Every few years various countries update their osteoarthritis treatment guidelines to keep their Doctors up to date with the latest research. It is an impossible task for GPs to read all the research on all the conditions they see in practice but surely they should always read the guidelines put out by their governing bodies and adhere to them?
This article in the Pulse summarising osteoarthritis treatment guidelines is the best I have read in a long time. It is written by Dr Jens Foell is GP and NIHR Clinical Lecturer in the department of Primary Care and Public Health at Queen Mary University of London and specialises in musculoskeletal medicine. All I can say is I wish she was my GP as she has a really sensible all encompassing knowledge of how best to treat osteoarthritis!
I highly recommend you read the whole thing as she discusses all of the following:
- Current standard treatment
- What’s newly available
- What’s fallen out of fashion and why
- Special/atypical cases and their treatment
- Non-drug options and their evidence base
Are the Osteoarthritis Treatment Guidelines Being Followed?
Dr Foell is obviously up to date but from my experience I suspect many of her GP colleagues are not. In her article she talks about the risks from various drugs saying:
Oral NSAIDs, apart from naproxen, are rarely prescribed as regular high doses of ibuprofen and diclofenac affect the stomach and kidneys, and have adverse effects on blood pressure. As such, there have been specific concerns about the negative cardiovascular effects of diclofenac.
Paracetamol alone, and in combination with ibuprofen, is linked to gastrointestinal side effects and a reduction in haemoglobin. This led NICE to include a recommendation of not using paracetamol in the consultation draft of the updated guideline, but opposition from professional groups in the musculoskeletal field led to a U-turn in this matter. The main argument for sticking to the recommendation of using paracetamol is the fact that the potential alternative – using stronger analgesics – is even more harmful.
Viscosupplementation has been appraised as inferior to steroid injections, but needing less therapist time for injection therapy. There is also very little information about its use in community settings.
Long-term opioid therapy has considerable side-effects such as constipation, endocrinological dysfunction, cognitive dysfunction and addiction. This may also occur with higher doses of commonly used weaker opioids, such as codeine-based compound preparations or tramadol.
She has this under the fallen out of fashion subtitle. My only comment is “Oh I wish this were the case!”
Each week I speak to people who are struggling with the side effects of long term use of these drugs.Their GPs are still prescribing them but now with other drugs to counteract the effect of these side effects!
I think the one that has shocked me most is a gentleman who was prescribed tramadol. He has been taking up to 8 of these a day on repeat prescription when he should have only been taking 2 maximum. Tramadol are an opioid and so are highly addictive. He is now trying to wean himself off but has suffered really bad withdrawal symptoms. How could his Doctor have not checked how many pills his patient was getting through?
All I know is that people contact me week in and week out. They are still getting drug regimes of paracetamol, ibuprofen and diclofenac and NO exercises!
The Evidence for Exercises if Overwhelming
Dr. Gabe Mirkin writes for the Epoch Times. He writes on a wide range of health topics promoting a balanced lifestyle. In a recent article he talks about how you should treat osteoarthritis with exercise.
He explains you need to do physical therapy type exercises and quotes a recent study which shows
One year of exercise therapy decreased pain and increased range-of-motion and function of the involved joints, and the improvements in joint function were even greater at two years.
I believe therein lies the problem:
YOU HAVE TO KEEP DOING YOUR EXERCISES!
Most of my clients start to get some pain relief after the first week as in my course you start by learning to massage and that helps. However the next month or so will be very up and down as the joint starts to move again. Then thing settle and after a couple of months they really feel the benefit. They start living life again and they stop doing their exercises. Why? Because it doesn’t hurt so much. Then when the pain comes back they either have to start all over again or they say well exercises didn’t cure me!
No that is because there is NO CURE for osteoarthritis!
I have done exercises for 25 years now. Does it work? Well I was diagnosed with OA in my neck and low back aged 28 and I am 53 next month and I just went out and pulled a bale of hay from the barn, carried to the trailer and went and fed my horses without a thought or a twinge! I don’t consider 20 minutes 3 times a week a high price to pay.
So I guess that’s why Doctors don’t follow osteoarthritis treatment guidelines and prescribe exercises. They know most of their patients would rather pop a pill than take responsibility and do the work necessary.
However if you are not one of those patients and you want to try and help yourself you can get my self massage and exercise programme here.