Osteoarthritis

osteoarthritis degeneration back painDegeneration of the spine is a prevalent problem that generally advances with age, though is not always restricted to the elderly1.

The presence of osteoarthritis is not always consistent with pain either. While progressive joint failure may cause pain and disability, approximately 50% of people with osteoarthritic changes don’t have any symptoms2. This is known as the “structure-symptom discord”.

How the spine degenerates and how pain is experienced is multifactorial. Firstly, osteoarthritis begins when there is an imbalance of mechanical load that exceeds the limit of what joint tissues can handle. Bony changes and inflammation cause dysfunction and instability of the joints. Secondly, changes to the nervous system occur around the spine, then spinal cord, and finally brain. How people move starts to change; muscle strength changes; and finally sensory awareness of their body changes. When these systems break down, the person experiences persistent pain (Fig. 1).

biopsychosocial model structure symptom_550

Figure 1. Biospsychosocial model depicting the relation of structural pathology to the experience of pain

How such dramatic alterations in shape of the spine occur over time (Fig. 2) is primarily due to a decrease in nutrition to the discs between the vertebrae3. The primary source of nutrition for the intervertebral discs are the end plates of the vertebrae. As degeneration progresses, fissures, cracks, clefts and fractures occur in the end plates, resulting in them thinning and water volume being lost from within the disc. This reduces disc height, misaligning mechanical forces and changing the shape of the spine (Fig. 3). As a consequence, more stress and strain is placed on the joints of the spine creating back pain. Long term pain can lead to more permanent, dysfunctional changes in the central nervous system ■

spinal degeneration disc compression_550

Figure 2. Spinewave case example of degeneration of the lumbar spine over 23 years resulting in scoliosis to the right and persistent low back pain

disc degeneration

Figure 3. Qualitative stress distribution across vertebral end plate for normal and degenerated intervertebral disc under pure compressive and eccentric compressive loading

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Heat versus ice for pain

heat-vs-cold pain 550

Can anti-inflammatory drugs make you infertile?

NSAIDResearchers found non-steroidal anti-inflammatory drugs (NSAIDs) “significantly inhibit ovulation”.

NSAIDs are among the most commonly used drugs worldwide, and are taken by more than 30 million people every day. Available without prescription, they are largely used for the treatment of pain, inflammation and fever; common features of conditions involving joint and muscle pain.

NSAIDs include naproxen, diclofenac, ibuprofen and aspirin.

The results of a study presented at the European League Against Rheumatism Annual Congress (EULAR 2015) show that diclofenac, naproxen and etoricoxib significantly inhibit ovulation in women with mild musculoskeletal pain. Of the women receiving NSAIDs, only 6.3 percent (diclofenac), 25 percent (naproxen) and 27.3 percent (etoricoxib) ovulated, compared with 100 percent of the control group.

These findings suggest that readily available NSAIDs could have a harmful effect on fertility, and should be used with caution in women wishing to start a family.

“After just ten days of treatment we saw a significant decrease in progesterone, a hormone essential for ovulation, across all treatment groups, as well as functional cysts in one third of patients,” said study investigator Professor Sami Salman, Department of Rheumatology, University of Baghdad, Iraq. “These findings show that even short-term use of these popular, over-the-counter drugs could have a significant impact on a women’s ability to have children.”

Thirty-nine women of childbearing age who suffer from back pain took part in the study, and received diclofenac (100mg once daily), naproxen (500mg twice daily) and etoricoxib (90mg once daily) or placebo. Treatment was given for 10 days from day 10 of the onset of the menstrual cycle; hormonal analysis (progesterone level) and follicle diameter were conducted via blood sample and ultrasonography respectively. At the end of the NSAID treatment period, the dominant follicle remained unruptured in 75 percent, 25 percent and 33 percent of patients receiving diclofenac, naproxen and etoricoxib respectively. Rupturing of the dominant follicle, and subsequent release of an oocyte (unfertilised egg), is essential for ovulation to occur.

Reference:

Salman S, et al. Effects of some non-steroidal anti-inflammatory drugs on ovulation in women with mild musculoskeletal pain. EULAR 2015; Rome: Abstract OP0131


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