Immobility: A global burden

Agbawn David

Joints and body pain is a major reason why many people are unable to engage in physical activities such as workouts, sporting activities and normal daily routines.

Osteoarthritis and Osteoporosis are responsible for 90 per cent of immobility and physical inactivity. These lead to obesity in most cases. And obesity triggers a chain of other chronic diseases such as diabetes, cardiovascular diseases and depression.

According to the International Society for the study of Pain, pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Pain, as generally acknowledged, is mainly a signal that the body has been injured (Jenkins 1998).

Similarly, osteoarthritis (OA) has been described “as a condition characterised by use-related joint pain experienced on most days in any given month, for which no other cause is apparent (Agel et al 2000). Rehman and Lane in 1999 described OA as a chronic, degenerative disease associated with joint pain and loss of function. The primary problem in OA is the damage to the articular cartilage, which triggers a series of other events that culminate in pain and loss/limitation of function in the affected joint. In The global burden of disease and ‘The burden of musculoskeletal conditions at the start of the new millennium’ published by World Health Organisation, OA is ranked fourth in health impact in women and eighth in men in the western world (Murray 1996, Agel et al 2000). OA is estimated to affect 70 to 80 per cent of people older than 55 years. Arthritic pain is common and is associated with worse functional outcomes and poor quality of life when compared with a range of other chronic conditions. Undoubtedly, pain which is the most prominent and disabling presentation of OA, is an increasingly important public health problem especially with an increasing aging population.

For those older than 50 years, the risk factors for OA include: crystals in joint fluid or cartilage; high bone mineral density; history of immobilisation, injury to the joint, joint hypermobility or instability; obesity (weight-bearing joints); peripheral neuropathy and prolonged occupational or sports stress.

The vast body of data and research findings over the last decade has led to a better understanding of the neurophysiology of pain. This invariably is beginning to influence clinical practice. For instance anti-inflammatory agents that prevent or reduce peripheral sensitisation cannot be neglected as an important adjunct in comprehensive pain management. The important role of peripheral mechanisms in chronic pain associated with chronic inflammation is suggested by the efficacy of aspirin and Non-Steroidal Anti-Inflammatory agents, whose action is predominantly peripheral.

Again, pain medications are now prescribed and given as scheduled regimens instead of the hitherto clinical practice of ordering pain medication on an as-needed basis. Furthermore, severity of chronic pain and its associated complications have been found to be greatly reduced when more potent analgesics are started earlier.

Thus, substantial pain control for some patients has been achieved by using sustained release opiate preparations aimed at reducing breakthrough pain and associated adverse effects (Hale et al 1999). Because of the present understanding of the neurophysiology of pain and because of the findings that opiates have both peripheral and central analgesic effects, opiates are now been used in conditions such as arthritis in which they had previously been avoided.

Although guidelines are increasingly used in a range of settings to promote effective multidisciplinary health care in managing arthritic pain ranging from education and behavioural change, there is still the use of analgesics such as paracetamol, opioids, non-steroidal anti-inflammatory drugs, to intra-articular injection of drugs such as steroids.

Unfortunately, the side effects of these agents such as the development of gastrointestinal events like ulceration, bleeding and perforation from the use of NSAIDS is of great concern and many patients have declined using these agents. Toxicity still remains a topical issue with opioids such as constipation, nausea, somnolence and addiction. The development of diabetes, immune-suppression and osteoporosis are also the challenges of using steroid for a long time.

Secondly, these agents are only for palliative purposes whereas the degenerative and pathologic processes continue.

The question now is; can there be an agent which can effectively stop the degenerative process, and which is the underlying factor for pain in osteoarthritis without these unfavourable adverse/side effects?

Currently, research has shown that biomolecules such as Glucosamine, Chondroitin, Hyaluronic acid, and so on, could be the way out. They have started gaining ground in the developed society with some research concerning their roles in halting the degenerative processes in arthritis and other arthropathies. However, these are not without adverse effects. Low bio availability and gastrointestinal toxicity is the major challenges of most existing medication.

Only recently, a Singapore company introduced URAH micellar transdermal cream which seems to work quite well according to most patients.

David, a medical doctor, sent in this piece via agbawnd3rd@yahoo.com

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