance companies will start to provide better reimbursement to patients that are exploring the holistic style of care as opposed to consulting with just a single medical professional.

“The research is backing it up,” Sandberg explained. “It’s the model that Intermountain Healthcare is working towards as well. You can see that it’s the direction that health care is going.”

Richardson said although collaboration with other doctors may sometimes be challenging to coordinate because of varying schedules, he echoed that the increase of experience and evidence confirms it as the new medical standard for pain treatments.

“Not only is the approach important, but it’s absolutely critical,” Richardson said of his regular communication with other doctors. “It’s no longer just giving patients a painkiller. When you look at one modality versus someone also using physical therapy and working through coping skills with a psychologist, that type of multi-modal approach has by far and away been proven to be the most successful.”

Restoring function

Richardson said one of the most common misconceptions regarding treatment for pain is the assumption that doctors will simply prescribe pain medication, but medication isn’t the core of treatment. Instead, the focus lies first on diagnosing the problem itself and then exploring ways to restore function in pained areas.

“Communication with the patient about what the goal is for treatment is before we begin,” Richardson said. “From there, we can manage expectations and work together on the same page.”

While short-term pain relief may be a priority depending on the needs of the individual patient, not all patients may need to be prescribed medication depending on their treatment plan. Richardson used the example of an 80-year-old woman slipping in her bathtub and suffering a compression fracture. In this case, a low dose analgesic may be prescribed to help relax the pain, but the patient would receive an MRI and a back brace first, while also meeting with a physical therapist. A procedure may be recommended if the fracture doesn’t heal naturally from there.

However, if pain medication is in the best interests of the patient, Richardson said enough is prescribed to meet the patient’s needs.

Every 30 days, Richardson would meet with the patient to determine how the treatment is progressing before processing a refill on any prescription.

“It’s rare that you have people with legitimate pain problems that don’t stick with the prescribed regimen,” Richardson explained. “It’s much more common to see people that want to get better.”

Sandberg, the physical therapist, said treatment is on a spectrum between restoring function and pain control. Working towards one end may be able to provide for a solution on the other end, however.

“Very rarely does a patient present without some form of pain,” Sandberg explained. “As therapists, what we do is try to address what’s causing the pain. Sometimes, unless you reduce stress on the joint or the structure, it won’t get better no matter how many pills you take. But other times if we can reduce the pain enough, we can work towards ways to restore that function.”

Sandberg said that many of his patients are on some form of pain medication, but the majority of his modalities aren’t related to pain medication. Instead, he may use ultrasounds or electrical stimulation on the affected areas to retrain the nerves to induce a proper pain response, or provide stretching or traction to joints and tendons to invoke chemical responses that help to relieve the pain.

Sometimes, techniques as simple as changing posture can help relieve pain without turning to medication.

Ending the stigma

Both Sandberg and Richardson acknowledge that there is a certain stigma surrounding chronic pain conditions that may cause patients to not enter treatment. For some, it may be a case of affordability, although Sandberg said that many physical therapy patients may be able to seek treatment for low or no cost regardless of their insurance status. For others, it may be a doubt that doctors really believe their claims of pain.

“Anybody would be frustrated if they got the response, ‘There’s nothing wrong with you,’” Sandberg said. “Sometimes there is a stigma that you may be faking it, but for doctors that notion is completely unacceptable. That can’t exist in the medical community. Pain is taken at face value. Just because there isn’t visible damage now doesn’t mean that there wasn’t damage at some point.”

Richardson said advances in pain management clinics over the past 15 years alone are countering the old notions of simply receiving pain pills.

“We’re committed to finding out what is causing pain and why,” Richardson said. “It can sometimes be a challenge, but once they come through the door and realize what we’re trying to accomplish, that perception changes rapidly.”

Acute vs. chronic pain

Pain takes many forms, which means that professionals like Richardson and Sandberg treat patients on an individual basis to best suit their needs.

“Sometimes the pain is an acute pain, which is here and now,” Richardson said. “For example, you may have a patient who has tweaked their spine tossing a bale of hay and now has nerve pain. If we can treat these conditions quickly enough, we may be able to phase out that pain completely. But with chronic conditions, expectations may need to be reevaluated. Sometimes pain just can’t be cured — there may not be one thing to fix that will stop it from coming back.”

For chronic patients, the involvement of a psychologist can be beneficial, helping patients to learn effective coping strategies regarding the control of their pain. In the cases of psychosomatic pain, which is pain that is caused by the brain’s misinterpretations of nervous system responses, psychologists can also help to reduce the pain or eliminate it entirely.

Sandberg said chronic pain is often the result of a previous injury where the problem is a maladaptive nerve response instead of lingering damage, in which the nerves are unable to register pain in the correct fashion.

“These people may still be in pain because their nervous system hasn’t been able to register the pain response appropriately,” he explained. “To help, we retrain the nervous system through modalities like exercise or electrical stimulation.”

Sandberg said his first sessions with chronic pain patients are often educational, defining the difference between acceptable levels of pain and non-acceptable ones.

“For many, pain is associated with discomfort,” he said. “But there can be different levels of pain that can be improved upon through therapy. For chronic pain patients, the pain may never completely improve, but the function can make progress.”

Exploring alternatives

Aside from the patient’s prescribed regimen, some patients may also choose to supplement their care with other forms of therapy. Richardson said it isn’t uncommon for patients to ask about options such as chiropractic care, massage therapy and acupuncture. Richardson said he encourages proactivity in his patients, noting it as a sign of the patient’s desire to reach to the heart of the problem.

“If someone is willing to explore other functions in addition to their treatment, that means they’re obviously interested in getting better,” he said.

Sandberg said these alternative care options should be weighed on a cost-to-benefit ratio.

“Is it worth the cost? Does it help, or do you feel like it helps?” he said. “Things like herbal medicine or foot zoning may not have as much evidence that they’re helpful, but if the patient is feeling better, we never discourage that. The mind is a powerful thing when it comes to pain control. If you believe that it’s helpful, then it’s helpful.”

Sandberg also encourages patients to explore the options as long as it doesn’t conflict with their current treatment.

“I think proactive searching is important,” he said. “It shows good coping skills. Those patients seem to do really well. If I have a patient that comes in and hasn’t tried anything on their own, I might refer them to a psychologist.”

Original Article Here by Clayton Gefre

Pain Awareness Month: More Questions Than Answers?

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An Article From The HuffPost Healthy Living:

According to the American Chronic Pain Association (ACPA), September was anointed Pain Awareness Month in 2001 “to raise awareness in the issue of pain and pain management,” with a goal of creating “greater understanding among health care individuals, individuals and families who are struggling with pain management, the business community, legislators, and the general public that pain is a serious public health issue.” I think it is safe to say that over the last 14 years a lot of success has been achieved in building awareness about chronic pain and the enormous shadow it casts on the lives of patients, their families, and communities. Greater public awareness has come through the hard work of many activists and organizations like the ACPA, but unfortunately, a lot of the publicity surrounding pain over the last few years has come about over concerns surrounding the use, misuse, and abuse of prescription pain killers.

In 2015, we need a lot more than awareness. What we really need are tangible, measurable, and impactful solutions for millions of Americans who are hurting and suffering. Unfortunately, for health care providers and their patients, when it comes to pain treatment, there are often more questions than answers. If there is one lesson we have learned over the last 14 years, it is that we won’t solve America’s pain crisis by just throwing more drugs at it.

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Perhaps no health problem in America is in bigger need of an infusion of quality care right now than the treatment of pain. With an estimated annual cost of around $600 billion in treatment and lost productivity, we spend more on pain than we do treating cancer, heart disease, or diabetes, but we don’t seem to be getting a great return on our investments. The burden of chronic pain on our medical and disability systems remains high and unfortunately only seems to be getting worse.

Alarmed by our country’s struggles to effectively treat pain, Congress mandated for a study to take place, and in 2010 the National Institute of Health contracted with the Institute of Medicine to perform a comprehensive assessment with recommendations. The Institute’s 2011 eye opening results brought to light the enormity of the problem as well as the lack of consistently good answers for treatment. The study authors called for a “cultural transformation” in how our country goes about studying, assessing and treating pain.

More recently a follow up report has been released, titled the National Pain Strategy, released by the Interagency Pain Relief Coordinating Committee (IPRCC) at the charge of the Assistant Secretary for Health which falls under the U.S. Department of Health and Human Services (HHS).
While the National Pain Strategy is bold in its scope and may seem overwhelming to those in the trenches who treat pain, it offers promise and hope for an estimated 100 million Americans struggling with pain on a regular basis. The report is lengthy and comprehensive, and it raises many good discussion points for patients, doctors, and insurance companies. The full report can be found here.

Here are a few key take home points worth highlighting:

• The report introduces the concept of high-impact chronic pain. While a large proportion of the population may experience some level of daily pain, a certain subset experiences pain to the degree that they can’t function well at work or at home, and even their ability to interact with others is limited. This high-impact group would be expected to require a considerable amount of assistance and treatment. Being able to better identify this group may help streamline the delivery of effective treatment.
• The importance of a more comprehensive, integrated, and interdisciplinary model of care is made clear throughout the report. The committee recognizes that a major lack of access to such programs along with our concurrent over-dependence on more unimodal therapies like pharmaceuticals and risky invasive treatments is a huge problem that must be addressed. They rightfully point out that a major barrier to providing more comprehensive treatments is a lack of necessary insurance coverage and its dependence on the old fee for service payment system. Physician behavior can’t change without an economic system in place to facilitate providing better care to patients.
• The committee wants to emphasize the need for self-management programs. We know that coming up with ways to help pain patients learn valuable tools to effectively self-manage their pain improves their quality of life, reduces pain, and lightens the load on healthcare and disability systems. Making this an important feature of better pain management across the country is an excellent idea.
• The report also brings up the concept of prevention at a number of different levels. This includes studying ways to prevent injuries or diseases from happening in the first place, as well as designing strategies to curtail acute pain problems from progressing into chronic ones.
• The role of the primary care physician also gets a lot of attention. Many simply don’t have the training and expertise to assess more complex chronic pain problems, nor do they typically have the resources at their disposal to provide effective treatment. Primary care doctors need a lot of help and support to better serve their patients in pain.

Creating wholesale changes in the way thousands of doctors interact with millions of patients is no small feat. But as the National Pain Strategy points out, we have a moral obligation to do this better.

Article by:  Original Post HEREChronic pain specialist, author, radio host