Cortisone – Not So Safe
Cortisone injections for hip and knee pain lead to more complications than previously thought, research has found.
The anti-inflammatory jabs are used by athletes to mask pain, and to treat symptoms of osteoarthritis. But the study by Boston University School of Medicine found that the treatment could speed up a joint’s disintegration and force patients to have total knee or hip replacements. Researchers found 10 per cent of their patients given injections in the hips in 2018 suffered complications, along with four per cent of those who had the jabs in the knees. These can include stress fractures, progressive osteoarthritis or even the collapse of joints.
Study leader Dr Ali Guermazi, of Boston University School of Medicine in the US, said: “We’ve been telling patients that even if these injections don’t relieve your pain, they’re not going to hurt you. But now we suspect that this is not necessarily the case.” “We are now seeing these injections can be very harmful to the joints with serious complications.” He said patients contemplating such injections should be given more information about potential risks. “What we wanted to do with our paper is to tell physicians and patients to be careful, because these injections are likely not as safe as we thought.” The findings appear online in the journal Radiology.
The NHS provides the injections for those suffering moderate to severe osteoarthritis and inflammatory conditions such as rheumatoid arthritis, and it is also used in sports medicine. Dr Guermazi said: “Physicians do not commonly tell patients about the possibility of joint collapse or subchondral insufficiency fractures that may lead to earlier total hip or knee replacement. This information should be part of the consent when you inject patients with intra-articular corticosteroids.”
Researchers said patients with little sign of osteoarthritis on their X-rays should be particularly closely monitored, if the pain they were experiencing was disproportionate to evidence on the scan. Such patients are at greater risk of destructive arthritis after injections, they said.
Laura Donnelly • The Telegraph • October 15, 2019
Many natural solutions exist to treat or manage pain in the back, hips and knees. These solutions may not work instantaneously (like a cortisone injection), but they also do not carry any of the negative side effects of using steroids as previously mentioned.
Herbal Therapy
While glucosamine sulfate has been helpful, there are other ingredients that are even more beneficial for your patients: curcumin, boswellia, and devil’s claw. Each is strong in its own right, but in combination they address the key areas rebuilding joint structure, reducing damaging inflammation, and reducing pain.
Reduce Inflammation with Curcumin
Curcuminoids (usually referred to simply as “curcumin”) are well-known compounds from turmeric (Curcuma longa) that play a dual role in reducing the inflammation that destroys joint mobility and flexibility. They protect chondrocytes (the specialized cells found in joint cartilage) from being broken down by inflammatory compounds and simultaneously stop pain without causing side effects. When curcumin is combined with turmeric essential oil (a source of beneficial anti-inflammatory turmerones) it enhances absorption and you may find it increases efficacy as well.
In fact, one study found that compared to a drug intervention (diclofenac sodium) for rheumatoid arthritis, whether curcumin with essential oil was combined with the medication or simply in a regimen of its own, it was superior to the drug. In both curcumin groups, there were no dropouts due to adverse effects, but in the diclofenac sodium group, 14 percent withdrew due to adverse effects. Curcumin can also help treat osteoarthritis symptoms. In a clinical study, a curcuminoid and turmerone essential oil combination was teamed with boswellia, another effective anti-inflammatory, and compared to a generic form of celecoxib (known under the brand name Celebrex). For pain relief, nearly 65 percent of those taking the herbal ingredients versus 30 percent in the drug group improved to such a high degree that they were able to shift from having “moderate to severe arthritis” to “mild moderate arthritis.”
Joint Relief with Boswellia & Devils Claw
Boswellia (Boswellia serrata) is especially potent at reducing joint pain. It inhibits the inflammatory enzyme, 5-LOX, which makes it a rarity even among other strong anti-inflammatory botanicals. When boswellia is standardized to be low in beta-boswellic acid (which interferes with beneficial activity) and provide higher levels of AKBA, it increases its effectiveness. In fact, this is the form that was used in the clinical study of osteoarthritis with curcumin.
Another botanical, devil’s claw (Harpagophytum procumbens), is a must for practitioners to recommend for restoring joints and improving flexibility. In a clinical study published in the Phytomedicine, devils’ claw relieved hip pain by almost 55 percent and knee pain by 40 percent in eight weeks. In another German clinical study, devil’s claw was equal in pain-relieving ability as Vioxx, a prescription non-steroidal anti-inflammatory drug (NSAID) that has since been pulled from the market because of its side effects.
The botanicals discussed here have a long history of traditional use that is being confirmed in clinical studies and ongoing research. They provide practitioners and patients alike with an effective and viable alternative to pharmaceuticals, without complications and side effects, to help promote an active, vibrant life.
Acupuncture
Over the years there has been substantial debate about whether acupuncture really works for chronic pain. Research from an international team of experts adds to the evidence that it does provide real relief from common forms of pain. The team pooled the results of 29 studies involving nearly 18,000 participants. Some had acupuncture, some had “sham” acupuncture, and some didn’t have acupuncture at all. Overall, acupuncture relieved pain by about 50%. The results were published in Archives of Internal Medicine.
The study isn’t the last word on the issue, but it is one of the best quality studies to date and has made an impression. “I think the benefit of acupuncture is clear, and the complications and potential adverse effects of acupuncture are low compared with medication,” says Dr. Lucy Chen, a board-certified anesthesiologist, specialist in pain medicine, and practicing acupuncturist at Harvard-affiliated Massachusetts General Hospital.
Daniel Pendick • Harvard Health Blog » Acupuncture is worth a try for chronic pain.
Our patients agree: Acupuncture is a safe and effective treatment for hip and knee pain.
Chiropractic
Chiropractic cannot stop you from getting older, but it might stop you from feeling older!
It has been suggested that chiropractic can prevent further arthritic development and regular treatment can even prevent osteoarthritic changes occurring in the first place. All we know for sure is that many of our patients say that it helps them feel better, they are less dependent on medications and they are able to stay more active.
When it comes to arthritis of the hip and knees, it’s important to be sure that your body is balanced. Think about your car for a moment. Driving your car for a long time while it is out of alignment can put unnecessary wear and tear on your tires, breaks and struts leaving your car vulnerable to bigger problems than just the alignment issue. Now apply this logic to your body. If your body isn’t balanced and distributing weight and forces properly, you can (and do) heap additional wear and tear on your knee and hip joints.
These imbalances may first present as chronically tight muscles or a recurring back problem, but over time, as the body is unable to adapt to the imbalance, you begin to experience the pain and symptoms associated with this extra wear and tear in the form of arthritis.
There is no real strong evidence that degeneration of your joints can be reversed by any means, but your chiropractor can help improve muscle and joint function and flexibility and therefore reduce the symptoms of arthritis.
Cold Laser Therapy
Cold Laser Therapy is effective, in relieving short-term pain for rheumatoid arthritis, osteoarthritis, tendinopathy, and chronic joint disorders. Recent research has also shown that Cold Laser Therapy can even help treat the underlying causes of neuropathy and help with symptom management. Cold Laser Therapy helps by actually stimulating microcirculation around the nerve fibers, which increases blood flow to the nerves and helps to heal and reduce neuropathic pain. With cold laser, there is no localized heat produced on the surface of the tissues and patients often feel absolutely nothing during their treatments. Laser therapy has a deeper effect than both electric muscle stimulation and ultrasound therapy with markedly shorter treatment times. If you have pain, burning, numbness or tingling and other therapies have failed, Cold Laser may just be the solution for you.
For more information on the herbal remedies and treatments mentioned here can help you manage your knee and hip pain, please call our office for a consultation at (239) 243-8735.