Acupuncture and chronic pain
Posted by on September 17, 2012 - 11:49am

Acupuncture provides more relief from various types of chronic pain than does usual care and should be considered a valid therapeutic option, according to Andrew J. Vickers, DPhil of Memorial Sloan Kettering in NYC and colleagues who conducted  a meta-analysis of raw data from 29 studies.

For back and neck pain, osteoarthritis, and chronic headache, pain scores among patients treated with acupuncture were  below the pain scores for patients receiving sham acupuncture. The pain score improvement was even larger when acupuncture was compared with no acupuncture, the researchers reported online in Archives of Internal Medicine.

Acupuncture is recognized as having certain physiologic effects that can contribute to pain relief, but no plausible mechanism has been identified that could lead to long-term benefits for chronic pain, with the result that the treatment remains "highly controversial," according to the researchers.   Many controlled studies of acupuncture for pain have been published, but quality has been inconsistent and reliability has been questioned.

To provide more clarity about the effects of acupuncture on pain, Vickers and colleagues conducted an individual patient data meta-analysis based exclusively on high quality randomized trials.  Included trials required pain of at least a month's duration, with the primary endpoint being assessed at least a month after acupuncture treatment began.

This is "of major importance for clinical practice," meaning that acupuncture should be considered "a reasonable referral option for patients with chronic pain," they stated.

In an invited commentary accompanying the meta-analysis, Andrew L. Avins, MD, of Kaiser-Permanente in Oakland, Calif., argued that the benefits indeed were primarily those associated with the placebo effect, because the pain relief was so much greater when acupuncture was compared with usual care than when compared with the sham procedure.

But whether that should mean acupuncture has no value for patients, largely because of uncertainty as to its mechanisms of action, is a crucial concern, he pointed out.

"The ultimate question is: does this intervention work (or, more completely, do its benefits outweigh its risks and justify its cost)?" Avins wrote.

For acupuncture, the current meta-analysis offers "some robust evidence" that acupuncture does provide greater chronic pain relief than usual care, mechanisms of effect aside.

"Perhaps a more productive strategy at this point would be to provide whatever benefits we can for our patients, while we continue to explore more carefully all mechanisms of healing," Avins concluded.

Primary source: Archives of Internal Medicine
Vickers A, et al "Acupuncture for chronic pain: individual patient data meta-analysis" Arch Intern Med 2012; DOI: 10.1001/archinternmed.2012.3654.

If you have arthritis.....keep moving!
Posted by on August 20, 2011 - 6:33am

Being physically active is one of best ways people with arthritis can improve their health, but a new study from Northwestern University Feinberg School of Medicine shows that more than half of women and 40 percent of men with arthritis are virtually couch potatoes.

This is the first study to use a device to objectively measure the physical activity of people with arthritis and determine if they meet federal guidelines. Past research relied on self-reported accounts of exercise and activity.

Researchers asked more than 1000 people with radiographic knee osteoarthritis to wear an accelerometer---a small, sophisticated device that looks like a pedometer---to measure their physical activity for one week during waking hours. The participants are part of a larger national study called the Osteoarthritis Initiative and are 49 to 84 years old.

“We had assumed that people might be overstating physical activity in past self-reported data, but were surprised to find that the physical activity rates were much, much lower than what was previously reported,” said Dorothy Dunlop, associate professor of medicine at Feinberg and lead author of the study.

Physical activity can help people with arthritis better control and lower pain and improve general function. Some studies indicate exercise may delay or even prevent disability in people with arthritis, Dunlop said.

The federal guidelines recommend that adults with arthritis participate in 150 minutes per week of moderate-intensity, low-impact activity. That amounts to an average of slightly more than 20 minutes per day. Previous studies estimated that a quarter of people with arthritis met those guidelines.

“This study found that fewer than one in seven men and one in 12 women met those guidelines when we had this objective measure, using the accelerometer,” said Dunlop a health services researcher who also is with the Institute for Healthcare Studies at Feinberg. “The more alarming finding is that so many people actually qualified as being inactive.”

Participants were deemed inactive if they failed to sustain a 10-minute period of moderate-to-vigorous activity over the entire week of wearing the accelerometer. A substantial 40.1 percent of men and 56.5 percent of women studied were found to be inactive.

While more than half of men engaged in significantly more moderate-to-vigorous activity than women, the majority of men who didn’t fall into this category were spending their time in no to very light activity.

“The fact that so many people with arthritis are inactive should be a wake-up call to physicians,” Dunlop said.

Brisk walks and water aerobics are two recommended activities for people with arthritis, but Dunlop said patients should talk with their physician about any concerns before starting an exercise program.

“Even though they have joint disease, patients need to be reminded that physical activity is actually good for them,“ Dunlop said. “People with arthritis should be as physically active as possible, even if they accomplish less than the recommended levels. When it comes to physical activity, there is good evidence that the benefits far outweigh the risks and being inactive is especially detrimental to health.”

The study was published in Arthritis & Rheumatism, August 2011.

Source:   Northwestern Newscenter, Erin White

Physical Activity Helps People with Osteoarthritis Walk Faster
Posted by on January 24, 2011 - 2:45pm

When a traffic light at a busy intersection flashes the WALK sign, people with knee osteoarthritis worry they can’t walk fast enough to make it across the street in time. New Northwestern Medicine research shows people with this common arthritis are more likely to walk fast enough if they lead physically active lives.“The more active people are, the faster they can walk,” said Dorothy Dunlop, associate professor of medicine at Northwestern University Feinberg School of Medicine and lead author of the study. “This is strong evidence that even a small increase in activity is related to better walking function. The bar for improvement isn’t that high. This should motivate people to get moving, even if they have pain or stiffness."The study is published in the January 2010 issue of Arthritis & Rheumatism.

Knee osteoarthritis is a leading cause of disability in adults. As it progresses, it can threaten an individual’s ability to live independently. Maintaining function and independent living is an important goal for the more than 27 million U.S. adults with osteoarthritis.   Osteoarthritis may first appear between ages 30 and 40, and is present in almost everyone by age 70. Before age 55, it affects men and women equally, but after age 55 the incidence is higher in women.

“This study provides encouragement for people who are on the low end of the physical activity spectrum to increase their physical activity,” said Dunlop. “You don’t have to be in the top physical activity group before you start to see improvements in your walking speed.“

Physical activity produces big benefits for people with knee osteoarthritis. In addition to improving the ability to walk, physical activity also promotes healthy joint cartilage and reduces pain, depression and fatigue, Dunlop noted.

Federal guidelines recommend adults with arthritis should participate in at least 2.5 hours a week of moderate intensity, low-impact activity in sessions lasting 10 minutes or more. Even if people can’t meet these levels, Dunlop said they should be as physically active as possible.

Researchers divided participants into four physical activity groups, from lowest to highest, using a general activity score. In the lowest physical activity group, less than half, or 49 percent, walked fast enough to cross the street before the light changed. (Traffic lights generally allow a walking speed of four feet per second.) In the next three higher physical activity groups, 63 percent, 71 percent and 81 percent, respectively, walked fast enough to cross the street.

Author:  Marla Paul is the health sciences editor at the Northwestern Feinberg School of Medicine.

Arthritis Prevalence Higher in Women than Men
Posted by on August 31, 2010 - 10:24am

In 2006, the Center for Disease Control and Prevention (CDC) reported that 21.6% of the US adult population reported arthritis, with significantly higher prevalence in women than in men (24.4% vs. 18.1%). Arthritis prevalence increased with age and was higher among women than men in every age group.    With the aging of the US population, the prevalence of doctor-diagnosed arthritis is expected to increase in the coming decades.   By 2030, it is estimated that 67 million adults age 18 and older will have arthritis, compared with the current 46 million.  Also, by 2030 an estimated 25 million adults will report arthritis-attributable activity limitations.

Functional limitations in routine activities are common among adults with arthrtis:   40% report it is "very difficult" or they "cannot do" at least 1 of 9 important daily functions which include their ability to stoop, bend, grasp, kneel or walk 1/4 mile.  Obesity is a known risk factor for the progression of knee osteoarthritis and possibly of other joints.   Reducing body weight may result in significant improvement in the health-related quality of life of people with arthritis.

Although physical activity and exercise have been shown to benefit people with arthritis by improving pain control, function, and mental health, many people with arthritis report no leisure time physical activity. Low levels of physical activity place individuals with arthritis at further risk of inactivity-associated conditions such as cardiovascular disease, diabetes, obesity, and functional limitations.

Some interesting research is currently taking place at Northwestern U. that is looking at knee alignment and its role in progression of knee osteoarthritis that could lead to earlier and novel interventions that could decrease or prevent arthritic disability in the future.  Many Illinois women who are part of the Illinois Women's Health Registry are participating in those studies.

In the meantime, women (and men) who have arthritis could benefit from keeping their weight down and keeping physically active!!!   As we age, it is even more important that we develop a lifestyle that includes healthy eating and exercise.


Participating in a Research Study can be Fun
Posted by on March 5, 2010 - 12:07pm

Throughout my career, I have been a strong proponent of medical research through consumer advocacy and educational activities. But recently, I had the opportunity to actually participate as a research subject!  As an enrollee in the Illinois Women's Health Registry, my health profile matched the criteria that a researcher was seeking for an osteoarthritis (OA) study.  The project is called the MAK-3 Study and its purpose is to explore whether people with stronger hip muscles have a slower rate of OA progression and whether different factors of knee instability are related to knee OA progression.

My camera flash picked up the reflector balls/markers taped to my joints ---  could this be the new look in jewelry!!

My Registry profile included "knee pain" which flagged me as a potential match for this study.  I gave permission for the Registry staff to give my name to the research coordinator for the study and I was selected!  The study is being done at Northwestern University and it involves 2 or 3 visits for a variety of non-invasive evaluation procedures.   They would be done at baseline (this past month) and repeated two years later.   This is what they call an "observational" study.  It will not directly benefit me, but it would help scientists better understand this condition and the factors that influence it.  Since my family was riddled with osteoarthritis, I wanted to participate.

I chose to do the evaluations in three rather than two sessions because it fit my work schedule better.   At the first session, I filled out numerous surveys about pain, my medications and my exercise habits.    A physical therapist watched me walk down the hall several times to observe my "gait".    I was then hooked up to equipment that measured muscle strength ( it looked like much of the equipment you see at your local gym, just with gauges to measure strength). They asked me to perform some typical knee and hip movements like leg lifts and recorded my muscle strength.  After that a physician examined my legs and hips and reviewed my medication history.  I was asked if I would provide an optional urine sample that would be stored to eventually be used to test any new biomarker tests for OA that may be developed.  I was provided a diary where I recorded by physical activity for a week at home.

At the second session I met the team in a research lab that was equipped with sensors along the ceiling and a hollow floor that ran wires to a lot of computerized equipment. They taped small reflective balls to my joints and had me walk up and down the room many times while the sensors picked up the signals from these balls  (see picture!)    When I finished, the researcher showed me what the sensors were detecting.    The computer screen showed a stick figure (me) with multicolored dots on my joints (representing the reflecting balls) moving across the screen.   They were recording my alignment and gait.   It was very interesting to see my stick figure move across the screen.    Once they pulled off the sensor balls, they measured the speed of my normal walk by making me walk down a hallway and timing me.

A few weeks later I went to a different location where I had a special x-ray taken that included, on one film, my ankle, knee and hip joint to see how they lined up.  This was followed by rather long MRIs on each of my knees.   This was the hardest (but tolerable) part of the study, I needed to stay still for 40 minutes per knee.   At least they gave me headphones and my head was outside the MRI machine where I watched a bird trying to get through the window.  Throughout this experience the research coordinator explained what would happen and why it was done.   Since I was going to physical therapy for my knee at the time, it was helpful to have her explain where they saw strengths and weakness in my hips and knees.  It made me appreciate why the PT was having me do certain exercises on these related muscle groups.

Finally, the best part of this experience was knowing that I may actually be contributing to science, with little interruption (total 7- 8 hours) in my life.   They will have me back in two years to repeat these tests and determine the status of my OA symptoms.  By the way, I was given a stipend to cover my expenses like parking---and  just enough  to take a few girlfriends out for a nice lunch and get them to join the Illinois Women's Health Registry!