THE GROWING PROBLEM OF KNEE PAIN
"Recent Center for Disease Control and Prevention (CDC) and National Center for Health Statistics (NCHS) data suggest substantial rates of pain from the various causes...... For U.S. adults reporting pain, causes include knee pain (19.5%)" From the American Academy of Pain Management's Facts and Figures on Pain.
A new study (Annual Incidence of Knee Symptoms and Four Knee Osteoarthritis Outcomes in the Johnston County Osteoarthritis Project) from the official journal of the American College of Rheumatology (Arthritis Care and Research) sheds some light on the explosive manner in which KNEE PAIN and arthritis are increasing in America.
Johnston County, North Carolina, with a population of around 175,000 is not too far from the Raleigh / Durham / Chapel Hill metro area, and has been home to an ongoing study on Osteoarthritis (OA), otherwise known as DEGENERATIVE ARTHRITIS or DJD since 1991. After specifically looking at arthritis of the knee, the authors concluded that, "The annual onset of knee symptoms and four OA outcomes in Johnston County was high, and may preview the future of knee OA in the US." This itself begs the question of how many people are being diagnosed with new cases of knee pain / knee arthritis each year in Johnston County? Try 5.6% of the population on for size (the CDC's website says it is 3.5%).
Of course the authors said that this, "underscores the urgency of clinical and public health collaborations that reduce risk factors for, and manage the impact of, these outcomes." Other than being older (over 75) one of the top risk factors for knee pain was, as you might guess, OBESITY / OVERWEIGHT. Is this a problem in North Carolina? Here is what a collaboration between the government and private sector (Eat Smart, Move More NC) says. "In North Carolina, two-thirds of all adults (65.7%) are overweight or obese, and North Carolina ranks 5th worst in the US for childhood obesity." It's almost guaranteed that these figures are too low, as a brand new study (Prevalence of Overweight and Obesity in the United States, 2007-2012) published one week ago today in JAMA Internal Medicine, revealed how severely we have been underestimating / under-calculating America's weight problems.
It's interesting, but even though every article or study I see talks about the nature of our national poor health issues as related to our burgeoning waistlines --- calling for more money to be spent on education, physical activity, better diet, etc (see the first red sentence in the previous paragraph) ---- the problem continues to grow, with every study being worse than the study that came out before it. Unfortunately, many doctors are taking advantage of this --- and not only with unnecessary surgeries (HERE or HERE).
Doctors of all kinds are advertising solutions for Chronic Knee Pain and Obesity, not to mention DEPRESSION, INFERTILITY, TYPE II DIABETES, NEUROPATHY, FIBROMYALGIA, and a myriad of others (just look at the ads in the newspapers of any large city). Because most health problems and pain syndromes are based on INFLAMMATION, these health problems are not only related to each other, but have common origins. HERE are some examples of solutions that you can have free of charge. Although there are some knee-specific exercises and protocols you may need to do in order to solve your specific knee problem, following this program (with your doctor's permission) will help you with any number of health problems and pain syndromes you may be dealing with, and help get you off the DANGEROUS DRUGS you are continually advised to take.
1.) Dr. Marcia Angell, former editor of The New England Journal of Medicine
2.) Jerry Kassirer, also a former editor of the New England Journal of Medicine
3.) Richard Horton, editor of the Lancet
A.) "Journals have devolved into information laundering operations for the pharmaceutical industry".
B.) Big Pharma is "primarily a marketing machine," that destroys or takes over "every institution that might stand in the way."
C.) "The moral compass of many physicians has been deflected by the pharmaceutical industry."
"The most conspicuous example of medical journals' dependence on the pharmaceutical industry is the substantial income from advertising, but this is, I suggest, the least corrupting form of dependence. The advertisements may often be misleading and the profits worth millions, but the advertisements are there for all to see and criticize. The much bigger problem lies with the original studies, particularly the clinical trials, published by journals. Far from discounting these, readers see randomized controlled trials as one of the highest forms of evidence. A large trial published in a major journal has the journal's stamp of approval, will be distributed around the world, and may well receive global media coverage, particularly if promoted simultaneously by press releases from both the journal and the expensive public-relations firm hired by the pharmaceutical company that sponsored the trial. For a drug company, a favorable trial is worth thousands of pages of advertising, which is why a company will sometimes spend upwards of a million dollars on reprints of the trial for worldwide distribution. The doctors receiving the reprints may not read them, but they will be impressed by the name of the journal from which they come. The quality of the journal will bless the quality of the drug."
Gulp! But this was written just over ten years ago. Surely things are different now? Surely they've changed? Surely this situation is under control? It would be nice to believe so, but they aren't, they haven't, and far from it. Despite all the talk, the studies, the meetings, the regulations, and the governmental oversight, this thing we erroneously refer to as EVIDENCE-BASED MEDICINE continues to disappoint.
Some of the highest-rated recent shows on television have been the programs where magicians pull back the proverbial curtains to reveal how the profession's tricks and illusions are actually done. One of the most interesting parts of this study is where Smith does the same --- he reveals a few of the ways that drug companies are able to prove anything they want to. I've dealt extensively with some of these, but below is some of his list.
- If a study looks like it's going south, simply bail on it and don't publish it (HERE).
- Set up the study in absurd fashion, but make wild claims because no one reads these things anyway (THE CUPCAKE STUDY and the recent Chocolate study / hoax by Dr. John Bohannon --- I Fooled Millions Into Thinking Chocolate Helps Weight Loss. Here's How) are prime examples of this phenomenon.
- Make sure your drug is being tested against a drug that is already known not to supply great results.
- Play with dosages of the competitors drugs. Just make sure that when you compare your drugs against theirs, the dose of theirs in not in the "optimal" range.
- Data Mining is another technique where you do a study, and twist the data in any number of ways until you find something you can tout in a journal.
- Present impressive results by showing decreases in relative risk rather than decreases in absolute risk
- Use small sample sizes. If you've ever studies statistics, you already know how important it is to have a study large enough to provide "Statistical Significance".
- Multicenter Studies are done by different groups at different facilities, sometimes on different continents. The results can be combined, juggled, or both (or not) so that it appears that the drug is far better than it is.
IT'S ALL ABOUT THE MONEY
Interestingly enough, the first major topic in Rosenbaum's first letter concerned THE LATEST CHOLESTEROL GUIDELINES, which, as you can tell if you click the link, I addressed myself last year. She says, "True, 7 of the 15 committee members had current or previous ties to industry, mostly in the form of research support or consulting fees. Nevertheless, it does not seem reasonable to conclude that their recommendations were motivated by a desire for financial gain." If you believe that, I have some Ocean Front Property in Arizona that I bought from George Strait back in 1986 --- I'll make you a great deal on it!
She then goes on to justify the incestuous relationships between Big Pharma and Big Medicine by saying that, "Physician–industry interactions are common and diverse, ranging from the $10 bagel sandwich to the $1 million research grant... I think we need to shift the conversation away from one driven by indignation toward one that better accounts for the diversity of interactions, the attendant trade-offs, and our dependence on industry in advancing patient care." Diversity. It's a popular catch-word in our modern world. In light of what's going on in the industry, using it in this context is a greasy, shallow, and hollow attempt to justify COI --- financial or otherwise.
After discussing Merck's VIOXX DEBACLE and mentioning the THREE BILLION DOLLAR SETTLEMENT a few years back by GSK, and referring to it as what it was; "the cost of doing business, " she ends with this. "As the gap between evidence and impressions grows, reasoned approaches to managing financial conflicts are eclipsed by cries of corruption even when none exists." This 'gap' could undoubtedly be likened to the CHASM between the research side of the medical field and the practice side. I would suggest that you go back and click on my 'Cholesterol Guidelines' link above and tell me that no corruption exists. I would also suggest you read this article, as well as the next two in the series. They are free online. I would contend that Rosenbaum is taking a position that is extremely difficult to defend in light of the rampant corruption taking place within the industry. Some ex-editors would agree.
THREE ON ONE: HITTING BACK HARD
After Dr. Angell dropped her COI bombshell in 1998 (you can read about it HERE), she was replaced as editor of the NEJM. But for the next few years, policies were created to "force" authors of studies to reveal their financial conflicts of interest. It didn't last long. I well remember the policy being eased because it was so difficult to find authors without ties to the industry. The authors admit this by revealing that, "In 2002, however, after Drazen succeeded Angell, the policy was weakened, so that it only applied to authors with 'any significant financial interest in a company (or its competitor) that makes a product discussed in the article.'"
Their article ends with them rhetorically wondering if the purpose of this series of articles is to get the public ready for another 'loosening' of NEJM's financial COI policies. The three answer thusly; "In 1990, it was a bad idea for authors of editorials, review articles, and other opinion articles in medical journals to have financial conflicts of interest. A quarter of a century later, it is a very bad idea." Having been watching this fiasco since 1988, I can assure you that things are not getting better. The amount of money on the table is unfathomable, with everyone trying to get as big a slice of the pie as they can get.
ADHESED FASCIA IN CHILDREN
MORE COMMON THAN YOU MIGHT SUSPECT
The May issue of Practical Pain Management carried an article called Pain in Children that dealt with everything from HEADACHES, Growing Pains, Abdominal Pain, etc, etc. But since it did not tell me how many children are dealing with pain on a day-to-day basis, I went to the peer-reviewed literature. The December, 2011 issue of Pain (The Epidemiology of Chronic Pain in Children and Adolescents Revisited: A Systematic Review) had the statistics, but they were all over the place. "Prevalence rates ranged substantially, and were as follows: headache: 8-83%; abdominal pain: 4-53%; back pain: 14-24%; musculoskeletal pain: 4-40%; multiple pains: 4-49%; other pains: 5-88%. Pain prevalence rates were generally higher in girls and increased with age for most pain types."
Several months prior to that, The Scandinavian Journal of Caring Sciences (Pain in Children and Adolescents: Prevalence, Impact on Daily Life, and Parents' Perception, A School Survey) came to similar conclusions. "Pain problems in children and adolescents have increased during the last 20 years and have been identified as an important public health problem. Sixty per cent of the children and adolescents reported pain within the previous 3 months. Pain increased with age, where girls aged 16-18 years reported the most pain. Total prevalence of chronic pain was 21%. Children reported impact on social life; inability to pursue hobbies, disturbed sleep, absence from school, and inability to meet friends because of pain. The girls reported significantly more frequently disturbed sleep, loss of appetite, and use of medication, compared to the boys. There was little agreement between parents and children regarding pain. Pain is a common problem and influences the daily lives of children and adolescents." This statement raised a couple of good questions. Why would pain be increasing in children, and why would there not be much agreement between parents and children about said pain? Answering these two questions will help get us to the crux of the matter.
Many, if not most, of the most common forms of Childhood Pain are FUNCTIONAL. In other words, when we look at things like MRI or blood work, there is no overt pathology present. And as far as musculoskeletal pains go, much of this inability of doctors not being able to determine what is really wrong with a child has to do with the fact that FASCIA DOES NOT IMAGE well with standard tests despite the fact that it is far more linked to health (or a lack of it) than you have ever imagined (HERE). Even though various forms of MUPS are thought to be the most common reason for physical problem in America, patients (in this case, children) are sent home and their parents are told there is nothing really wrong with them (Growing Pains is the most common 'bucket diagnosis' for this age group). Thus you can see the reason that there is disagreement between parents and children. And as far as non-musculoskeletal problems in children, THIS POST should begin to help you understand the discrepancy.
WHAT CAUSES FASCIAL ADHESIONS IN CHILDREN?
To grasp this concept, you first have to understand what Inflammation really is (HERE). Secondly, you have to realize that there are any number of things that can drive it (GLUTEN, MOLD, YEAST, DYSBIOSIS, screwed up MICROBIOMES, a LEAKY GUT, MERCURY TOXICITY, HIGH CARB DIETS, etc, etc, etc). And finally, it is critical to realize that the end result of Inflammation is always the same thing --- Scar Tissue and Fibrosis (HERE, HERE, HERE, and HERE). I have seen Fascial Adhesions in very young children (my own son had some issues in his neck as the result of a minor TRAMPOLINE incident when he was four or five). One of my "EARLY PATIENTS" this morning was an 11 year old gymnast with OSGOOD SCHLATTER SYNDROME --- a perfect example of a painful childhood condition that is tissue-based.
SOLVING PAINFUL CONDITIONS IN CHILDREN
The really cool thing is that when it comes to ADJUSTING CHILDREN, few things are easier. And as for the BRUISING associated with clearing out problems with the Fascia, not only do I rarely have to get that intense with really young kids, if I do, they almost universally tolerate it better than you might think. And the neat thing is, many of these changes are IMMEDIATE, as opposed to requiring months of treatment --- or using DANGEROUS DRUGS to mask symptoms, while hoping (keep those fingers crossed) that the problem eventually takes care of itself. If you are looking for some general guidelines, HERE they are.
CHILDREN IN PAIN
Robbins gets the ball rolling by telling us that, "Headache is a common complaint among children and adolescents." Because he doesn't tell us just how prevalent HEADACHES are in this population, I looked at the science. The December, 2013 issue of Pediatrics in Review (Pediatric Headache: A Review) stated that, "Headaches are common in children and adolescents and are a frequent chief complaint in office and emergency department visits. Depending on the study definition of headache, population involved, and time periods studied, 17% to 90% of children report headaches, with an overall prevalence of 58% reporting some form of headache in the past year." How many of these Headaches are MIGRAINE HEADACHES? In a brand new article for Medscape (Migraine in Children), Dr. William C. Robertson reveals that, "Migraine is a common disorder in children. Estimates indicate that 3.5-5% of all children will experience recurrent headaches consistent with migraine."
We learn that in similar fashion to adults, "the vast majority of headaches in children and adolescents are.... migraine, tension-type headache, and chronic daily headache." He goes on to tell us how said headaches should be diagnosed --- via a "thorough history and physical examination." What's interesting is that regardless of anything that Dr. Robbins is doing in his clinic, what should be and what is, are two very different things. For instance, for years I have been increasingly hearing the same thing from people visiting specialists for all sorts of musculoskeletal complaints --- I went to yet another doctor and he didn't examine me either. In fact, I find it particularly ridiculous that despite the huge amounts of peer-reviewed literature linking abnormal ranges of motion of the cervical spine to Headaches, THESE RANGES OF MOTION are rarely if ever checked --- particularly in children, and particularly if there is no history of trauma (HERE).
Instead, even though Dr. Robbins lets us know that the guidelines clearly state that most diagnostic tests are completely, "unnecessary" (laboratory investigation usually is not warranted.... Neuroimaging studies usually are not indicated in children with a normal neurologic examination...., especially migraine or tension-type headache. These children usually will not have significantly abnormal findings on head CT scans or MRI), the first thing that most physicians immediately order is some sort of advanced imaging --- HERE (especially CT) and blood work --- just to make sure that we're not dealing with a brain tumor.
So, when Robbins says that, "Nonpharmacologic treatments are particularly important because they typically are more effective in children and help to minimize the use of medications and their related side effects," I'm not fully convinced that he is being completely sincere. Even though he mentions things like diet, food, allergies, missed meals, perfume or other smells, stress, hormones, cigarette smoke, exercise --- to much or lack of (he recommends a half hour per day and specifically mentions swimming, walking, biking, and yoga by name), there is little time spent in discussion of any of these ---- despite having just spoken so highly of their collective benefits. When you get down to it, the focus of this paper is the drugs used most often to treat these kids.
Unfortunately, when you talk to the average person who struggles with severe headaches (child or adult), you'll find that while drugs can certainly provide some relief in some instances, drugs are not a great therapy for most people, and the results are always short-lived. There are several tables in the article and all but one concern the two classes of drugs used for treating children with headaches.
- PREVENTATIVE: These are headache meds that are taken daily with the hope that they will keep the child from getting a headache in the first place. Because these meds tend towards the harsh side, I appreciate Dr. Robbins mentioning that it is important to, "attempt to avoid daily preventive medication." If they see a 30% improvement with this class of drug, it is considered successful.
- ABORTIVE: Once the child has a headache, the goal is to catch it early enough that the medication(s) can head the brunt of it off at the pass.
Some of the drugs that are specifically mentioned include NSAIDS, various forms of ACETAMINOPHEN & IBUPROFEN, Caffeine (which also acts as a trigger for many people), NEURONTIN, ANTIDEPRESSANTS (children are the new frontier for this class of drug), BETA BLOCKERS, CALCIUM CHANNEL BLOCKERS, BOTOX, Topomax, Imatrex, and an array of others. In his defense, he does mention Magnesium as well as several herbs as showing benefit against Headaches.
But what do we already know happens to these kids once their Headaches are severe enough they are seeing doctors for them? They end up being prescribed NARCOTICS. In case you think I am being harsh or simply making this up, HERE are the studies. And if we are honest with each other (and regardless of what Dr. Robbins is doing in his clinic), we already know that not one doctor in 100 is giving any sort of meaningful dietary advice to the families of children with Headaches, other than possibly the sort given here; "eat a proper diet" (HERE'S WHY). In light of the science, I'm almost not sure how an article like this could be written without at least taking a few sentences to discuss the GLUTEN / MIGRAINE CONNECTION or mention the premise of fellow Neurologist, David Perlmutter's #1 best selling book, Grain Brain?
And in this age of EVIDENCE-BASED MEDICINE, how can an overview of Childhood Headaches fail to spend at least a paragraph on one of the hottest topics in Headache Research today (not to mention for the past decade); REBOUND HEADACHES (the headaches that are both relieved and caused by the same medications)? And what about manipulation? He fails to as much as mention it in any capacity. When a combination of CHIROPRACTIC ADJUSTMENTS and SCAR TISSUE REMODELING are used for patients with Chronic Headaches, the results are frequently nothing short of miraculous (HERE). And when this approach doesn't work, it's time to find the source of the INFLAMMATION that's driving the problem.
There are any number of Inflammatory drivers that children (or adults) can potentially be dealing with that are causing their Chronic Headaches. One of the chiefest of these has to do with GUT HEALTH. When you look at the research linking Chronic Migraine to the combination of messed up MICROBIOMES and LEAKY GUT SYNDROME, you should already be thinking along these lines ---- particularly when Dr. Robbins specifically mentions that DEPRESSION (heavily linked to Gut issues --- HERE or HERE) and GI PROBLEMS are both common "comorbidities" of Chronic Headaches. There's nothing in his article about MOLD. There's nothing said about YEAST. There's nothing mentioned about DYSBIOSIS or the various drugs that cause it (HERE). The silence on some of these issues is deafening.
Maybe this was just an issue of space (not enough of it), and Dr. Robbins did not have enough time to deal with some of these issues. But methinks not. I would contend that if Dr. Robbins combined what he already knows about Headaches, with some of DR. CARRICK'S FUNCTIONAL NEUROLOGY (or just hire a Functional Neurologist) and a took a "Functional Medicine" approach, his results would go through the ceiling. Naturally, there would be much less time spent discussing medication in his articles. If you are looking for a starting point as far as getting your child off their Headache Medications, or preventing some time on the MEDICAL MERRY-GO-ROUND, why not at least take a quick gander at THIS POST.
As always, the information in this post and on my site is just that --- information. It is not meant to diagnose or treat any sort of disease. THE FDA has declared that drugs and surgery are the only "cures" for diseases. If you feel you or your child has a disease, make an appointment with your doctor immediately, as this post is not meant to take the place of medical advice.
Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).
Brain Based Therapy
Can You Help
Cardio Or Strength
Cold Laser Therapy
Death By Medicine
Degenerative Joint Disease
D's Of Chronic Pain
Evidence Based Medicine
Gluten Cross Reactivity
Ice Or Heat
Jacks Fork River
Leaky Gut Syndrome
Number One Health Problem
Platelet Rich Therapy
Post Surgical Scarring
Re Invent Yourself
Rib And Chest Pain
Scar Tissue Removal
Sleeping Pills Kill
Stay Or Go
Stretching Post Treatment
Tensegrity And Fascia
The Big Four
Thoracic Outlet Syndrome
Whole Body Vibration