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LIVING WITH THE PAIN OF OSTEOARTHRITIS…

Osteoarthritis is the most common form of arthritis. It is often referred to as “wear and tear” arthritis or degenerative joint disease. Osteoarthritis patients are mostly affected in the hands, hips and knees, experiencing pain, aching, stiffness, decreased range of motion and swelling.

The main symptoms of osteoarthritis are joint pain and stiffness, and problems moving the joint. Some people also have symptoms such as: – swelling – tenderness – grating or crackling sound when moving the affected joints

The severity of osteoarthritis symptoms can vary greatly from person to person, and between different affected joints.

For some people, the symptoms can be mild and may come and go. Other people can experience more continuous and severe problems which make it difficult to carry out everyday activities.

Almost any joint can be affected by osteoarthritis, but the condition most often causes problems in the knees, hips and small joints of the hands as spoken about above.

Genetics can play a part in determining whether a person will develop osteoarthritis, but other factors are also at work. It is the process of the breaking down of cartilage in the joints and the inflammatory response to that.

The symptoms may come and go in episodes, which can be related to your activity levels and even the weather. In more severe cases, the symptoms can be continuous. Mine seem to come and go and I am definitely very stiff and in pain first thing in a morning. A morning hot shower and some medication soon gets me moving better.

My main pain is in my sacroiliac joint and given the vital role that the large SI joint plays in transferring upper body weight to the lower extremities, it is commonly affected in osteoarthritis. In particular to people who have had lumber spinal fusion which puts more pressure on the SI joint. People who have osteoarthritis in their SI joints often develop osteophytes or bone spurs around the joint, leading to pain and dysfunction. I have just had this confirmed after my recent MRI.

Other symptoms you or your doctor may notice include:

  • joint tenderness
  • increased pain and stiffness when you have not moved your joints for a while
  • joints appearing slightly larger or more “knobbly” than usual
  • a grating or crackling sound or sensation in your joints
  • limited range of movement in your joints
  • weakness and muscle wasting (loss of muscle bulk)

They say you should make sure you are not overweight ( I’m not) and to try and exercise daily. Regular exercise can build muscle strength, ease joint pain and stiffness and lower your disability risk. Stretching, walking and water aerobics are good activities for people with osteoarthritis. I can only manage walking but I try and walk at least 20 minutes each day which is around 3,000 steps.

There’s no cure for osteoarthritis, but the condition does not necessarily get any worse over time. In a few cases, where other treatments have not been helpful, surgery to repair, strengthen or replace damaged joints may also be considered.

Surgery for this problem would mean fusion surgery, a bone graft and/or instruments are used to encourage bone growth over the sacroiliac joint and create one immobile unit. Joint fusion can effectively reduce pain and instability caused by sacroiliac joint dysfunction or inflammation (sacroiliitis). This is a last resort if my steroid injection doesn’t last for long but not one I am thinking of embarking on in the near future.

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7 CAUSES OF LOWER BACK PAIN IN WOMEN…

There are some causes of lower back pain which are directed to women in particular. Lower back pain can be uncomfortable and worrying, but there are lots of potential causes – and many of them are issues that can be easily dealt with.

“If you’re in severe pain which interferes with daily life, please see a doctor as soon as possible – they’ll be able to identify why you have the pain and refer you for the right treatment,” says Dr Samantha Wild, women’s health lead at Bupa Health Clinics.

Dr.Wild also explained what lower back pain in women could potentially be a sign of…

1.Premenstrual pain

Your lower back pain could just be down to your good old monthly visitor – so it’s worth checking your calendar to see where you are in your cycle. “Premenstrual syndrome, or PMS, tends to affect women a few days before their period starts and continues until a couple of days after it starts,” says Dr Wild. “Many women tend to cite lower back pain as a symptom of PMS, as well as stomach cramps, fatigue and bloating.”

2. Endometriosis

Endometriosis is a condition where the type of tissue that lines the uterus grows outside of the uterus. It tends to grow on the ovaries, fallopian tubes and other tissue surrounding the pelvis. Most say they get pain in your lower tummy or back (pelvic pain) – usually worse during your period. If you think you might be suffering from endometriosis, it’s best to make an appointment with your GP so they can investigate.

3. Pregnancy

Back pain is often considered more a symptom of late pregnancy, low back pain can actually begin in the early stages of pregnancy. Women can experience some degree of back pain throughout pregnancy. Mood changes: Mood swings are relatively common during the first trimester of pregnancy due to changing hormone levels.

4.Ovarian cysts

These are fluid-filled sacs that develop on an ovary, and the vast majority are benign. An ovarian cyst only tends to cause pain if it ruptures, or if it’s so large that it blocks blood supply to the ovaries. If this is the case, lower back pain tends to be a symptom, along with pelvic pain, irregular and heavy periods and the frequent need to urinate.. Your GP will be able to advise you on next steps if you’re worried you have an ovarian cyst.

5.Muscle strain

If your lower back pain flares up after a vigorous workout, or you first noticed it after an injury, you might have strained a muscle. Muscle strain is one of the most common causes of lower back pain. It often occurs due to repeated heavy lifting, bending or twisting awkwardly, a sudden awkward movement or over-stretching the muscle. Symptoms to expect from a pulled lower back muscle—or any type of lower back strain—typically include: Dull, achy low back pain. Strained muscles usually feel sore, tight, or achy. Pain that feels hot, tingling, or electric is more likely caused by an irritated nerve root, not a pulled muscle. Many strains can heal by themselves, but if it’s taking a long time, head to your GP, who may be able to refer you to a physiotherapist.

6. Kidney infections

Symptoms of a kidney infection often come on within a few hours. You can feel feverish, shivery, sick and have a pain in your back or side. In addition to feeling unwell like this, you may also have symptoms of a urinary tract infection (UTI) such as cystitis. A common symptom of kidney infections is pain in the lower back. If this happens, speak to your GP, who will be able to run tests and treat you.

7. Bone issues

Conditions that can cause back pain include:

  • slipped (prolapsed) disc (a disc of cartilage in the spine pressing on a nerve) – this can cause back pain and numbness, tingling and weakness in other parts of the body
  • sciatica (irritation of the nerve that runs from the lower back to the feet) – this can cause pain, numbness, tingling and weakness in the lower back, buttocks, legs and feet
  • ankylosing spondylitis (swelling of the joints in the spine) – this causes pain and stiffness that’s usually worse in the morning and improves with movement
  • spondylolisthesis (a bone in the spine slipping out of position) – this can cause lower back pain and stiffness, as well as numbness and a tingling sensation

These conditions are treated differently to non-specific back pain.

Very rarely, back pain can be a sign of a serious problem such as:

  • a broken bone in the spine
  • an infection
  • cauda equina syndrome (where the nerves in the lower back become severely compressed)
  • some types of cancer, such as multiple myeloma (a type of bone marrow cancer)

If you see a GP with back pain, they’ll look for signs of these.

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HOW TO GET THE BEST TREATMENT FOR FIBROMYALGIA…

With still an alarming number of GP’s poo pooing the symptoms of Fibromyalgia it is important that you know how to get the best treatment for it.

News 800 recently wrote an article on this saying that the first step in this process is to arm yourself with the facts. Fibromyalgia is a real disorder. The American College of Rheumatology created criteria in 1990 and 2010 that doctors have used for research studies and in clinical practice. A 2016 revision of the criteria is the most recent effort to improve on these and includes three characteristic features:

  • Significant and widespread pain
  • Severe symptoms (such as fatigue or “brain fog”) present for at least three months
  • No other clear explanation for these symptoms

Fibromyalgia often coexists with mental health conditions such as anxiety and depression, but it is not caused by mental illness.  Fibromyalgia is not “in your head,” but it is likely related to abnormal brain function. Differences in how the brain processes pain can be seen on functional MRI scans of people with fibromyalgia.

Standard approaches to treating fibromyalgia include patient education, exercise, treatment of other conditions that may contribute to symptoms (such as depression or sleep apnea) and medications.

The American FDA has approved three drugs specifically for treating fibromyalgia, including pregabalin (Lyrica), duloxetine (Cymbalta) and milnacipran (Savella). However, other medications, such as amitriptyline (Elavil), cyclobenzaprine (Flexeril) or gabapentin (Neurontin) are usually considered first-line treatments. Each of these drugs is prescribed for other conditions, such as depression or nerve pain.

So now you know the facts its time to decide who you are going to see. You will have to start with your GP but if you have heard yours does not seem to understand your condition then you can just book an appointment with another GP. The first port of call after that is to see a Rheumatologist who specialises in this type of condition.

The National Fibromyalgia Association website (America) and the UK one lists support groups in each area that can help you make these initial connections. The organization can also provide a list of “fibro friendly” doctors in your area. There are also lots of groups online you could join and ask someone near you who they would recommend. If you get a name of a Rheumatologist before you see your GP then you can request the one you want.

Keep a diary to take to the appointment with your GP of all your symptoms and when they come and what helps and what does not help it. The more you have written down the easier it is for the GP to understand. Finding the right specialist to look after you can dramatically impact on your pain and symptoms.

When I was living back in the Midlands it was a Rheumatologist who diagnosed me properly after a spinal consultant had asked me to write a diary of my pain and he was sure that it wasn’t all spine related but also Fibromyalgia. I was then referred to a pain specialist. He was my first port of call whenever I needed him. If I had a flare up he would always fit me in. He kept me relatively pain free with the right medication and different types of steroid injections and he also had me referred to a Professor of Medicine who looked after what medication I took. This made a big difference to my life and I felt in control of my pain.

Since moving down south I had to start again and my pain consultant in the Midlands wrote a letter to my new GP in the south so that I could be referred straight away to a Pain Clinic down here. The pain clinic here was totally different to the one in the Midlands and they first wanted me to go off all my medication as they were convinced a lot of my problems were side effects from them. They then sent me for a bone scan and blood tests as they felt I might be low in Vitamin D which would not help the situation.

I must admit I was a bit unsure about coming off all my medication but I decided it would probably do me good to have a change and slowly came off my opioids but just cut down on the rest of my medication. I felt so different after coming off the opioids that I made a conscious decision I would try to live without them.

Then Covid-19 hit so I had no further dealings with the pain clinic but did get a scan and they found I had osteopenia and I was low in Vitamin D so I was put on some medication to sort this out. However, the spinal and fibromyalgia pain was starting to get worse and worse so I ended up seeing a consultant through my insurance company who sent me for an MRI where they found that I also had arthritis in both my sacroiliac joints. He then referred me for a steroid injection for it. The difference was amazing and I was told I could have them every four months. I was absolutely delighted.

Four months down the line and I was ready for a top up but my insurance company decided they would not cover me for the injections any more as they were classed as a treatment for a chronic condition which my arthritis would be. So, it was back to square one again in the hope that I could get the pain team to maybe refer me to someone for the injections.

However, because of Covid-19 everything stopped in the pain clinics so now the waiting list is endless and I just have a telephone appointment for the middle of May. I knew I would not be able to manage until then unless I started taking the opioids again which I really didn’t want to do so I decided I would pay for the injections myself so I could get back in control of my pain again.

It is so essential that you get the right team set up to look after you when you are in chronic pain in order to be able to enjoy life the best you can. Just little delays and slip ups like my recent ones can set you back months. Pacing and planning have been my mantra for a long time now so that I can enjoy special times with my family without being in too much pain, but without help with injections and drugs I know I would be a terrible mess.