I have recently attended the annual Canadian Association of Orthopaedic Medicine conference, this year held in the big TO. As usual there were some excellent presentations and workshops, and I left feeling inspired and privileged to be working in musculoskeletal pain management. There was a lot of focus on nutrition: so much of pain can be attributed to the foods we eat! Also there was an excellent talk on genetic testing - knowing one's genome can help tailor treatment very specifically and even prevent certain problems/diseases from occurring. I presented a workshop on the hydrodissection of peripheral nerves using 5% dextrose under ultrasound guidance, along with a colleague, Dr Jag Gupta. This was well-attended, showing the interest in treating neuropathic pain without using drugs which have many side effects (aka brain fog). Dr Gordon Ko organised a terrific conference and I hope to incorporate new pearls of wisdom into my practice!
We now have a meta-analyis of 10 level 1 studies (level 1 being the highest calibre of studies) showing that platelet-rich plasma (PRP) should be offered for knee osteoarthritis as it is more effective than hyaluronic acid injections (a frequently used treatment) at the 1 year mark. You can find the article about this under our research tab. This is encouraging news for those of us offering and receiving PRP.
I have just returned from the AAOM's annual conference in Seattle. There were many memorable presentations, with very positive and encouraging reports on the use of regenerative medicine. One was by an Italian surgeon who has a procedure using a stem cell plug in arthritis knees, and many of his patients avoid knee replacement surgery and do well even 5 years later. There were some interesting talks by 2 veterinarians, which may sound odd, but vets are ahead of "people docs" in the field of regenerative medicine and have a good perspective to offer us! Here is an article about platelet-rich plasma injections to a Jaguar at an Albertan zoo, published on the CBC website...
In January we left for Guadalajara, Mexico, to join an international group of prolotherapists for a week-long mission. Dr David de la Mora arranges this "brigada" annually, to help many Mexicans obtain treatment who otherwise would not be able to afford it. The group treated more than 1000 patients, had fun, experienced daily education times, exchanged experiences and techniques, and we feel blessed to have been included. This is one of the HHPF's (Hackett Hemwall Patterson Foundation) organised medical missions, led by the very capable Mary Doherty. This year in Mexico we had 5 Canadian physicians, many Americans, and also doctors from Mexico, Puerto Rico, Turkey and Italy volunteering! Here is the Canadian team goofing around, and also a photo of all the doctors volunteering.
Striving to obtain the best medical evidence for a treatment is a good goal to have. We are pleased to report one more study (well, really it is a review of several good studies, and in this case it is the highest level of medical research, even more exacting than randomized and blinded trials) showing that prolotherapy is an effective treatment for knee osteoarthritis. This is good news to those suffering this type of knee pain. Not everyone is helped, as some arthritis is too far-advanced, but many people have a great response to prolotherapy as a treatment for arthritis.
After reviewing the medical literature we have decided to offer medical ozone injections to relieve painful joints. We are excited at this addition to our practice as it is yet another excellent option for the treatment of pain. It has been used for many years in Europe with success, and there are many studies on its use and effectiveness in the literature. We will be posting some of these under our research page in the near future. Medical ozone is injected into the affected joint following a local anaesthetic injection and is well-tolerated.
David and I have enrolled in a recent pain management certificate program at the University of Alberta. We never stop learning! Things have certainly changed since we were undergraduates. Over the next couple of years we'll be participating "virtually", attending "e-classes" and online lectures, submitting assignments electronically, searching virtual libraries and accessing a wealth of material, adding citations with a computer-generated program that automates the process so quickly, and best of all, able to enjoy Victoria instead of the frozen north!
Here are the doctors, nurses and volunteers who headed down to inject prolotherapy in Honduras this year. It was my third opportunity to work in Honduras, where we helped many hurting people at clinics in 3 small towns there. It is such a privilege to do this, teaching, learning and helping. My lecture there this year was on wrist prolotherapy - we take it in turns to present topics. The Hackett Hemwall Patterson Foundation is such an excellent teaching organization based in Wisconsin, where we meet up with good friends that we have made from different countries. In addition the foundation also sends down an Ear, Nose and Throat team as well as a Varicose Vein and Ulcer team. What a difference they make!
Jannice is a family physician with an interest in the treatment of pain. Anything to help the process is added to this blog.