Overweight and obese people with knee arthritis tend to report more pain than slimmer people with the same degree of joint damage

Past studies have found that heavier people, especially women, are more likely to develop osteoarthritis and often have more severe osteoarthritis (OA). This study goes a step further. It suggests that people with a higher body mass index (BMI) may have more pain than normal-weight people with the same amount of arthritis-related damage.

Overall, 1,390 participants had already been diagnosed with knee osteoarthritis, 3,284 did not have the disease but were at risk of developing it, and 122 did not have osteoarthritis or related risk factors.

Weiss analyzed X-rays to determine the severity of patients' arthritis and used the health records to gather information on their BMI and pain levels during everyday activities.

She found that patients with a higher BMI reported more pain, even after adjusting for the severity of their joint damage. For each category of arthritis severity, pain scores were substantially higher among obese patients than among normal-weight patients. Scores for overweight patients fell somewhere in the middle.

Even though osteoarthritis is a progressive disease and its effects are irreversible, losing weight should help reduce pain related to the condition, Weiss wrote online June 17 in Rheumatology.

Losing weight could jump-start a healthy cycle, Weiss said: a decrease in body weight could lessen pain, which in turn might make people more likely to take on more physical activity, resulting in even more weight loss.

It might be difficult for a person who is already experiencing a high level of pain to become active in order to lose weight, however. Weiss suggested trying to lose the weight before starting exercise.

"It is easier to lose weight through dietary changes than through exercise. Small changes can sometimes make big differences," she said. "For example, drinking water rather than cola or finding ways to increase activity that will become a habit, like parking further from the store entrance or taking stairs instead of an elevator."

SOURCE: http://bit.ly/1mK8QcO

Rheumatology 2014.

Knee Osteoarthritis (OA): Daily Walking Maintains Function

Patients with knee OA can gain significant benefits and avoid physical function limitations by simply walking more.

"As clinicians, we should be promoting walking in our patients with knee OA. We should have them measure their physical activity with a pedometer, much like people measure their weight with a scale. Those starting on a walking program should get to a target of at least 3000 steps/day and ultimately try to reach 6000 steps/day. This is well below the popular anecdote of 10,000 steps/day, which may be good news to those starting out. It doesn't take much to get to 3000 steps/day," Dr. White told Medscape Medical News. He is research assistant professor, Department of Physical Therapy & Athletic Training, Boston University College of Health and Rehabilitation Sciences, Massachusetts.

Long-Term Study Documents Benefits of Walking in Patients With Knee OA

The researchers measured daily steps taken by 1788 people with or at risk for knee OA who were part of the Multicenter Osteoarthritis (MOST) Study, a large multicenter longitudinal cohort study of community-dwelling adults. Mean age was 67 years, mean body mass index (BMI) was 31 kg/m², and 60% of participants were female.

The researchers measured the number of steps patients walked with an ankle monitor over 7 days. They measured functional limitation at baseline and again 2 years later. The researchers defined functional limitation as walking speed less than1.0 m/s 

The authors reported, "Among study participants who did not develop slow walking at the two-year follow-up (<1.0 m/s), 80% walked at least 5300 steps/day." The minimum for preventing functional decline was between 3250 and 3700 steps/day. Walking an additional 1000 steps each day was associated with a 16% to 18% reduction in incident functional limitation 2 years later.

"Our findings add to the idea that walking is good for people with knee OA. Specifically, walking that occurs during unstructured activities, a few steps here and there, add up and do seem to make a difference in terms of prevention of functional limitation in this patient population. I hope that these findings will lead to clinicians encouraging their patients to use a pedometer to measure their physical activity and work towards the 3000 then 6000 steps/day goal," Dr. White said.

 Physical activity stimulates the expression of lubricin, a lubricant molecule of synovial fluid that is important for cartilage growth and that contributes to the delay of OA development.

More Walking Might Reduce Healthcare Costs Associated With Knee OA

According to Dr. White, data from the National Health and Nutrition Examination Survey showed that 80% of patients with OA have some limitation in movement and that 11% of adults with knee OA need assistance with personal care.

"Our findings strongly suggest that walking does work to prevent the onset of problems with physical functioning in the future in people with knee osteoarthritis," Dr. White said.

Arthritis Care Res. Published online June 12, 2014. Abstract

Treatments for Chronic Low Back Pain

An Update of the Cochrane Review

Luis Enrique Chaparro, MD, Andrea D. Furlan, MD, PhD, Amol Deshpande, MD, Angela Mailis-Gagnon, MD, MSc, FRCPC, Steven Atlas, MD, Dennis C. Turk, PhD

Disclosures

Spine. 2014;39(7):556-563. 

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• Abstract and Introduction
• Materials and Methods
• Results
• Discussion
• Conclusions

• References
• Key Points

Abstract and Introduction

Abstract

Study Design. Systematic review and meta-analysis.

Objective. To assess the efficacy of opioids in adults with chronic low back pain (CLBP).

Summary of Background Data. Opioids for CLBP has increased dramatically. However, the benefits and risks remain unclear.

Methods. We updated a 2007 Cochrane Review through October 2012 of randomized controlled trials from multiple databases. Use of noninjectable opioids in CLBP for at least 4 weeks was compared with placebo or other treatments; comparisons with different opioids were excluded. Outcomes included pain and function using standardized mean difference (SMD) or risk ratios with 95% confidence intervals (CIs), and absolute risk difference with 95% CI for adverse effects. Study quality was evaluated using Grading of Recommendations Assessment, Development, and Evaluation criteria.

Results. Fifteen trials (5540 participants), including twelve new, met the criteria. Tramadol was better than placebo for pain (SMD, −0.55; 95% CI, −0.66 to −0.44) and function (SMD, −0.18; 95% CI, −0.29 to −0.07). Compared with placebo, transdermal buprenorphine decreased pain (SMD, −2.47; 95% CI, −2.69 to −2.25), but not function (SMD, −0.14; 95% CI, −0.53 to 0.25). Strong opioids (morphine, hydromorphone, oxycodone, oxymorphone, and tapentadol), were better than placebo for pain (SMD, −0.43; 95% CI, −0.52 to −0.33) and function (SMD, −0.26; 95% CI, −0.37 to −0.15). One trial demonstrated little difference with tramadol compared with celecoxib for pain relief. Two trials (272 participants) found no difference between opioids and antidepressants for pain or function. Reviewed trials had low to moderate quality, high drop-out rates, short duration, and limited interpretability of functional improvement. No serious adverse effects, risks (addiction or overdose), or complications (sleep apnea, opioid-induced hyperalgesia, hypogonadism) were reported.

Conclusion. There is evidence of short-term efficacy (moderate for pain and small for function) of opioids to treat CLBP compared with placebo. The effectiveness and safety of long-term opioid therapy for treatment of CLBP remains unproven.

Level of Evidence: 1

Does Eye Colour Predict Response to Pain?

The colour of  our eyes may predict our response to pain

Pain is known to be linked to many factors including gender; age; hair colour and so on and is likely to be governed genetically. For instance having red hair can mean an increased resistance to anaesthetics and and increased propensity to anxiety.

A recent study looking at pre and post partum women wanted to see if eye colour had a link to how these subjects responded to pain. The subjects included 24 dark eyed ( brown and hazel) people and 34 light eyed individuals(blue and green).

Those with dark eyes had increased levels of anxiety; sleep disturbance; pain  on rest and with movement and an increased likelihood of depression.

This indicates a genetic control the molecular physiology of pain.

American Pain Society 33rd Annual Meeting

Chiropody and Podiatry at the Physio Therapy Centre, Haywards Heath

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CHIROPODY & PODIATRY

When your feet hurt you hurt all over.

Our Foot Specialist takes great pride in the quality of professional advice and treatment you receive. Our aim is to ensure total foot health for you and your family through preventative, routine and corrective treatments.

As well as offering traditional Chiropody care of nail and skin conditions we also offer specialised services to treat foot Pain including Heel/Arch/ Ball of Foot Problems, Arthritic/Diabetic Problems, Foot & Ankle Disorders and Sports Injuries.

SKIN AND NAIL CONDITIONS

We treat problem nails (including painful, ingrown, thick and discoloured nails), corns and callus, verruca pedis and plantar warts (by herbal, chemical and freezing therapy), cracked heels, athletes foot, blisters and sweaty feet. We also offer diabetic foot assessments and advice. In addition we offer vascular and neurological assessments of the feet in relation to medical complications when indicated. Advice and education will always be offered to prevent reoccurrence of any of the above problems.

HEEL, ARCH /BALL OF FOOT & TOE PAIN

We specialise in treating the following conditions by diagnosing the problem, identifying the cause and prescribing corrective treatments including special shoe inserts called orthotics and shoe recommendations: Heel spurs/ Plantar Fasciitis (pain on the sole of your heel often worse in the morning), Metatarsalgia (generalised pain in the ball of the foot), Morton’s Neuroma (nerve entrapment causing pain in the ball of the foot extending into the toes), Bursitis & capsulitis (inflammatory conditions where pain is felt in one or more of the metatarsal heads), sore ankles, Achilles tendonitis, heel bumps, shin splints, arthritic joint pain (pain in the toe joints when walking and or pain on the top of the foot), Bunion problems (where a swelling of the bone and stretching of the tendons occur on the big toe joint causing pain when wearing shoes and walking).

GAIT ANALYSIS & BIOMECHANICAL EXAMINATION

If you have heel/arch pain, corns and callus, inflammatory conditions such as tendonitis or bursitis, joint problems or a sporting injury Biomechanics is the key to discovering why you are suffering these symptoms. By examining the complex movements of your foot joints and the relationship between your pelvis, thigh, hip, knee and leg, abnormality and compensatory problems can be identified and appropriate treatment or referral can be initiated. Podiatry Treatment can include the use of prefabricated insoles or bespoke prescription foot supports as well as a stretching and strengthening regimen.

FOOT ORTHOTICS /ARCH SUPPORTS & APPLIANCES

Orthotics – What are they? Also known as arch supports/ appliances etc they are fully custom made comfort devices made to your exact prescription that readily fit into regular shoes. State of the art, lightweight materials such as carbon graphite and thermoplastics may be used in their construction.

Orthotics – How do they help? They support weakened structures of the feet, deflect pressure from painful areas of the feet, re-align the feet and ankles. This therapy results in an improved posture – beneficial to so many leg and foot problems.

Orthotics – Are they for me? A biomechanical exam and gait analysis is always required before orthotic therapy is prescribed.

Arthritis sufferers listen to professional advice related to exercise and how it helps them

It was found that there is an association between health care providers' recommendations for physical activity and adherence to physical activity guidelines among adults aged 45 or older who had arthritis. This was less in those with other health problems and were overweight.

Subjects who received providers' recommendations were more likely to adhere to physical activity guidelines than those who did not. The rationale for why people follow providers' recommendations for physical activity can be explained by Parsons' traditional sick role perspective, which states that people respond to pain, discomfort, and overall sense of well-being. They consult health care providers when symptoms interfere with their ability to function in their daily activities and seek providers' care and cooperate with them in the process of recovery. The difference in knowledge between the health care providers and patients justifies both the providers' assumption of authority and the patients' trust, confidence, and norm of obedience. Hence, with the debilitating pain that interferes with their daily functions, people with arthritis are more likely to adhere to physical activity guidelines when they receive providers' recommendations.

It is recommended to take 30 minutes of low- to moderate-level physical activity 5 days per week for people with all forms of arthritis.  The low adherence to physical activity among people with arthritis can be addressed with providers' recommendations in clinical settings.

Providers may ask patients about their engagement in physical activity and advise them about the benefits of physical activity during their visits. Providers can assess patients' readiness to engage in physical activity and develop strategies to facilitate patients' physical activity engagement. Furthermore, providers may assist patients in planning and including physical activity in their daily schedule. Finally, in every subsequent visit, providers may follow up on patients' adherence to physical activity.

These results indicate that health care providers should be aware of the effect of their recommendations on patients' adherence to physical activity guidelines and should promote physical activity engagement in clinical settings. Future research should focus on the influence of race/ethnicity on the association between providers' recommendations and adherence to physical activity guidelines among people with arthritis and strategies to promote physical activity, especially in minority populations.

Shamly Austin, PhD, Haiyan Qu, PhD, Richard M. Shewchuk, PhD

Preventative Chronic Diseases. 2013;10 

Risks of running in minimalist shoes

Advocates of trendy "minimalist" running shoes promise a more natural experience, but runners in a new study reported higher rates of injury and pain with the less structured shoes.

Three months after switching from traditional running shoes to the minimalist variety, study participants had two to three times as many injuries compared to runners who stuck with traditional shoes.

Be aware of the risks of running in minimalist running shoes. If you are going to go running in these shoes break them in over many weeks; say at least 6. Walk around in them for 6 weeks; don't attempt to run and then slowly build up the distance. This is likely to reduce the risk of injury initially and improve the quality of running form and reduce injuries in the long term. Ideally get expert advice to learn proper running form.

SOURCE: http://bit.ly/1eum9M5

Br J Sports Med 2013.