Literature Review Paper

Joint pain, particularly in the knees and shoulders as well as back pain constitute the large majority of patients who present to their doctor's office with a complaint of pain. Many of these patients proceed to have surgery, all too often with less than optimal outcomes. Many of these patients still have the same pain

1. The researchers found a significant difference between the two groups (control and treatment) for change in mobility of the women with osteoarthritis (OA) over 12 weeks with the results of F(1, 22) = 9.619, p = 0.005. Discuss each aspect of these results.

Acupuncture can be used to treat osteoarthritis. It is based on an idea that there are channels throughout the body called “meridians” and that these allow the transport of an energy known as “Qi.” (NHS. 2012. Acupuncture.) Generally, acupuncture involves the insertion of needles at specific points along the body - these are known as “acupoints.” This insertion is thought to lead to the movement of Qi throughout the body, which causes biomedical changes that result in the “promotion of physical and emotional well-being” through the release of endorphins. (British Acupuncture Council. 2011. Acupuncture and Osteoarthritis.) Inserting needles at specific acupoints to treat osteoarthritis sends a message to the brain that assists in the reduction of “sensitivity to pain and stress.” (British Acupuncture Council. 2011. Acupuncture and Osteoarthritis.) This reduction in pain can allow for a better range of movement, thus function.

In addition, regression analysis was used to determine independent variable among age, BMI, grip strength, sex and K/L grade for knee pain. The result indicated that the most significant variable was BMI correlated with the occurrence of knee pain. ORs of BMI (+5 kg/m2) was 1.54 and the risk was 0.60 which was significant. This implied that the ORs of K/L grade for knee pain can be overestimated due to the possibility of extremely low risk of K/L grade. In fact, the percentage of participants who suffered from knee pain with K/L (grade 2) and K/L (grade 3 and 4) was just 61.0% and 71.0% respectively. In other words, it will be about 40% of participants with K/L grade 2 and about a third of subjects with K/L grade 3 and 4 had no pain at the knee joint at follow-up.

1. The researchers found a significant difference between the two groups (control and treatment) for change in mobility of the women with osteoarthritis (OA) over 12 weeks with the results of F(1, 22) = 9.619, p = 0.005. Discuss each aspect of these results.

“Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals (Mayoclinic Staff, 2015).” There are several theories as to why this pain continues to exist post treatment. Researchers have postulated that this disease process amplifies painful sensations in your brain, others retain that it acts like an arthritic condition as it degrades the joint capsule and most soft tissue within. These patients can display a wide variety of symptoms ranging from sleep problems and fatigue, to pain and muscle spasms and or muscle

A post hoc-pair-wise comparison test was done to obtain the mean change among the three treatment groups with p values. P values that was greater than 0.5 were considered to be significant for the study. The author found that there were some changes in the participants physical activities where the TENS unit had caused the Fibromyalgia pain to subside where patients were able to have an improved quality of life. The effectiveness of this study does remain controversial due to TENS unit being self-administered by the

Ng, N., Heesch, K., & Brown, W. (2012). Strategies for managing osteoarthritis. International Journal Of Behavioral Medicine, 19(3), 298-307. doi:10.1007/s12529-011-9168-3

The fifth article critiqued is the first update of a clinical practice guideline (CPG) authored by the American Academy of Orthopedic Surgeons (AAOS). The purpose of this systematic review is to evaluate the best available evidence associated with nonsurgical treatment of knee OA. To be included in this study, the subjects must be original research treating knee OA with pain, function, and disability status as the primary outcome measures. Studies were excluded based on design and if they were of very limited strength of evidence. The authors searched the databases PubMed, EMBASE, CINAHL, and Cochrane Register of Controlled Trials. The recommendations in this CPG are based upon the evidence found in these studies. When critiquing the articles, the authors analyzed the quality and applicability of the studies using the Grade Evidence Appraisal System and the PRECIS Instrument. The authors made the following recommendations for braces and insoles.

Pharmacological treatments include analgesics, nonsteroidal anti-inflammatory drugs (NSAIDS), opioids hyaluronic acid, corticosteroid injections (Citiation Garcia) or disease-modifying osteoarthritis drugs (DMOADs) such as sodium pentosan polysulfate. Kumagai et al researched the efficacy of subcutaneous injections with sodium pentosan polysulfate on the improvement of cartilage while Garcia-Padilla et al researched the efficacy of intra-articular injections of bicarbonate and calcium gluconate. For treatments to be clinically significant they must alleviate the symptoms; therefore, the treatment should decrease the patient?s level of pain and/or joint stiffness from moderate to mild while resting or being active. The normal range of motion of the knee is 0 to 130 degrees for flexion and 120 to 0 degrees for extension(CITATION Mercks); therefore, within the affected joint the range of motion should increase by 10 degrees. However, the range of motion will be affected by the amount of cartilage lost and scar tissue in the knee joint; therefore, a full recovery in the range of motion should not be

Muscle strength and neuromuscular control is compromised. This could develop into long-term muscle weakness and motor planning dysfunction. Transcutaneous electrical nerve stimulation (TENS) could be utilized to help control pain and improve muscle weakness related to arthrogenic muscle inhibition. Evidence shows that TENS is effective in improving maximal voluntary torque and electromyographic signals of muscles (Konishi, McNair, & Rice, 2017). Mr. Versace may benefit from TENS on quadriceps femoris muscle to minimize muscle strength deterioration

The great traditional healing for joint affliction, equivalent to osteo­arthritis often involves prescribed exercises to maintain the joints flexible, motivate nourishment of the cartilage, and support

Osteoarthritis is the most common joint disorder, and more than half of all Americans who are older than 65 have been diagnosed with osteoarthritis. However, recent US data has revealed knee osteoarthritis does not discriminate age, and there is growing evidence that osteoarthritis affects individuals at a young age. The annual cost of osteoarthritis due to treatment and loss of productivity in the US is estimated to be more than 65 billion dollars.1 With no cure currently available for osteoarthritis, current treatments focus on management of symptoms. The primary goals of therapy include improved joint function, pain relief, and increased joint stability. Although the exact cause of osteoarthritis is unknown, many risk factors have been identified including increased age, female gender, obesity, and trauma.2 Within these risk factors, the etiology of osteoarthritis has been divided into anatomy, body mass, and gender.

OA is a musculoskeletal disease that causes chronic joint pain and reduced physical functioning (Laba, brien, Fransen, & jan, 2013). Osteoarthritis (OA) is a non-inflammatory disorder of synovial joints that results in loss of hyaline cartilage and remodeling of surrounding bone. OA is the single most common joint disease, with an estimated prevalence of 60% in men and 70% in women later in life after the age of 65 years, affecting an estimated 40 million people in the United States (Goodman & Fuller, 2009). Women are more commonly affected after the age of 55, almost everyone has some symptoms by the age of 70 (Tan, Zahara, Colburn & Hawkins, 2013, p.78). Osteoarthritis can be described radiological, clinical, or subjective.

The second journal article I found was about TENS at both high and low rate frequencies reducing primary hyperalgesia in rats with joint