Posts tagged medication
Is Acetaminophen Effective For Hip Or Knee Arthritis?

Paracetamol, or acetaminophen, was initially introduced in the late 1800s and has become the most commonly prescribed medication for fever and pain in the United States. It is one class of medications recommended by the American College of Rheumatology for patients with arthritis who have not responded favorably to weight loss and Physical Therapy. Although a relatively inexpensive and commonly prescribed medication recent research has demonstrated the harmful effects of acetaminophen when combined with other pain medications which may also contain the same drug. A recent Cochrane Review of the evidence analyzed acetaminophen’s effects on patients with hip or knee arthritis.

Leopoldino and colleagues reviewed 10 randomized placebo controlled trials of 3541 patients with either hip or knee arthritis (Cochrane Review. 2019). Patients within these trials were followed for up to 24 weeks to determine the impact of the medication on pain, activity, and adverse events. Authors reported at 3 and 12 week follow there was high quality evidence that acetaminophen provided no clinically important improvements in pain and physical function. No increased risk of adverse events was found among the medication vs. placebo patients. Patients with knee or hip arthritis should follow up with their physician before making any medication decisions.

Early Physical Therapy Associated With Reduced Long Term Opioid Use

Each day over one hundred Americans die from an opioid overdose. Over prescription and use of prescription pain relievers has largely contributed to these unnecessary deaths and the $78 billion dollar economic burden of the opioid epidemic. Authors estimate over 2 million Americans are currently suffering from a substance abuse disorder related to these prescriptions. Experts are now recommending non pharmaceutical pain relieving alternatives including meditation and Physical Therapy. Research strongly points to the early utilization of Physical Therapy as a safe, clinically and cost effective intervention for patients suffering from musculoskeletal pain. A new research study Physical Therapists may play in the opioid epidemic.

The Journal of the American Medical Association published a review article on the impact of early Physical Therapy on the utilization of opioid medication (Sun et al. 2018). Authors reviewed the cases of over 88,000 patients with neck, back, knee, or shoulder pain. Patient cases were then reviewed retrospectively to determine the type and amount of interventions utilized to treat these patient’s symptoms. Authors reported early Physical Therapy was associated with a significant reduction in the amount of opioids prescribed and the duration of these prescriptions. Authors recommended Physical Therapy as a first line intervention for a treatment of these musculoskeletal conditions.

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Patients Who Seek Care from Physical Therapists Are Less Likely To Use Opiates

Some of the highest quality Physical Therapy research details the effectiveness of our profession treating patients with neck pain.  Patients can expect an accelerated recovery with less short and long term pain if they see a Physical Therapist for their neck symptoms.  In addition, Physical Therapy interventions including manual therapy and exercise are about 1/3 the cost of seeing a primary care physician first for neck pain.  Recent research is also highlighting other important benefits of seeing a Physical Therapist first for neck pain.

Researchers from Duke University analyzed 1700 patients with neck pain to determine which interventions and providers they utilized during their course of care (Horn et al. Proceedings: Innovations, Quality, and Outcomes).  The authors reported patients chose to see either their Physical Therapist, primary care physician, specialist, or chiropractor as the first provider in their care.  Patients seen by a Physical Therapist first were less likely to receive opioid medication in the first year after the onset of their symptoms.  In addition, these patients were less likely to use more expensive, risky, and invasive procedures for their neck pain including injections compared to patients seen by physicians.

This study highlights the importance of patient self referral to Physical Therapy for neck pain symptoms. 

Ibuprofen's Impact on Muscle Growth and Development

Non Steroid Anti Inflammatory Drugs (NSAIDS) such as ibuprofen are the most common drugs listed on our patients intake paperwork.  Patients are often using these drugs due to their beneficial effects on pain and inflammation.  Due to being sold over the counter these drugs are often thought to be free of side effects, but they lead to close to 80,000 hospitalizations and 8,000 deaths due to gastrointestinal bleeding.  In addition to these serious consequences, NSAIDs are also thought to delay or prevent healing after acute ligamentous and bone injury as well as reduce the beneficial adaptations to exercise.

A recent article in the American Journal of Sports Medicine studied the impact of NSAID use on the effects of an exercise program (Rooney et al. 2016).  The authors conducted an animal study placing animals in either an exercise or sedentary group.  Within each group half of the animals were placed on NSAIDs and were followed over the 8 week course of exercise.  The authors found the NSAIDs did not impair the beneficial mechanical adaptations to exercise such as stiffness or tissue quality, but did decrease the cross sectional size of the muscle.  The results of the study suggest the animal's medication use attenuated the normal growth of the muscles in response to the exercise.    

This study adds to the existing literature on the impact of NSAIDs on healing and adaptations to exercise.  Patients are advised to speak with their primary care doctor regarding these medications, their effects and side effects.