Ronald Reagan once remarked during a CBS news interview that, "Life not only begins at 40, so does lumbago and the tendency to tell the same stories over and over again."
Lumbago, now an outdated term, refers to that nagging, chronic low back pain so many of us have experienced.Most lumbago is a combination of over-used muscles, tendons, nerves, ligaments and joints.
Osteoarthritis, what I tend to refer to as "worn-out joints," is one of the most common problems I treat. It affects hips, knees, hands and backs mostly, although it can beat up just about any joint. Some of my patients refer to it as "Arthur," which I've always thought might offend persons who are called by that name.
It is important to distinguish regular arthritis from other less common joint diseases.Gout pain is a phenomenon usually occurring in the big toe. It results from a build-up of uric acid crystals in the joint space. The immune system detects these joint crystals and attacks them, and the otherwise healthy joint is wounded as an unlucky bystander.
If you have ever had a severe cold or the flu, you may have experienced joint pain brought on by the virus itself.These fairly common illnesses only last a few days but can make you miserable.
Rheumatoid Arthritis, also known as Rheumatism or RA, is classified as an autoimmune, inflammatory arthritis. In RA, the body's immune system attacks the joints, producing a swollen and sometimes red joint. There are a number of these autoimmune malefactors that can make us miserable. You may have heard of lupus and polymyalgia rheumatica, a big word that means your hips and shoulders hurt, especially when you get out of a chair. Although these kinds of arthritis are serious diseases, their incidence is only a fraction of that of run of the mill arthritis.
This article's concern is the most common arthritis, osteoarthritis. Risk factors include age, gender (occurs more frequently in women), obesity, genetics and past trauma. The story's villain is an enzyme (a little molecule that causes other tissues to fall apart) that breaks down joint cartilage, the cushion attached to the ends of our bones.Although the medical community has invested a large amount of research dollars in arthritis, we have not yet found a way to control this particular enzyme and prevent osteoarthritis.
If you go to your physician for help with arthritis, you probably will receive only a brief physical exam as diagnosis. The clinician will be assessing joint mobility, swelling, warmth, symmetry and deformity. X-rays and lab tests are typically not helpful. In fact, many of the tests available to detect an autoimmune cause of joint pain are often falsely negative, resulting in extra tests, unnecessary referrals and anxiety, all of which cost a lot of time and money.
Fortunately, there are a number of ways to alleviate joint pain. Always wanting to start with the least invasive options, physicians generally recommend Tylenol, exercise and weight loss as first-line treatment.
A 2007 study showed that a modest 5 percent weight loss results in significantly lower pain scores and increased joint function. Non-weight bearing exercises, such as riding a recumbent bike and swimming, also increase mobility and improve pain scores. Acupuncture may provide some benefit as well, although it has not yet been proven. Bracing or splinting joints can be helpful, but because it is only effective in the most severe cases, I rarely utilize that method of treatment. Therapeutic ultrasound has not proven to be effective.
Tylenol is just as effective as Advil and is safer. Advil, Naprosyn and Aleve, which are in a class of pain relievers called Non-Steroidal Anti-Inflammatories (NSAIDS), can cause stomach ulcers, hypertension, and kidney failure. One NSAID, Celebrex, is somewhat safer from a stomach standpoint but may still cause heart problems. Glucosamine at 1,500 mg a day is just as effective as these other oral treatments.
Topical creams and gels that contain anti-inflammatory medications work well for some patients. Aspercream, which is available over the counter, and Voltaren gel, a prescription, are two examples. I prescribe them often.
More invasive treatments include injections and joint replacements. Because steroid injections provide quick and significant relief, I regularly inject my patients" arthritic knees and shoulders. An injection typically provides 4-8 weeks of relief, but I perform knee injections no more than four times a year on any one person. The procedure is simple and safe, with only a very slight risk of bleeding and infection.
Orthopedic surgeons inject knees with a synthetic form of hyaluronic acid (Synvisc, Orthovisc, and Hyalgan), one of the main components of joint fluid. For this reason, it is referred to as "viscosupplementation." This treatment does not have as quick a response as steroids, but it provides longer-lasting relief. These treatments cost two to three times as much as steroid injections.
Joint replacement surgery performed by an experienced surgeon is a great option for people who have not had success with less-invasive treatments. Some of the new hardware allows the surgeon to shave off less bone, creating a better chance for long-term success. We expect a knee replacement to last 15-20 years. The key to success is the patient working very hard during the six weeks after surgery. Taking advantage of this rehabilitation window is the difference between a so-so result and a really great outcome.
Maybe your "lumbago" will decide to leave you alone this winter. If not, hopefully, you can get some relief from what I mentioned in this article.