Tag Archives: pain management

The Implausible Rheumatologist

A few weeks ago, Dr. R.W. posted this article about Rheumatologists’ views of complementary and alternative medicine. The results were as follows:

Of 600 rheumatologists who were sent the questionnaire, 345 responded (58%); 80 (23%) were women. Body work had the highest perceived benefit, with 70% of respondents indicating benefit. Acupuncture was perceived as beneficial by 54%. Most were willing to recommend most forms of CAM. Women had significantly higher composite benefit and recommend responses than men. Rheumatologists not born in North America were more likely to perceive benefit of select CAM therapies.

Is this surprising? No, not to me. One of the challenges of caring for people with chronic pain is that brick wall both the doctor and patient hit time after time. With the best intentions, I will deliver my evidence-based argument about how time, exercise and other conservative treatments like ice/heat and NSAIDS are best for musculoskeletal complaints like back pain. I will cite studies that dissuade use of narcotics for chronic musculoskeletal pain. I will try to convince my patients that an MRI is not needed “just to make sure” at the first twinge of pain. And yes, I can find studies to back up all these things. And when the patient hasn’t had any success with my evidence-based recommendations? Why can’t massage be beneficial? I don’t think many people in this day and age think of massage as an “out there” treatment. Yoga? Great. Meditation? Super. Anything that helps us slow down and relax. Start talking about energy treatments and I’m a little skeptical but if you think it helps you and it’s not hurting you, go for it (and I am hoping a certain Reiki practitioner isn’t reading this, you know who you are).

Chronic pain is very difficult to have and very difficult to treat. I’d like to try to keep an open mind regarding possible therapeutic options. I think, and perhaps this survey illustrates the point, that I’m not alone in this opinion. OK, I’m ready for the onslaught!

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I said, “DOES YOUR KNEE HURT?”

Have you heard this? (Pun intended). There was a recent article in the American Journal of Medicine on analgesic use and risk of hearing loss in men. [picapp align=”right” wrap=”false” link=”term=man%27s+ear&iid=5066105″ src=”f/9/4/7/Young_man_with_bf0a.jpg?adImageId=11190073&imageId=5066105″ width=”337″ height=”506″ /] The full text of the article can be found here. The study concluded that regular use of aspirin, NSAIDs, or acetaminophen increases the risk of hearing loss in men, and the impact is larger on younger individuals. In the days after this study was published, I saw these findings quoted on dozens of websites, news programs, blogs and twitter. Haven’t had any patients ask about it yet.

It is difficult to know how to interpret this. People aren’t typically throwing back handfuls of analgesics for no good reason. Use of these medications always requires a careful risk/benefit analysis. Might it cause someone to pause and consider whether he/she really needs an oral analgesic? Sure, but many times the other options are limited. Interesting to note, but at this point not something that will change clinical practice.