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Orthopedics and Health

Knee pain, relief from pain

A Novel Way To Ease Knee Pain

By Dr. W. Gifford Jones

January 16, 1994

What a pleasure in 1994 to find an internationally famous doctor who isn't interested only in CAT scans and MRI's that cost megadollars! One who believes "the art" of medicine shouldn't be banished to the Smithsonian Institution. And who recently reported novel ways to ease knee pain while he was Visiting Professor at the Wellesley Hospital In Toronto.

Dr. Paul A Dieppe, Professor of Rheumatology, at Bristol University, Bristol, England is one of the world's authorities on osteoarthritis, the most common type of .

Dr. Dieppe claims there are too many patients saying, "My family doctor says there's nothing that can be done about my arthritis." He believes that doctors must get rid of the defeatist attitude that osteoarthritis is as inevitable as the wear and tear on our cars. This approach, he suggests, in the light of today's knowledge, is totally inappropriate.

Professor Dieppe says the fact is that most people don't get osteoarthritis. In general 10 to 20 per cent of the population develop osteoarthritis if they live to a reasonable age. But it must be remembered that 80 per cent won't get this condition.

Moreover only a few joints succumb to osteoarthritis. Those that do are the base of the thumb, the tips of the fingers and one part of the knee and hip.

Dr. Dieppe says people often chuckle when he suggests elementary ways to ease arthritic pain. But thousands of patients are not aware of simple techniques which can make a huge difference in the resolution of arthritic pain.

For instance, he refers to sophisticated studies in the U.S which show that merely listening to patients improves their quality of life.

Doctors who make regular contact with their patients convey an important message to those in pain. It says, "I care about your arthritis and I'm here to help".

Dieppe claims this compassionate approach is often lacking. But if used it changes the pain threshold. Arthritic pain is more often dependent on psychosocial factors than on damaged joints. Doctors and patients also have to rid themselves of a popular myth about exercise and pain. Activity, he stresses, is vitally important. But the tendency is for patients to reason, "My joints hurt and they hurt more when I move them, so I must be causing damage. Pain means damage, therefore I'll do less".

Dr. Dieppe says there's now overwhelming evidence that the opposite is true.The more patients exercise the less likelihood of further joint damage and the pain burden gets less.

Patients with arthritis should always wear shock absorbing insoles in shoes. Dieppe reminds us our ancestors used to run around on grass. By concreting floors we have increased the impact on joints, putting tremendous pressure on knees, hips and spine.

Patients who make the switch to sensible shoes return to their physicians saying, "This is incredible, I feel so much better". It also means these patients can exercise more to fight pain.

Professor Dieppe mentioned one trick that amuses his staff because it's so simple. At Bristol University doctors place strapping on every patient with painful knees.

What happens surprises patients. Those whose knees were strapped in a neutral position, or when strapping pulled the knee joint laterally, showed no improvement in pain. But if the seven™inch adhesive strapping pulled the knee joint medially there was a 30 per cent decrease in pain within one day! And patients who previously couldn't walk up stairs could suddenly do so.

Dr. Dieppe advocates another minor procedure. He inserts a small cannula into the knee joint. Saline is pumped into the space to blow it up and then removed. Pumping fluid into the joint expands the knee capsule and washes it out. This is done several times. Pain relief can last six months to a year.

Dieppe says there's very little chance of introducing infection by this procedure. And he washes out joints once or twice a year for patients who get relief and don't want surgery.

Occasionally Professor Dieppe uses more than simple measures for his patients. He says "calcitonin", a new drug that affects bone metabolism, is good for bone pain of almost any cause such as arthritis and bone malignancy.

He believes calcitonin holds great promise for future treatment of arthritis. Current evidence shows calcitonin, affects subchondral bone and possibly the metabolism of damaged cartilage of arthritic joints.

His final message was optimistic. Medical books claim arthritis invariably gets worse. But his studies show this is not true. Many patients with severe arthritis will get better over a decade with proper and often simple treatment. —


W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com

My book, �90 + How I Got There� can be obtained by sending $19.95 to:

Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1

Pre-2008 articles by Gifford Jones
Canada Free Press, CFP Editor Judi McLeod