Physical Therapy Can Help You Avoid Opioids When Joint Pain Strikes

Physical Therapy Can Help You Avoid Opioids When Joint Pain Strikes

People who get prompt physical therapy for pain in the knee, shoulder or lower back may have less need for opioid painkillers, new research suggests.

The study, of nearly 89,000 U.S. patients, found that people given physical therapy for their pain were 7 percent to 16 percent less likely to fill a prescription for an opioid.

The researchers said the findings suggest that early physical therapy is one way to reduce Americans’ use of the risky, potentially addictive painkillers.

“For people dealing with these types of musculoskeletal pain, it may really be worth considering physical therapy — and suggesting that your health care provider give you a referral,” said lead researcher Dr. Eric Sun. He is an assistant professor of anesthesiology, perioperative and pain medicine at Stanford University.

Dr. Houman Danesh, a pain management specialist who was not involved in the study, agreed.

“This study shows how important physical therapy can be,” said Danesh, who directs the division of integrative pain management at Mount Sinai Hospital, in New York City.

Physical therapy does require a much bigger investment than taking pain medication — and, he said, patients may have to travel to find a therapist who is the best fit for them.

“Physical therapy is highly variable,” Danesh said. “Not all physical therapists are equal — just like not all doctors are.”

But the effort can be worth it, according to Danesh, because unlike painkillers, physical therapy can help people get at the root of their pain — such as imbalances in muscle strength.

“You can take an opioid for a month, but if you don’t get at the underlying issue [for the pain], you’ll go back to where you started,” he explained.

The findings, published online Dec. 14 in JAMA Network Open, come amid a growing national opioid epidemic. While many people who abuse opioids are hooked on illegal versions — like heroin and illicitly manufactured fentanyl — prescription opioid abuse remains a major concern.

Medical guidelines, from groups like the American College of Physicians, now urge doctors to first offer non-drug options for muscle and joint pain. Opioids, such as Vicodin and OxyContin, should be reserved as a last resort.

The new findings support those guidelines, according to Sun’s team.

The results are based on insurance records from nearly 89,000 Americans who were diagnosed with pain affecting the lower back, knee, shoulder or neck.

All of the patients had a second doctor visit within a month of the diagnosis, and an opioid prescription within 90 days. So the group included only people with significant pain, the researchers said.

Overall, 29 percent of the patients started physical therapy within 90 days of being diagnosed. Compared with those who did not have physical therapy, the therapy patients were 7 percent to 16 percent less likely to fill an opioid prescription — depending on the type of pain they had.

And when physical therapy patients did use opioids, they tended to use a little less — about 10 percent less, on average, the researchers found.

The findings do not prove that physical therapy directly prevented some opioid use.

Sun explained that, “since physical therapy is more work than simply taking an opioid, patients who are willing to try physical therapy may be patients who are more motivated in general to reduce opioid use.”

But his team did account for some other factors — such as a patient’s age and any chronic medical conditions. And physical therapy was still linked to less opioid use.

While this study focused on physical therapy, Danesh said, there are other opioid alternatives with evidence to support them.

Depending on the cause of the pain, he said, people may find relief from acupuncture; exercises to strengthen particular muscle groups; injections of anti-inflammatory steroids or other medications; platelet-rich plasma — where a patient’s own platelets (a type of blood cell) are injected into an injured tendon or cartilage; and nerve ablation, where precisely controlled heat is used to temporarily disable nerves causing the pain.

It’s also possible that some simple lifestyle adjustments will help, Danesh pointed out. An old worn-out mattress could be part of your back pain woes, for instance. Ill-fitting, non-supportive or worn shoes could be feeding your knee pain.

What’s important, Danesh said, is to get at the underlying issues.

“We have to match patients with the right treatment for them,” he said.

More information

The U.S. National Center for Complementary and Integrative Health has more on managing pain.

SOURCES: Eric Sun, M.D., Ph.D., assistant professor, anesthesiology, perioperative and pain medicine, Stanford University School of Medicine, Stanford, Calif.; Houman Danesh, M.D., assistant professor, anesthesiology, perioperative and pain medicine, and director, division of integrative pain management, Mount Sinai Hospital, New York City; Dec. 14, 2018, JAMA Network Open, online

Nerve Zap Might Ease Pain of Herniated Disk

Nerve Zap Might Ease Pain of Herniated Disk

TUESDAY, Nov. 27, 2018 (HealthDay News) –What if a simple zap to the spine could relieve the debilitating lower back and leg pain brought on by a herniated disk?

Such is the promise of “pulse radiofrequency” therapy (pRF), which sends inflammation-reducing pulses of energy to nerve roots in the spine, a new study claims.

The therapy is not new, having first received U.S. Food and Drug Administration approval in the 1980s.

But recent advances in CT scan technology now enable clinicians to deploy those energy pulses with much more accuracy, experts said. And the new research suggests the treatment could prove a boon to back pain patients for whom standard therapies have failed to do the trick.

“I was amazed with the results of pRF,” said study author Dr. Alessandro Napoli. “Especially having read, as a radiologist, numerous lumbar MRI scans of patients with recurrent hernia after surgery.”

And as a patient himself, Napoli added that “from personal experience I can tell you that the treatment is not painful, and the results are appreciated within days after a single treatment lasting 10 minutes.”

Napoli is a professor of interventional radiology at Sapienza University of Rome in Italy.

He and his colleagues plan to report their findings Tuesday at the Radiological Society of North America annual meeting, in Chicago. Such research is considered preliminary until published in a peer-reviewed journal.

Lower disk herniation results when the insulating disks that sit between spinal vertebrae tear open, allowing jelly-like material to protrude and exert pressure on surrounding nerve roots. Beyond lower back pain, the condition often triggers sciatica, a pain that radiates down a patient’s leg.

Standard therapies include over-the-counter pain meds, corticosteroid spinal injections, and/or invasive spine surgery that sometimes involves disk removal and vertebrae fusion.

The problem, said Napoli, is that such options entail risks without assured relief.

“Steroid injections are effective only in portion of the patients, and generally require more sessions,” he noted. And though surgery safety has “largely improved,” Napoli pointed to the risk for bleeding and infection, the need for a minimum two- to three-day hospital stay, the high cost, and the fact that some patients ultimately realize little benefit.

By contrast, pRF is scalpel-free, delivering radio signals directly to affected nerves via a CT scan-guided electrode. The process, said Napoli, requires no hospital stay, is noninvasive, far cheaper and less risky.

“The rationale for using pRF on disk herniation is that we eliminate the inflammation process of the compromised nerve root,” he explained. “Without inflammation the pain fades, and the body starts a self-healing process that allows for complete resolution of the disk herniation in a large proportion of patients.”

For the study, the Italian investigators compared 128 lumbar herniation patients who underwent a single 10-minute round of CT-guided pRF with 120 patients who received one to three rounds of steroid injections.

All the patients had already undergone standard interventions, with poor results.

By the one-year mark following either treatment, a full “perceived” recovery was reported by 95 percent of the pRF patients, compared with just 61 percent of the steroid injection patients.

Dr. Daniel Park, director of minimally invasive orthopedic spine surgery at William Beaumont Hospital in Royal Oak, Mich., offered some caution on the findings.

He noted that because “the majority of people with back pain improve with time and exercise alone,” it remains an open question as to whether the pRF procedure really cured the condition.

Still, Park noted that diagnostic uncertainty can undermine the ability of surgery to get at the true source of a patient’s pain, given that “the problem with low back pain is that there are many causes of it, and physicians have trouble identifying the cause of pain.”

Nevertheless, he remains unsure if pRF is truly ready for prime time.

“Best case, I think [pRF] could be an option for people if they [have already] failed therapy and medication,” said Park. “It may be a similar option for people if they do not or cannot have steroid injections, but they need more treatment. I think this is experimental, and should not be first-line.”

More information

The American Academy of Orthopaedic Surgeons offers more information on herniated disks.

SOURCES: Alessandro Napoli, M.D., Ph.D., interventional radiologist and professor, interventional radiology, department of radiological, oncological and pathological science, Sapienza University of Rome, Italy; Daniel Park, M.D., orthopedic spine surgeon, associate professor, orthopedic spine surgery, and director, Minimally Invasive Orthopedic Spine Surgery, William Beaumont Hospital, Royal Oak, Mich.; Nov. 27, 2018, Radiological Society of North America annual meeting, Chicago

Copyright ©2017 HealthDay. All rights reserved.
Healthful Diet = Healthy Bones

Healthful Diet = Healthy Bones

MONDAY, Nov. 19, 2018 (HealthDay News) — Trying to eat a healthier diet? Don’t forget that certain foods can help protect your bones, a nutrition expert says.

“Bone disease is often preventable by getting enough calcium and vitamin D into your diet,” said Kathryn Weatherford, a registered dietitian at Beth Israel Deaconess Medical Center in Boston.

“By eating the right combination of calcium- and vitamin D-rich foods, we can boost our immune system and protect our bones,” she said. “Many foods are now fortified in calcium and vitamin D, making it easier to meet our daily recommended intake.”

Start your day with a calcium-fortified cereal that is high in fiber (more than 3 grams) and low in sugar. Whole grain cereal with a cup of milk adds up to 600 milligrams (mg) of calcium.

Fatty fish is also an excellent source of vitamin D. A 3-ounce portion of wild salmon provides more than 100 percent of daily value of vitamin D, according to Weatherford.

Eat a variety of dark, leafy greens such as spinach, kale, Swiss chard and bok choy, she added.

An 8-ounce serving of yogurt provides 400 mg of calcium. Choose non-fat yogurt or Greek yogurt, which provides additional protein.

Another suggestion is milk alternatives. Whether it is almond, soy, cashew or hemp milk, almost all milk alternatives are fortified with both vitamin D and calcium. For example, almond milk provides up to 45 percent of daily value of calcium and 25 percent of daily value of vitamin D, Weatherford said.

Your body also produces vitamin D when exposed to sunlight. Just 10 to 15 minutes of sunshine a day can produce enough vitamin D.

It’s important to monitor how much calcium and vitamin D you consume each day. If you suspect you’re not getting enough, talk to your doctor or dietitian, Weatherford suggested.

“It’s good to know if you’re vitamin D-deficient so you can take steps to fix the problem and keep building strong bones,” Weatherford said.

More information

The U.S. National Library of Medicine has more on vitamin D.

SOURCE: Beth Israel Deaconess Medical Center, news release, Nov. 6, 2018

Copyright ©2017 HealthDay. All rights reserved.
Health Tip: Warning Signs of Carpal Tunnel Syndrome

Health Tip: Warning Signs of Carpal Tunnel Syndrome

Carpal tunnel syndrome occurs when the nerve that runs from the forearm to the wrist becomes squeezed or compressed.

The condition can be caused by an injury to the wrist, stress to the joint, rheumatoid arthritis, or repetitive motion of the hand and wrist.

Here are some common symptoms of carpal tunnel syndrome, courtesy of the U.S. National Institute of Neurological Disorders and Stroke:

  • Numbness, burning, or tingling sensations in the fingers and/or palms of the hands.
  • Having these sensations at night, with symptoms increasing in severity and frequency.
  • Fingers feeling weak or swollen, even with no visible swelling.
  • Weak grip.
  • Difficulty perceiving hot and cold.
Copyright ©2017 HealthDay. All rights reserved.
An Expert’s Guide to Avoiding Back Pain

An Expert’s Guide to Avoiding Back Pain

THURSDAY, Oct. 25, 2018 (HealthDay News) — Back pain is a common problem in the United States, but there are ways to protect yourself, an expert says.

“The back is a complex structure with many delicate parts, but with good judgment and healthy lifestyle habits — including proper lifting, good posture and exercise — it’s possible to avoid common back pain caused by strained muscles,” said Dr. Lawrence Lenke. He is director of spinal deformity surgery at the Spine Hospital at New York-Presbyterian in New York City.

For more complicated spinal problems such as scoliosis, stenosis, fractures or injuries, medical intervention is usually necessary, Lenke said.

“But each person with or without spinal problems can benefit from adopting healthier lifestyle habits to keep your spine as strong as possible,” he said.

Lenke offered this advice:

  • Maintain a healthy weight, don’t smoke, do stretching and strengthening exercises that increase back and abdomen flexibility, and get regular cardiovascular exercise. If your job involves a lot of sitting, get up and walk around every 15 to 30 minutes.
  • Maintain good posture even while sitting. Don’t slouch or hold your head too far forward. Be sure your feet are supported, hips are level with or slightly above the knees and your spine is slightly reclined. There should be a small arch in the lower back.
  • When sitting at a computer, your shoulders should be relaxed and away from the ears. Your elbows should be at the sides, bent to about 90 degrees, and your wrists should be neutral — not bent up, down or away from each other. Your head should face ahead without being too far forward.
  • When using a mobile device for non-voice activities, hold it up instead of bending your neck to look down. At just 45 degrees, the work your neck muscles are doing is equal to lifting a 50-pound bag of potatoes.
  • When lifting, make sure objects are properly balanced and packed correctly so weight won’t shift. Keep the weight close to your body. And take your time. Bend at the hips and knees and use your legs to lift. Maintain proper posture with your back straight and head up.

More information

The U.S. Office of Disease Prevention and Health Promotion has more on preventing back pain.

SOURCE: New York-Presbyterian Hospital, news release, Oct. 16, 2018

Brisk Walks May Help, Not Harm, Arthritic Knees

Brisk Walks May Help, Not Harm, Arthritic Knees

If you suffer from knee arthritis and worry that walking will only worsen your damaged joint, a new study suggests you put your fears aside, slip on some sneakers, and take a brief but brisk walk.

The researchers estimated that if older adults with the condition added just 5 minutes of brisk walking to their day, their odds of needing knee replacement surgery could dip by 16 percent.

On the other hand, light walking — akin to a “stroll” — may have no impact, said lead researcher Hiral Master, a Ph.D. candidate in biomechanics and movement sciences at the University of Delaware.

Her team reached those conclusions by digging into data from over 1,800 older adults with knee arthritis who wore portable devices that tracked their walking intensities for at least four days.

Over the next five years, 6 percent of the participants had total knee replacement surgery.

The researchers used the data on people’s walking habits to examine the effects of replacing “non-walking” time with time spent walking at different intensities. The findings showed that substituting just 5 minutes of down time with moderate-to-high intensity walking was linked to a 16 percent decline in the odds of needing knee replacement surgery.

The study authors defined “moderate-to-high” intensity as more than 100 steps per minute. In laymen’s terms, Master said, that’s a “brisk” walk that gets your heart rate up — not a stroll around the block.

The findings were presented Saturday at the American College of Rheumatology’s annual meeting, in Chicago. Such research should be considered preliminary until published in a peer-reviewed journal.

Knee osteoarthritis develops when the cartilage cushioning the joint gradually breaks down, which can eventually result in bone scraping on bone.

The condition is common among middle-aged and older Americans. According to the Arthritis Foundation, up to 13.5 percent of men and 19 percent of women aged 45 and older have knee arthritis that’s severe enough to cause pain and other symptoms.

And those patients often wonder whether walking is good or bad for their arthritic joints, said Dr. Paul Sufka, a rheumatologist at the University of Minnesota, in Minneapolis.

“They often ask whether they should minimize their activity, keep doing what they’re doing, or intensify,” said Sufka, who is also with the American College of Rheumatology’s communications committee.

“The general advice we give to patients is to stay active,” Sufka said. But, he added, the truth is there is too little evidence to give patients definitive recommendations.

The new findings do not prove that brisk walking directly lowers the risk of needing knee replacement surgery, Sufka noted.

But, “this gives us some useful information to bring to the discussion,” he added.

Overall, Sufka said, research does suggest it’s better for people with knee arthritis to be active rather than sedentary. And that’s not just for the sake of their knees. Physical activity has a range of health benefits, including lower risks of heart attack and stroke.

Master agreed, and pointed out that exercise can help arthritis patients’ mental well-being, as well as physical.

And it doesn’t take a huge lifestyle change, she explained. The new findings suggest people can benefit from adding a short, brisk walk to their day.

In fact, Sufka said, such incremental shifts may be best.

“The best exercise program is the one you can actually stick with,” he said. “If right now, you’re walking around the block every day, what would be 5 percent or 10 percent more than that? You can gradually build from where you are.”

And what if walking is painful? That’s a tricky question, Sufka acknowledged. Some patients might benefit from physical therapy rather than only exercising on their own, he said.

Beyond aerobic exercise like walking, strengthening exercises for the leg muscles supporting the knees can also be helpful, he suggested.

More information

The Arthritis Foundation has an overview on knee arthritis.

SOURCES: Hiral Master, P.T., M.P.H., Ph.D. candidate, biomechanics and movement sciences, University of Delaware, Newark, Del.; Paul Sufka, M.D., assistant residency director, internal medicine residency program, University of Minnesota, Minneapolis, and member, communications and marketing committee, American College of Rheumatology; Oct. 20, 2018 presentation, American College of Rheumatology annual meeting, Chicago