Sunday, November 16, 2014

How a American Civil War Invention Is Used Today for Relief From Osteoarthritic Knee Pain

By Pariswiederstein M

As an orthopaedic surgeon specialising in knee problems the majority of my patients suffer from osteoarthritis and although knee replacement surgery is generally successful, most patients who are referred to me are not suitable for surgery. These patients are managed with conservative treatment, the main components of which are painkillers and anti-inflammatories, weight loss and exercise.

Each treatment has its own advantages and disadvantages. Painkillers can be very effective in reducing the symptoms of osteoarthritis and for long term use in chronic conditions, paracetamol is the safest drug. Adding an anti-inflammatory like ibuprofen significantly improves the effectiveness of the medication.

However, there are risks associated with long term use of anti-inflammatories. Stomach ulcers with bleeding, kidney failure and cardiac problems are all associated with anti-inflammatory use. Side effects can be decreased by using the anti-inflammatory as a cream which is applied to the knee but in general, I have found that many of my patients simply do not like the idea of having to take long term medication in any form for their knee pain.

Weight loss is very effective in those patients who are overweight but as anyone who is overweight knows, it is not easy to lose weight and many patients often cannot manage this. Exercise has a dual benefit of encouraging weight loss and releasing 'feel good' endorphins which can act as a natural painkiller. However, exercising the knee is difficult when the knee is painful.

What is needed for successful conservative treatment is a form of pain relief which is not drug based, is easy and convenient to use and effective in managing patients symptoms of Osteoarthritis. In fact, such a treatment has been available for over 150 years!

In 1862 during the American civil war a technique was discovered that is becoming increasingly available today as a method of treating pain. With no available anaesthetics for battlefield use it was discovered that injured soldiers with painful amputation stumps could obtain pain relief by having the painful stump 'drummed' with drumsticks at a particular frequency. This produced pain relief lasting for many hours. By 1865 nearing the end of the conflict, drummer boys, when not leading the troops into battle, were employed to provide pain relief in field hospitals using this technique.

The mechanism by which this effect was produced would not be discovered for another 100 years.

It was only in the early 1960′s that two scientists Merzack and Wall discovered the process and named it the 'gate theory of pain'. They found that stimulating the vibration sensors in the body causes the pain signal to be blocked on its way to the brain, producing a pain relieving effect. This is due to the spinal column being unable to carry both the pain signal and the vibration signal together. The introduction of the vibratory signal 'closed the gate' to the pain signal.

With this in mind I explored using vibration therapy for the management of knee pain in my patients. We used a commercially available vibration therapy device which was designed for use on the elbow and adapted it for the knee. We then tested it with a large group of patients in a clinical trial. The results were impressive. Some patients who suffered with osteoarthritis pain obtained complete pain relief without using drugs and many subsequently improved so much that they reduced their pain reliving medication to much safer levels. We also saw a reduction in stiffness of the knee joint and greater mobility which enabled many patients to go back to work, to take up gentle exercise and start weight loss programmes and to generally increase quality of life.

Although not a miracle cure for osteoarthritis, the trial showed that vibration therapy can allow patients to delay the need for a knee replacement and reduce their medication use, giving greater safety and increased health benefits. I now use vibration therapy as a significant part of my conservative management programme for patients.



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