The good news about arthritis – it’s not as simple as you’ve been told…

“…they found that it is very common for people to be walking around without any pain who have terrible joints!”

Western medicine is updating it’s understanding of why arthritis hurts – the answer is that they are not completely sure anymore.

For most of the 20th century, the arthritis story was very simple. The patient was told “See these changes on the X-ray/ MRI? That’s what is causing the pain.”   Patients then feel educated while they wait for for the surgeon – back fusion, knee replacement etc. etc. The expectation is, if no change to the bone and cartilage of the joint – no pain relief.

But in the 21st century, new information has made that picture become less clear.

Researchers began to ask questions:

For example, if the bone pathology causes the pain, why does it not hurt all the time?

Why do some people have flare ups of pain after overeating?

Why is it when people actually have corrective surgery, the pain does not always go away?

Finally they began to take X-rays and MRI’s of people who are totally without any pain or stiffness. To their amazement, they found that it is very common for people to be walking around without any pain who have terrible joints! Even when finding the dreaded “bone on bone” situation.

In fact, if radiologists have never met the patients and only look at the X-rays, they cannot predict which patient has no pain, which patient has pain and if so what kind of pain they have in terms of location, intensity and frequency. Some predictability is possible for very severe cases, but even then, not always.

This is really good news – the patient can now explore all the other factors for why the joint may have pain and stiffness, with reasonable expectation of preventing or delaying surgery.

So what does cause the pain?

The research suggests that arthritic changes to joints happen against the background of many other changes to nerve physiology, tendons, ligaments, muscle and immune system physiology. There can also be a significant stress/ psychological component.

Using the word”physiology” here very specifically refers to changes in gene expression, enzyme function, immune function lymph and blood flow changes, as well as biomechanical changes. Many of which have been shown to be reduced or eliminated by electroacupuncture, bodywork, herbs, nutrition and lifestyle factors. (I will have a more detailed post about the science of pain in a few weeks. Try Googling “genetic control of central sensitization” if you are curious before then.)

This explains situations I see in the clinic. I often have patients who have been told that they need surgery but wanted to try acupuncture first. Well of course, those of you familiar to my practice know it’s not just acupuncture that they may need. These patients receive a thorough review of their current and past global metabolic situations before various procedures and options may be utilized.

What can be done about the pain and stiffness then?

Consider the following situations for patients with osteoarthritic pathology seen on an X-ray or MRI. When I find trigger points in the thigh muscle, the arthritic knee pain can go away completely in 1 or 2 sessions. When a patient regularly overeats on foods that cause inflammation, 3 or 4 weeks of digestive repair and lifestyle changes can also restore function. Some folk are over exercising or doing the ‘wrong’ types of exercise, some are too sedentary and do not know how even just a little more activity will create a big change. Some people do not even need office procedures at all but need to simply move the joint regularly throughout the day in the range without pain.  This will allow the lymphatic and blood circulation to improve. Also common is pain in a joint on a limb that had previously experienced poorly healed strain and injury – e.g. clearing the effects of an old neck injury can help wrist or hand pain.

We you come to see me, I take the label from your surgeon’s diagnosis off the the table for a moment and look at the whole picture. A good diagnosis means a good treatment, and understanding the whole person is the best route to the best diagnosis. Detailing what the body needs allows us to design treatments using many options to surround the problem and get stable progress.