Friday, 27 September 2013

Does osteoarthritis cause pain? Maybe, but only if you know about it!

The dreaded arthritis! From my experience of talking to patients I think this is one of the conditions that people fear the most. Being told you have arthritis can seem like the end, that’s it, you can’t exercise again and you can’t enjoy the things you previously enjoyed. You have to accept the gradual deterioration of your joints and the gradual reduction in mobility and the gradual increase in pain. Being told you have arthritis can seem like a massive blow!

What’s interesting about osteoarthritis is that it takes a long time to develop, years in fact. It doesn't occur over the space of days, weeks or even months, but often the pain that gets associated with it does. You would have thought that if arthritis was the cause of the pain, then you would get a gradual steady increase in pain over the years at whichever joint was affected as it gradually deteriorates. This isn't the case. Quite often what happens is someone develops pain, goes to see their doctor, has an x-ray, the x-ray finds some degenerative changes in the joints in that area and the pain gets attributed to the degeneration. The person then stops doing as much, as they think this will cause more damage. Often this makes the pain worse, as the joint isn't being moved as much and the nervous system becomes more protective of that area.

I want to use the example of a patient I once saw, where this was the case. This gentleman had pain in the area around his hips. He had this pain for a few months so his GP sent him for an x-ray of his back and his hips. The x-ray found no degenerative changes in his hip joints but that he did have mild degenerative changes in his lower back. Interestingly, not long after this his hip pain settled down but he developed pain in his lower back. I asked him what he did once he was told he had arthritis in his back and he said ‘he stopped doing exercise as he thought it might be damaging for his lower back’. I think the pain he developed was caused by the nervous system perceiving that the lower back needed protecting more and by not doing certain movements this protective pain mechanism was maintained by the nervous system. It was only once he knew he had arthritis that he began to get pain in his back. Once he understood that it was OK to exercise and that the arthritis is a naturally occurring development that happens to all of us and is actually incidental to his pain, he began to exercise again, he began to enjoy exercising and his pain improved dramatically!

In a study by Kalichman et al. (2008) they found that there was a high prevalence of osteoarthritis (OA) in the facet joints in the lower back, in a community population. They also found that there was no association between the OA and pain.  Follow this link to read the article:

I think the important thing to remember here is that arthritis doesn't spell impending doom! Particularly mild to moderate OA, you can still do exercise. Also, the pain that may have been attributed to arthritis may have been caused by something else, probably the nervous or muscular system. So don’t panic, if you have just been diagnosed with arthritis, life isn't over! 

1 comment:

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