2016: IASP Global Year against pain in joints.

dr oz 

(We all know how true some ‘medical talkshows’ are…)

People, health talkshows, magazines, advertisements keep talking about joint degeneration, ‘wear and tear’ but the primary thing that keeps people worried about their joints is: pain.

If there is no pain to begin with, will you be even worried or concerned in the first place? My aim here is to bring awareness about joint pain in associated joint disease and disorders. Pain is not a sign of degeneration, but a signal to act upon it before it gets too late to affect your life.

As an industry, we are placing too much emphasis on the joint and too little on why pain happens and why it does not get better. So much so that people believe that pain is directly caused by the damage to the joint and prevention/treatment need to be directly targeted at joint protection.

Why should we place less emphasis on degeneration, and more on pain?

One participant described her experience with acute back pain in a qualitative research study done by Darlow an colleagues (2013):

When [the current episode] first happened, the only thing that was going through my mind is the seriousness of my dis-alignment [sic] of my back…. I was really petrified…you get scared in the sense that you could damage your spinal cord, or anything, to such an extent that you might become paralyzed.

The word ‘degeneration’ means differently to the medical professional and a patient. For us, it is probably a sign of ageing, but to a patient it may mean “damage”, “disintergration” or “just 2 more steps to being confined to a wheelchair”, because degeneration means it’s only going to go ‘downhill’ from here.

Words can heal and also harm, choose them wisely.

Investigation findings may not be related to your joint pain.

Scans and investigations may inform us about the stage of joint damage, but is not always a strong predictor for pain intensity. This can be said to be true in the knee, when osteophytes (bone spurs) can be seen on scans but it is also very commonly an incidental finding in people without pain. When one gets old, it is very likely to find degenerative changes like osteophytes in the knee joints.

For spinal pain regardless of pain intensity, performing an MRI in the absence of progressive leg weakness, numbness or bladder and bowel incontinence has more harms than benefits. Unless the doctor suspects an underlying serious issue like spinal infection, fracture or cancer, early scanning tend to increase the fear for the patient as abnormalities are often picked up in MRI scans. They then go on worrying about these abnormalities rather than focus on their rehabilitation and recovery. It is now widely accepted that abnormalities (including degeneration) are prevalent in the pain-free population are can be taken to be ‘normal’. Research also show that early MRI scans usually lead to unecessary spinal surgeries performed.

Having said these, scans like MRI and ultrasound can detect joint and bone inflammation, which can be treated effectively by doctors. Scans can be very useful if utilized in the appropriate way.

Now we know that we shouldn’t be overly-focused on joint degeneration…

We should be concerned with how joint pain disorders actually affect our lives.

Spinal joint pain (Neck and back)

To stress the seriousness of addressing joint pain, it has been shown that musculoskeletal disorders are causing a surprisingly large share of the disease burden around the world. In every region, regardless of income or other demographic factors, low back pain and neck pain rank high on the list of causes of ‘years lived in disability (YLD)’. This article has been publised in The Lancet, December 2012. Despite not bring a life-threatening disease, low back pain is the leading or second leading cause of YLDs in 17 of the 21 regions.

  1. chronic back pain (No. 1)
  2. chronic neck pain (No. 8)

Pain causes irrational thinking, fear and it STOPS people from moving. That’s the deadly part of neck and back pain.

fear-avoidance-model

Knee pain

People avoid seeking care for knee pain at the early stage of osteoarthritis. Early osteoarthritic knee pain usually feels stiff in the morning, gets better after moving but too much physical activity usually makes the pain worse. They may cope with pain using unproven therapies like complementary and alternative therapy (acupuncture, massage, etc) or avoid making it worse, usually on the advice of these therapists or their friends and families. When it eventually turns chronic and difficult to treat, seeking care is usually expensive (medication, physiotherapy, bracing, surgery) and it disrupts their lifestyle and work. Many become disabled and stop seeking help.

Another kind of knee pain due to the immune system, called Rheumatoid Arthritis, is more difficult to treat, as it involves lifelong medication most of the time. Rheumatoid Arthritis is a condition whereby your immune system creates inflammation in many of your joints, eventually causing damage to the joints. People with rheumatoid arthritis often have accompanying fever and significant joint pain and stiffness that affects their daily activities and serious cases are very disabling.

What should we be doing about pain in the joints?

I’m very happy that International Association for the Study of Pain (IASP) is focused on ‘joint pain’ this year.

Joint pain is usually the primary indication for a doctor to refer the patient to see a physiotherapist. It is crucial to seek help early when in pain because physiotherapy can address the fears and uncertainties that you may have about pain, “do’s and dont’s” and provide evidence-based strategies and treatment to get your moving towards recovery in the right direction (pardon my pun)! Joint pain can be treated well enough to avoid being a disability.

fear avoidance physiotherapy

Here, you can see how we can intervene at every stage of the vicious cycle of disability.

Read more from IASP‘s website!

Thank you for reading!

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