Saturday, October 2, 2010

Why Drugs Aren't the Answer to Knee Pain

I think everyone fighting chronic knee pain at some point reaches that dark place where they think, "God, if only this pill were more effective! If only it could drown out the pain for a little while and let me once again do the things I love!"

Be careful what you wish for.

Pfizer developed a potent arthritis drug called tanezumab. They began to put the experimental medication through studies to test its efficacy. And this unfortunately is what they discovered, according to a Bloomberg News story (the bold is mine):
An experimental arthritis drug from Pfizer Inc. reduced pain more than researchers anticipated, doctors said. It also allowed previously hobbled patients to overuse and permanently damage their joints.
Bone destruction developed in 16 of 6,800 patients taking the medicine, tanezumab, as part of Pfizer’s development program, and they all needed a complete joint replacement for the affected knee, hip or shoulder, according to a report in the New England Journal of Medicine. Pain-free patients may have put excessive pressure on their fragile joints because they weren’t getting natural pain signals to take it easy, said the lead researcher, Nancy Lane.
There was no dispute over whether the drug worked:
Reduction in knee pain ranged from 45 percent to 62 percent in those given the Pfizer drug, depending on the dose, compared with 22 percent for those given placebo.
But its larger failure -- the "rapid progression of arthritis" that occurred in 16 subjects -- may cause a rethink about chronic inflammatory pain:
“Pain has an important role in the avoidance of self-harm, but chronic inflammatory pain has generally been considered to be wholly undesirable,” said John Wood, professor of neurobiology at University College London, in an editorial that accompanied the research. “The study by Lane et al. suggests that a complete quenching of pain in patients with osteoarthritis may not necessarily be a good thing.”
Here is one of those places where medical science is going to get smarter in the next decade or two, I predict. I think chronic inflammation is wholly undesirable. But I think the associated pain, at least within reasonable limits, is actually desirable. The burning has levels of intensity, which are a way of providing invaluable feedback, telling you what not to do. Drugs to mute that pain -- to mask it, to immerse a knee pain sufferer in a cloud of false, pleasant feelings -- are simply obstacles to healing.

When I was frustrated and desperate, seeking to beat patellofemoral pain syndrome and tame a pair of knees that were constantly inflamed while sitting, I was given drugs by a doctor who said I had arthritis. One afternoon at work, I took the pills -- one was to combat inflammation, the other was to combat the effects on my stomach of the first pill. I have to admit, they did make normal bent-knee sitting easier.

And the next morning, when I woke up, I noticed my knees felt worse than normal.

Why? Because the arthritis drug allowed me to ignore the inflammation pain signals and engage in an activity (sitting) that I simply wasn't strong enough to do yet. When I realized what was happening, I swore I'd never take one of those damn things again. And over the next two or so years -- which included more than a few bad days, and a long recovery from knee pain -- I never did.

Anti-inflammatories allow knee pain sufferers to do things they shouldn't. For example, on a message board once I read about how someone had trouble climbing and descending stairs, so he just popped a couple of Advil for the pain ... and I just shook my head. Sure, the Advil will enable someone to climb stairs better. But if your knees can't handle stairs, why not try to figure out how to strengthen them so that they can, and in the meantime -- I know it's hard -- avoid stairs. It can be done.

Do you really want to heal? Or do you just want to forget you hurt?

One last important note: I know there are people who have knees that hurt terribly, and having gone through my own hell, I wouldn't take pain drugs out of their hands. It's awful when your knees hurt all the time. I've been there. But if you want to heal -- and you can; that's my message of hope -- beware of medication. I think it does much more harm than good.

1 comment:

  1. Exactly!

    Since bicycling has began healing my knee and I feel much better, I tackled my first hike of the year last month. I popped some Advil and my knee felt spectacular for all 12 miles of the hike. But a couple days later I hurt and it took another month to gain that ground back.

    I've since went on a second hike without meds. I only made it 4 miles until my knee hurt, at which point I called it quits. The next day my knee felt great.

    My point = the uninhibited pain feedback loop is an accurate and needed metric.