Bad Knees Blog - take 22: It's all about the pain (relief)
Bad Knees Blog 20 – It’s all about the pain relief
There isn't much to report since my last entry. Four and a half months after my stem cell treatments, my knee continues to improve. Each week is better than the last, and I'm just about ready to tackle the Niagara Gorge hike. Worst case scenario- it'll hurt, and I'll have to take it slow. If that goes well, we'll do a couple relatively small climbs in the Adirondacks. I'll keep you posted.
How do you cope with pain? Ever since I started this weird knee journey, I’ve explored that question in depth. Here is my non expert take on the quest to make the hurt go away.
As most of you know, I’ve dwelled on the subject of pain and, as a result, have become something of a royal pain in the keester to anyone who is foolish enough to ask, “How are you feeling, Ralph?” Don’t ask and I won’t tell – well at least I’ll try to hold myself back. On the other hand, the world is full of kindred spirits, brothers and sisters in pain, so I have a whole new social group.
First, and most importantly, arthritis is not the problem. If I could have pain free arthritis, I’d be okay. That’s why cortisone has such a big fan club. Pain is the problem, and I have plunged the depths of pain relief over these many months. Here is my journey through the myriad pain relief anti-inflammation potions and schemes out there - all of which, I am mildly embarrassed yet delighted to say, I have tried. I'll discuss each one and give my not so objective opinion on its effectiveness.
ibuprofen
I love ibuprofen. It is, as my doctor likes to say, a good drug. In recent years I’ve taken to popping the little brown pills (off brown?) in handfuls. When a doctors asks me how much I take at time, I say 800 milligrams. That’s two to four times the recommended dose, but it’s typical for people overcoming muscle injuries. The bottom line for me is that it works. I took two ibuprofen tabs the other day for my back. I wound up an old injury by doing too much and forgetting that I’m not twenty. That was the first time I’ve used it since the end of February, and I think I’ll stay away. It works, but like most NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) it can have serious side effects. I’ve managed to get along without for this long, so I’ll keep it in reserve for those moments of need rather than sprinkling it on my cereal in the morning.
My verdict – ibuprofen is great, but it should be used carefully.
naproxen sodium (Aleve)
I’ve never had much luck with this particular little blue pill. I’m told it gives people long lasting relief, but it doesn’t do much for me. The same cautions apply here as with other NSAIDs.
My verdict – if it works, use it.
aspirin
Aspirin works fairly well on my pain, but like the previous two drugs, it has some serious downsides. I haven’t used aspirin much for many years, but a good buffered aspirin can take the edge off of pain, so go for it if you like it.
My verdict – see naproxen sodium
acetaminophen (Tylenol)
I find that acetaminophen doesn’t work well on my muscle aches and does nothing for inflammation. It’s great for headaches, but it can also burn out your liver if taken with alcohol and in massive doses.
Acetaminophen preparations often pair the drug with stronger drugs such as codeine and oxycodone. These work somewhat better than the drug alone, but they also contain opioids, so they should be taken cautiously.
My verdict – it has its place, but it shouldn’t be overused.
steroidal cortisone injections
First comes the needle pick, then the excruciating burning in the joint, and finally, the unbelievable relief. That’s what cortisone injections mean to me. If I could love a pain reliever, I’d love this one. But, like most solutions, they have a serious down side. Too many injections will compromise ligaments and bones and further degrade an injury.
My verdict – I said “love” and I meant it, so get a couple cortisone shots while you’re going through therapy and exploring other options.
acupuncture
In 1983, Cindy, six-month-old Erik and I were on a plane from L.A. to Shanghai. A number of our fellow travelers were on the way to a conference on Eastern medicine and the complementary practices of acupuncture, cupping, and moxibustion. I was intrigued, but I didn't experience either until about four years ago when I thought my knee problem was a simple IT Band injury. I went to a local acupuncturist (thanks to my insurance bonus card) and, although the treatments didn't cure anything, I found that I rather enjoyed the meditative process and the relaxing effects of the needles.
My verdict - acupuncture eased the discomfort and pain somewhat.
cupping
I mention this only because of my 1983 encounter and because, at one point, Mark, the acupuncturist pulled out his collection of small glass cups, heated them, and attached them to my leg. As the air inside the cup cools, it creates suction and, I'm told, stimulates healing. I don't know the theory, and it only happened once, but I mention it because it was an interesting experience. I went home looking like I'd been attacked by an affectionate octopus.
My verdict - hard to judge based on one experience, but it's worth exploring.
moxibustion
I’m not exactly sure. It’s something about burning or blistering the patient’s skin.
My verdict – I don’t think I’ll try this one.
sour cherry juice
As I became more aware of the gravity of my bad knee situation I looked for ways to lessen the inflammation and ease the pain. Sour cherries and cherry juice have a lot of fans, and there is strong evidence that a daily dose or two can help heal muscle and bone injuries and can be especially effective with osteoarthritis. I took two tablespoons twice a day for several weeks. I wanted it to work but, alas, I didn't notice any real improvement.
My verdict - I believe our cherries can be effective based on the studies I've read, but it didn't work for me.
ginger
I like candied ginger. I keep a bag of it next to my stash of 78% cocao dark chocolate. I like it. It works for heartburn.
My verdict - it's also great in Asian food.
fish oil
I wish I could say. I developed a sensitivity/allergy to crab, lobster, and the like in my thirties. The day I learned I could no longer hit the all-you-can-eat crab emporium without getting horribly sick for days after was a sad day indeed. Over the years the sensitivity has grown to include salmon and certain other pescetarian delights and, sadly, I am unable to take fish oil. Fortunately, I'm still good with trout, perch, mussels, clams, cod and other white fleshed dainties.
My verdict - the evidence that fish oil has numerous beneficial qualities is strong, but I can't say from my experience.
arnica
First, I confess that I came to arnica with a deep skepticism. On the other hand, I was prepared to be convinced that my doubts were unfounded. I'm sorry to say that I remain a skeptic. I wanted to be fair, so I used the stuff twice a day as directed, but the promised relief from inflammation and pain never came. Then I went to the research and, unlike cherry juice and acupuncture, there is no compelling evidence that arnica does anything for pain, inflammation, or bruising. I realize that a lot of people swear by the stuff, but their testimony is exclusively anecdotal, and any perceived effects are based on coincidence or simply wishful thinking.
For a current, thoughtful discussion of the various forms of arnica on the market, check out this article: "Does Arnica Cream Work for Pain?" by Paul Ingraham,
Vancouver, Canada. https://www.painscience.com/articles/arnica.php
My verdict - people will believe what they want to believe, but in my opinion, arnica gel and other arnica based preparations are snake oil. Save your money.
electrical stimulation
When Shaquille O’Neal tells me that the “Smart Relief” electrical therapy patch will give me relief from my arthritis pain, I’m a believer. So I bought one and, as with so many other promises, I was disappointed. I realize that tens units are proven to help many people with pain, but this thing made my knee blow up like a throbbing balloon. It didn’t help; it hurt. I returned it. I admit I may have misread the directions, and more expensive units may be more effective, but it was a nasty experience.
My verdict – talk to your doctor for this kind of advice, not Shaq.
oxycodone
I used it when I needed it for the procedure and for two days after. It got me through the pain, and for that I’m grateful.
My verdict – it still scares the hell out of me, but it can be a life saver.
muscle relaxants
I was prescribed a muscle relaxant with the oxycodone to get me through the drilling and harvesting process. I don’t recall what it was, but it worked, and it reminds me of a time many years ago when I was visiting a friend’s house in Minnesota. I had a headache, so she told me there was some Tylenol in the bathroom medicine cabinet. What she failed to mention was that there was a prescription muscle relaxant in an old Tylenol bottle. It seemed odd that they were green, but I’m no pharmaceutical color expert, so I took two. You’ve heard of Minnesota nice? I was Minnesota relaxed.
My verdict – the stuff works, but it ain’t Tylenol.
other minutia
I’ve used topical pain rubs of all kinds, tried various online therapeutic exercises, meditated, listened to hypnosis recordings, had deep muscle massage, chanted, and tried to will my knee into submission. I’m sure I’ve even forgotten a few things.
My verdict – Tiger Balm muscle rub feels good, physical therapy works if it’s the right physical therapy, I enjoy meditation, hypnosis is a lot like meditation, so I enjoy that too, deep muscle massage feels great, chanting will get people talking about you, and willpower can’t fix bone on bone pain.
My current regimen
I am following the doctor’s orders and taking prescribed doses of Collagen II, glucosamine chondroitin (vegetable based), vitamin D, curcumin (turmeric), and omega threes (through flaxseed oil in lieu of fish oil). I also apply infrared heat once a day or so, avoid icing the joint altogether, and am continuing a rigorous exercise routine that began as physical therapy.
My verdict – my fingernails are no longer thin and brittle, I have dramatically increased range of motion and strength, I’ve lost weight, and people swear that I’m not a day older than 35.
Be happy; be good; I'll be back soon.
