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Pain, Pain, Go Away!

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Pain, Pain, Go Away!

What the doctors aren’t telling you.
Vijay  Vad M.D.
Vijay Vad M.D. More by this author
Jun 14, 2010 at 10:00 AM

As a doctor specializing in sports medicine, I see plenty of highly active people suffering from arthritis—from young professional athletes who push their bodies too hard to weekend warriors who haven’t realized that their middle-aged frame isn’t what it used to be. But many of my patients are ordinary folks who suffer from garden variety osteoarthritis, the most common form of the disease. They’re afraid of taking prescription painkillers or, worse, having to have surgery to heal their condition.

I begin by calming them down and telling them we have better alternatives now. One 57-year-old woman with arthritis of the thumb, for example, had trouble doing the simplest things, like gardening or buttoning a blouse. I started her off on a regimen of gentle hand stretches and nutritional supplements including 500 mg of ginger, which has been used in India for centuries to alleviate arthritis pain. Within six weeks, she experienced a 70 percent decrease in pain and was back enjoying her garden. A man in his fifties who was overweight took charge of his knee arthritis by combining 45 minutes of bicycling with 15 minutes of icing afterwards; he eventually lost 40 pounds and reduced his knee pain by more than 50 percent. I also recommended that both of these patients cut back on red meat and soft drinks. Why?

Historically, we have viewed arthritis as mainly the wear and tear on the joints, resulting in a gradual loss of cartilage—the smooth layer of connective tissue that enables our bones to absorb the shock of joint motion and move smoothly and without pain. But what makes us lose cartilage to the extent that our joints start to ache and in acute cases may need surgical intervention? Accidents and injuries are one source of damage to joints and cartilage, but they account for a relatively small proportion of all cases of osteoarthritis (or OA).

The chief culprit is something that few doctors will tell you about and that gets very little ink in the popular press. It’s called inflammation, and its connection to arthritis, and to pain in general, has only recently come to the fore in scientific research.

Ironically, inflammation is a self-protective process that occurs when you are injured. It has many positive effects, including increasing blood supply to the injured area. But few people understand how this protective reaction can backfire on us. Sometimes inflammation continues long after it is needed, even in OA, leading to greater pain and further loss of cartilage in joints—not to mention an increase in heart disease, cancers and diabetes. The key to reducing arthritis pain lies in understanding the link between inflammation and arthritis and then doing what you can to reduce or stop unwanted inflammation. There is no cure for arthritis at present, but there are a few things you can do.

One is to eat foods that tend to reduce inflammation and avoid those that cause it. That’s where red meat and soft drinks sweetened with high fructose corn syrup come in. They’re both loaded with omega-6 fatty acids, which tend to promote inflammation. You need to consume more foods rich in omega-3 and omega-9 fatty acids, which reduce inflammation. Those come in the foods that many nutritionists are now saying we should eat more of, like deep-sea fish, flaxseed, fresh fruits, dark green leafy vegetables, and olive oil. Our ancestors, to whom arthritis was virtually unknown, ate a diet in which omega-6 was in about equal proportion with omega-3 and -9, But because of the enormous increase in consumption of red meat and the use of vegetable oils like corn and safflower in all kinds of food, that proportion is now way out of whack.

Because mainstream medicine has not provided enough arthritis treatments in the middle ground between painkillers and surgery, many arthritis sufferers have turned to complementary or integrative modalities. Of the common alternatives to conventional medical care, massage therapy has been shown to be beneficial for arthritis of the spine and hip, and acupuncture has shown promising results for knee arthritis in clinical trials. For those with continuing pain, doctors can inject a thick fluid (hyaluronate) into the afflicted joint. The main drawbacks to this procedure are that it does not work on knees that have more than moderate arthritis, or in overweight individuals. The future may be brighter, however.

We are right on the threshold of a whole range of new scientific developments that promise to change the face of arthritis treatment as we know it.  The future of arthritis care is early detection with early intervention. New generations of minimally invasive therapies targeted specifically toward the arthritic joint will help eliminate arthritis pain, enhance mobility, and protect cartilage. Researchers are working on new injectable gels that resemble the properties of healthy joint fluid and can reduce pain long-term while protecting the cartilage. Some preliminary data show that using one’s own blood plasma, which is rich in growth factors, can stimulate an arthritic joint to make high quality joint fluid of its own. Basic research has shown early promise using stem cells and gene therapies for possibly regrowing the cartilage.  But until these future technologies hit the market (which could be as soon as just a few years), eating a good, anti-inflammatory diet, taking safe supplements, and a sensible exercise regimen while keeping the body weight in check will remain the hallmark of arthritis management.

About Author
Vijay  Vad M.D.
Vijay Vad, M.D., is a sports-medicine specialist at the Hospital for Special Surgery and a professor at Weill Medical College of Cornell University. He is the author of Back Rx and Arthritis Rx. In 2007, he created the Vad Foundation, dedicated to tw Continue reading