Opioids Not Best Option for Back Pain, Arthritis, Study Finds

Opioids Not Best Option for Back Pain, Arthritis, Study Finds

Risky opioids are no better at controlling chronic back or arthritis pain than non-opioid drugs, including Tylenol or Motrin, new research finds.

With opioid overdose deaths rising in the United States, the findings suggest addictive medications like oxycodone (OxyContin) or morphine don’t have to be the first choice against crippling arthritis pain or chronic backache.

“We found that opioids had no advantages over non-opioid medications for pain, function or quality of life in patients with low back pain and osteoarthritis pain,” said study lead author Dr. Erin Krebs.

“This is important information for physicians to share with patients who are considering opioids,” added Krebs. She’s an investigator with the Minneapolis VA Center for Chronic Disease Outcomes Research.

Not only does the study suggest switching to opioids probably won’t help, but Krebs said the prescription painkillers will probably cause unpleasant side effects.

“Instead, they should consider trying other non-opioid medications or non-medication treatments,” Krebs suggested.

Long-term back pain hampers 26 million Americans aged 20 to 64, the American Academy of Pain Medicine has found. And roughly 30 million adults have pain from osteoarthritis, the wear-and-tear form of the disease, according to the U.S. Centers for Disease Control and Prevention.

In general, patients with chronic back or arthritis pain should first seek relief through exercise and rehabilitation therapies, said Krebs, who is also an associate professor of medicine at the University of Minnesota.

That’s because opioid medications, while promising significant pain control, come with substantial risks.

“The main harms are accidental death, addiction and physical dependence,” Krebs explained. “Everyone who takes opioids — even those who do not misuse them — is at risk for these serious harms.”

To compare the effectiveness of different means of pain relief, the new investigation enrolled 240 adults, average age 58, from June 2013 through 2015. All were receiving care for moderate to severe chronic back pain, or hip or knee arthritis pain.

None of the study participants had taken opioids on a long-term basis, the researchers noted.

After enrollment, half were randomly assigned to receive a year of opioid treatment. Depending on “careful trial and error,” Krebs said, this variously included morphine, hydrocodone/acetaminophen (Vicodin), oxycodone, and fentanyl patches. Daily dosages were restricted to 100 morphine-equivalent milligrams.

The non-opioid group received other pain relievers, including acetaminophen (Tylenol), and nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin) and naproxen (Aleve).

Over time, some patients in the non-opioid group were also offered prescription drugs, including amitriptyline or gabapentin, or topical analgesics such as lidocaine. In cases where nothing else worked, they were additionally prescribed nerve pain medications, such as duloxetine (Cymbalta) or pregabalin (Lyrica), or the narcotic tramadol (Ultram).

One year out, investigators determined that the two groups differed very little in terms of their ability to walk, work or sleep without pain.

The non-opioid group fared “significantly better” in terms of pain intensity compared with the opioid group, and experienced “fewer bothersome side effects,” Krebs said.

Dr. David Katz is director of the Yale University Prevention Research Center. He said that for treating long-term musculoskeletal pain, “use of opioids is both ineffective and ill-advised.”

“Anyone who has undergone surgery — and I have a number of times — certainly knows the value of opioid analgesia. When pain is acute and truly overwhelming, potent narcotics work, and essentially nothing else does,” he said.

“But the value of opioids fades quickly over time, and the liabilities increase,” Katz explained. “So an informed approach would tend to be very short-term use of opioids, when pain is most intense, with early and explicit plans to transition to alternatives.”

Katz agreed with Krebs that non-medicinal “holistic approaches to pain management, often involving team care, tend to be best” for controlling chronic pain.

“There are many ways to treat pain that don’t involve drugs at all,” Katz added.

The report was published in the March 6 issue of the Journal of the American Medical Association.

Health Tip: Shovel Snow Safely

Health Tip: Shovel Snow Safely

(HealthDay News) — Snow shoveling is a factor in thousands of injuries and as many as 100 deaths in the United States each year.

The National Safety Council suggests how to shovel safely:

  • Do not shovel after eating or while smoking.
  • Take it slow and stretch out before you begin.
  • Shovel only fresh, powdery snow; it’s lighter
  • Push the snow, rather than lifting it.
  • If you do lift snow, use a small shovel or only partially fill the shovel.
  • Lift with your legs, not your back.
  • Do not work to the point of exhaustion.
Spring is approaching, which comes sports & the rise of ACL injuries

Spring is approaching, which comes sports & the rise of ACL injuries

“The traumatic injuries are something that you can’t avoid in the nature of sports,” said Michael Hughes, Clinic Coordinator and lead Physical Therapist at Agape Physical Therapy of Gates. “A lot of kids will come from the winter and start their spring season, and they don’t have a good strengthening regimen when starting their specific sport. It can lead to some injuries if they don’t have the proper muscle training.”

Orthopedic surgeons at Strong Memorial Hospital are seeing similar trends. According to a hospital spokesperson, orthopedic sports medicine surgeon Mike Maloney, M.D., confirms that he’s seeing the same rate of increase in his practice. We’re told Maloney specializes in treating elite student athletes and says the following factors are causing the alarming increase in this injury:

• The increasing level of intensity in scholastic sports

• More kids specializing in one sport and doing year-round training in that sport

• Lack of emphasis on proper nutrition

• Lack of focus on preventive care – teaching kids how to get conditioned to be strong, and how to move to help prevent injury.

Jeff Bobzin can’t preach it enough to the youth soccer players he coaches in Gates.

“We encourage kids to drink a lot of water, eat right and exercise,” Bobzin said.

Boys between ages 10-14 make up more than half of the reported injuries in the study. Therapists at Agape say its important for parents and kids to map out a training plan to prevent serious body injuries.

Widely Used COPD Meds Tied to Increased Fracture Risk

Widely Used COPD Meds Tied to Increased Fracture Risk

TUESDAY, Feb. 13, 2018 (HealthDay News) — Many patients with chronic obstructive pulmonary disease (COPD) are placed on powerful inhaled corticosteroid therapy to ease symptoms.

But new research suggests the treatment might raise their odds for bone fractures.

Still, the Canadian study wasn’t able to prove cause-and-effect, and the overall risk remained small, said one expert not connected to the study.

“Looking at their data, there would be an estimated 1 [extra] fracture for every 241 patients using high-dose inhaled corticosteroids for over four years,” said Dr. Walter Chua. He’s the senior attending physician for pulmonary care at Northwell Health’s Long Island Jewish Forest Hills hospital in Forest Hills, N.Y.

Chua believes that although steroids may raise bone fracture risk, “patients should not panic as the risk of fracture is small and we have ways of monitoring that risk.”

COPD — often linked to smoking — is a combination of emphysema and chronic bronchitis. It is a progressive, debilitating illness that currently has no cure. COPD remains the number three killer of Americans.

Many COPD patients are given inhaled corticosteroid medications to help alleviate symptoms. But, according to the study team, prior research has suggested that the drugs may reduce bone mineral density, particularly in postmenopausal women.

The new study was led by Dr. Samy Suissa of McGill University in Montreal. His team tracked outcomes for more than 240,000 COPD patients, aged 55 and older, in the Canadian province of Quebec.

During an average follow-up of just over five years, the overall fracture rate was just over 15 people per 1,000 patients per year.

However, the rate was higher among patients who had used inhaled corticosteroids for longer than four years, at daily doses of 1,000 micrograms or more.

Gender didn’t seem to play a role, since the risk rose equally for men and women, Suissa’s team said.

The study appears in the February issue of the journal Chest.

“Since fractures are more frequent in women than men, our study suggests that the excess number of fractures associated with [inhaled corticosteroids] will be greater in women — even though we did not find that the risk increase was particularly higher in women than in men,” Suissa said in a journal news release.

So what does this mean for the many COPD patients who are using corticosteroids?

Dr. Ann Tilley is a pulmonologist at Lenox Hill Hospital, in New York City. She wasn’t involved in the new research, but read over the findings and stressed that it couldn’t prove cause-and-effect.

Information on other patient factors that might raise bone fracture — things like smoking status, obesity and exercise levels — weren’t accounted for, Tilley noted.

Still, “the most important take-home message here is that long-term use of high-dose inhaled steroids may not be without risk,” Tilley said, “and we should try to minimize their use when possible.”

“I would encourage patients to talk to their doctors about their inhalers and ask specifically if they need to be using an inhaled corticosteroid, and if so, could a lower dose be tried,” she said.

Chua agreed, noting that other research has also shown “a slight uptick in the rates of pneumonia [for COPD patients] while on inhaled corticosteroids.”

He believes that for patients with confirmed COPD, “inhalers containing corticosteroids should generally be reserved as a last line of treatment after optimization of other inhaler alternatives.”

And if patients must use steroids, they “should be monitored for bone mineral density and fracture risk, for which we have medications/therapies to help reduce that risk,” Chua said.

More information

The U.S. National Heart, Lung, and Blood Institute has more on COPD.

SOURCES: Walter Chua, MD , senior pulmonary attending physician, Northwell Health’s Long Island Jewish Forest Hills, Forest Hills, NY; Ann Tilley, MD, pulmonologist, Lenox Hill Hospital, New York City; Chest, news release, Feb. 5, 2018

Tips for preventing ski injuries

Tips for preventing ski injuries

Ski season is in full swing — but an injury can put you out of commission until next year’s first snowfall. Here’s how to stay safe on the slopes all winter long.

While many people huddle inside during the winter months, away from “bomb cyclones” and blizzards, a select few know that the best way to beat wintry weather is to embrace it — on the ski slopes, that is!

As any seasoned skier will tell you, however, their beloved sport does come with the risk of injury. Fortunately, taking some simple precautions before you hit the slopes can help you stay in peak condition regardless of how many tumbles you take.

We’ve outlined some of the most common injuries that afflict skiers, and what you can do to prevent them.

MCL Injuries

A number of injuries can affect the medial collateral ligament (MCL), but the most common by far is an MCL tears. In skiing, MCL tears most often occur when the skier falls while attempting to slow or stop in a snowplow position, in which the tips of the skis are pointed toward each other. To avoid injury in this position, make sure to always keep your weight balanced. In addition, sticking to runs with which you’re comfortable can reduce the need to enter the snowplow position at all.

ACL Injuries

A variety of falls on the slopes can result in a tear of the anterior cruciante ligament (ACL). It most commonly happens after a forward fall, during which the inner edge of the front of the ski becomes embedded in the snow, trapping the leg in the process. It can also occur when the top of the back of the boot pushes the tibia (the weight-bearing bone in the leg) forward, away from the femur. On other occasions, it arises when the skier leans back on the skis, loses balance, and falls backward. Strengthening the hamstrings, wearing proper bindings, and using shorter skis can all reduce the risk of sustaining an ACL tear.


Like torn ligaments, fractures are most commonly caused by falls while skiing. The wrist and ankles are particularly susceptible to breaks. To help avoid broken bones, always wear adequate protective gear and practice proper techniques for falling. Increasing cardiovascular endurance and developing the surrounding muscles can also be beneficial.

Shoulder Dislocations

Most shoulder dislocations happen when skiers fall, either directly onto the shoulder or onto an outstretched hand or arm. This injury results in heavy, immediate pain, significantly restricts the shoulder’s range of motion, and can leave it misshapen. Since dislocations are caused by sudden trauma, they can be difficult to anticipate, but strengthening the rotator cuff muscles, especially if you have previously dislocated your shoulder, can lower the risk of a dislocation. As with other common skiing injuries, employing proper form will also minimize the possibility of a dislocation.

Spinal Injuries

Aside from protecting the spinal cord, the spine ensures the strength and stability of the back. It is made up of various bony segments called vertebrae separated by pieces of fibrocartilaginous tissue called intervertebral discs, any of which can be injured while skiing. Some ways to avoid spinal injuries include using spine protectors, sticking to trails on which you are comfortable, using proper equipment, and learning the technique for “safe” falls.

While some ski injuries are immediately apparent, others can be more subtle, slowly progressing with time. Fortunately, the talented team of specialists at New York Bone and Joint has extensive experience working in sports medicine and can quickly diagnose and treat any of these common problems. If you think you may have suffered an injury during your latest trip to the mountain, call us today to schedule a consultation, or if the injury has been recent, stop in to our Orthopedic Urgent Care!