Exercise is better than medication for chronic low back pain :-) A new systematic review from the Alberta College of Family Physicians has been published, and this is encouraging news. Exercise should be part of any chronic low back pain management, and we advise this routinely. They found strength and stability training to be effective, but they also found aerobic exercises help. Likely a mix of strength, core and aerobics will give the best results. As always, start slowly, and gradually work at increasing exercises and you should have less pain.
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!
This is an important topic of interest to all physicians: that we should strive towards evidence-based medicine whenever possible. For this reason we have reorganized our website with a page dedicated solely to worthy studies, rather than include them in the links page. We encourage you to visit periodically as we add new studies when they become available.
The CAOM holds annual conferences in Regenerative Medicine and this year we met in Vancouver. It is always stimulating to listen to excellent speakers in the field, meet old colleagues and new, and exchange information that makes all of us better practitioners. This year we heard an excellent talk on nutrition and its importance by Dr Aileen Burford-Mason - this will have its own blog entry. In addition we had workshops on prolotherapy, platelet-rich plasma and ultrasound-guided techniques. Erik Ouellette, well-respected prolotherapist from Ontario gave a great lecture on injecting the shoulder, and followed up by doing just that. Physicians presented new research studies, some so new they haven't been published quite yet, and our North Vancouver colleague Dr Helene Bertrand discussed her positive shoulder prolotherapy study which has been accepted for publication. Kelowna physician Dr Francois Louw piqued our interest with favourable early trends in his TMJ (jaw) pain study. We came away tired but grateful to belong to such a good organization.
More people are becoming familiar with platelet-rich plasma, or PRP. This is an effective treatment for musculoskeletal pain which involves having your blood drawn, much like a lab test, centrifuging it into red cells, white cells and platelets, and removing the concentrated platelet section containing liquid gold growth factors (and there are many of these!). This PRP is injected into the area of concern (for example the knee joint) to begin the regeneration of healthy tissue needed for recovery. PRP is similar to prolotherapy in that it stimulates tissue repair, but it can speed up the healing process enormously. Our new system provides a whopping 8x concentration of the platelets and we think this leads to its effectiveness. While not guaranteed to work for everyone, it is gratifying for most. For more information see our updated FAQ page; and also our Links page for some studies on platelet-rich plasma.
Botox injections can provide very effective relief from migraine. If you have an extended medical plan this treatment may be more affordable than you think. Botox is thought to mediate pain by blocking the release of substances our bodies make (CGRP) which cause pain, as well as by relaxing some of the tense muscles around the face and neck. It prevents or lessens migraine intensity and frequency for at least 3 months before it needs to be repeated again. The procedure involves very superficial injections with tiny needles and is tolerated well and doesn't take long. Relief is in sight! Note: this is a preventative treatment meaning if it is effective, you won't suffer nearly as many migraines during the 3 months after treatment.
An interesting study was published recently. Having a knee arthroscopy (a surgical procedure with a "telescope" looking into the knee, and cleaning out any part that is rough or loose) does not improve pain. Many, many people suffer from knee arthritis and so this is helpful in deciding on a course of action. Having a knee replacement may be the eventual answer, but in the mean time regenerative injections (perineural injecting of dextrose, or prolotherapy, or PRP) can be a big help in reducing symptoms, and may even prevent the "kneed" to do surgery at all.
Jannice is a family physician with an interest in the treatment of pain. Anything to help the process is added to this blog.