But the subject of inflammation and knee pain is intriguing enough, and relevant enough (and what’s been found lately is also contrary enough) that it deserves plenty of space.
Take this article, now two years old:
Knee osteoarthritis should no longer be thought of as a "noninflammatory" condition, as inflammation associated with synovitis or effusion plays a bigger role in worsening pain than mechanical load, according to a new report from the Multicenter Osteoarthritis Study, published online November 10 in Arthritis & Rheumatology.There were 1,111 people in the study, aged 50 to 79 years, who either had knee osteoarthritis or were at risk for it. Initially, 21 percent of the subjects reported frequent knee pain.
One of the doctors involved noted an unexpected result:
I was surprised that we found no relation of bone marrow lesions to pain sensitization because one of our hypotheses, based on animal models, is that mechanical and/or inflammatory lesions can lead to sensitization.What was related to “sensitization” instead? Synovitis, or inflammation of the synovium.
Oh, another interesting finding that has grim implications:
The authors suspect that once sensitization has occurred, just cooling the inflammation might not be enough to correct it.So what’s the takeaway? Trying to quell inflammation early may be smart, the researchers suggest:
[Their findings] do suggest that early targeting of inflammation might reduce sensitization ... Preventing the altered neurologic processing of nociceptive signals that usually occurs in OA might also prevent the progressive worsening of pain.
I think they have finally hit the nail on the head. Unfortunately, I had to work this out for myself, and did so too late, so think my knees will perhaps always be prone to flareups due to the neurologic alteration they mention. But I've become much better as being able to distinguish chondromalacia pain (a sharp catching pain under the kneecap) from synovial inflammation pain (a burning/tightening/stiffness sensation), so can dial things back more appropriately when I feel the synovial issue flaring.
ReplyDeleteThe problem with the medicos/physios/PTers etc. is that the synovial and neurological altering produces symptoms just like cartilage damage, but in fact that is not the main source of the pain. So you get inappropriate treatment. The burning/heat/discolouration of the kneecaps/stiffness is the key to diagnosing synovitis/chronic inflammation in the knee IMO - but the mainstream medicos etc. can't seem to distinguish this from 'my knees hurt'.