Arthritis and Knee Pain: The Best Solution is Not Drugs or Surgery
Noel Peterson, N.D.
Osteoarthritis of the knee is a worrisome problem for millions of Americans, and the pharmaceutical giants know it. Television, radio, magazine, news papers and medical journals are full of advertising featuring the sweet smiles of arthritic actors freed from the jaws of their pain, doing Tai Chi and playing ball again with their children, saved from a life of pain by Celebrex, Vioxx, Advil, Naproxin, and the other non steroidal anti-inflammatory drugs (NSAIDs). Doctors themselves have been seduced by these multibillion-dollar advertising blitzes, and have long advocated NSAIDs or injected cortisone to control pain. When that is not enough, doctors perform arthroscopic surgery. But according to recent studies published in the New England Journal of Medicine and the British Medical Journal , none of these treatments really work! In fact, they often do more harm than good, and cause multiple side effects.
To understand why they don't work, and why they cause problems, one only needs to compare the mechanism of osteoarthritis to the mechanism of NSAIDs, cortisone and surgery:
Osteoarthritis (OA) is caused by the gradual wear and tear of joint cartilage. OA happens whenever the joint's ability to repair itself is outpaced by the rate of joint injury. When the conditions are right, OA of the knee can happen at any age and any level of activity. I have teenage patients with OA, and patients in their 80's without OA. What conditions make the difference?
First, our ability to self-repair our joint surfaces is controlled by our nutrition. For example, excess intake of sugar and high phosphorus-containing foods like meat and soft drinks combined with deficiencies in essential minerals like calcium, magnesium, zinc, and boron causes the loss of the boney foundation underlying cartilage. When the joint's foundation crumbles, the cartilage is weakened and wears more quickly. When people have good nutrition and exercise, the foundation is strengthened, and cartilage repair can keep up with wear and tear no matter what their age.
Second, strong leg muscles enhance knee joint stability. To be stable, a joint requires strong muscles for support. Weak muscles = weak joints. When muscles are weak the joint is lax and moves in a sloppy manner, enhancing friction and wear much like the way a sloppy wheel bearing overheats and wears out. When the muscles support the joint, it glides smoothly and cleanly.
Third, when it comes to healing both acute and chronic injuries, immobilization combined with NSAIDs , COX 2 inhibitors (Celebrex, Vioxx, Bextra), or steroid injections is a prescription for disaster. Why? To be successful, healing requires a specific inflammatory response. No inflammation, no repair. Steroids, NSAIDS, and COX2 inhibitors are toxic, have lots of side effects, inhibit healing in multiple ways, and actually weaken your joint tissue and accelerate degeneration.
Fourth, if not treated properly, trauma to the knee can set in motion ever advancing degenerative changes in the knee The healing response is dependent on the migration of the body's repair cells, called fibroblasts , to the injured area where they remove damaged cells and lay down new cells. At least five different growth factors have been identified as necessary for this healing response. Drugs have been shown to shut down this healing reaction, inhibiting the migration of fibroblasts into the injury, and turning off the growth of new cartilage. Remember, no inflammation, no repair. Cortisone is the drug most toxic to this repair process, and actually causes the structural breakdown of the very collagen, cartilage, bone and ligament tissues that make up your knee joints.
Fifth, What about NSAIDs for pain? In fact, multiple studies conclude that NSAIDs and COX2 drugs offer insignificant pain control while causing serious side effects and are not worth the risk in osteoarthritis. The November 30, 2004 online issue of The British Medical Journal reported on an analysis of 23 randomized trials of NSAIDs, including drug company sponsored studies, in the treatment of osteoarthritis of the knee. They found only a temporary, short term 15% reduction in pain, and no improvement in function in 7,807 patients using NSAIDs, even at the highest (and most dangerous) doses. Due to the long-term harm and lack of demonstrated benefit, these investigators recommend against long-term use of NSAIDs for OA.
Sixth, arthroscopic knee surgery has been shown to have no measurable benefit in OA of the knee! The definitive double-blind study on surgery for OA of the knee was performed by Dr. J. Bruce Moseley and his team at Baylor College of Medicine and the Houston Veterans Affairs Medical Center and published July 11, 2002 in the New England Journal of Medicine. Dr. Moseley studied a total of 180 patients with osteoarthritis of the knee that were randomly assigned to receive arthroscopic débridement, arthroscopic lavage, or placebo surgery. Patients in the placebo group received skin incisions and underwent a simulated débridement without insertion of the arthroscope. Outcomes were assessed at multiple points over a 24-month period with the use of five self-reported scores - three on scales for pain and two on scales for function - and one objective test of walking and stair climbing. At no time in the 2 year follow-up did either of the intervention groups report less pain or better function than the placebo group. Moseley concluded that "in this controlled trial involving patients with osteoarthritis of the knee, the outcomes after arthroscopic lavage or arthroscopic débridement were no better than those after a placebo procedure". Since this study was published, this surgery continues to be performed on over 650,000 knees in the US at a combined cost of over $5.2 billion a year!
What are the alternatives to drugs and surgery? First, take good care of your knees by following a nutritious diet and regular exercise. Second, if you have knee pain, avoid drugs and don't let anyone inject cortisone into your knee. Third, seek treatments that build your cartilage and strengthen the knees. And fourth, let us help you recover function and vanquish pain with our cost-effective osteoarthritis protocol that provides specific nutrition, focused exercises, physical therapy and joint-building Prolotherapy injections.