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Blog Arthritis & Pain: Are Doctors Failing You?

Arthritis & Pain: Are Doctors Failing You?

08/09/2024

Many doctors, medical and health websites still promote the myth that joint wear and tear from cartilage degeneration, aka osteoarthritis, causes chronic pain. 

The National Institute for Health and Care Excellence (NICE) defines osteoarthritis as "a disorder of synovial joints that leads to structural changes, local cartilage loss, bony spurs and mild synovitis".

HOWEVER, research studies consistently show very little association between the degree of cartilage breakdown seen on scans and the amount of pain reported by the patient. Many people have really ugly joints, yet aren't in pain.

So if cartilage degeneration isn't the main source of pain in arthritis, what is?!?

The pain and stiffness felt with osteoarthritis is more complex and involves many different factors including:

  • Inflammation, both locally in the joint and systemically
  • Muscle pain
  • Sensitisation of the nervous system to pain signals
  • Other metabolic health conditions, such as obesity and type 2 diabetes
  • Lifestyle, including sleep and stress
  • Psychology and mindset - depression, anxiety, catastrophising about your health

The good news is you can work on all of the above factors to reduce pain. .

According to a 2023 report by Versus Arthritis, approximately 10 million people in the UK are living with osteoarthritis (OA). An estimated 5.4 million people are affected by knee OA and 3.2 million by hip OA. Around 350, 000 people are diagnosed with osteoarthritis every year.

It's fair to say that osteoarthritis is a common musculoskeletal condition and a leading cause of disability.

When you receive a diagnosis of osteoarthritis, you're frequently told you can't do anything to reverse the damage and you just have to live with the symptoms. A Google search of mainstream medical and health websites seems to confirm this bleak outlook.

But are medical and health professionals failing you?

Is telling you that you have osteoarthritis and it's not possible to do anything to improve your situation actually worse for the person than the condition itself??

TRUTH BOMB!!!

Cartilage damage and big bony changes may not be reversible, but joint wear and tear is NOT the main source of pain in osteoarthritis.

There are no nerves, pain receptors or blood vessels in cartilage. This makes it very slow to heal, but also means you're unlikely to feel pain if it's damaged.

Let's dive into some of the factors that DO cause pain in osteoarthritis....

1) Inflammation

Even though cartilage doesn't have a nerve or blood supply, other structures within a joint do, such as the synovial membrane, subchondral bone (the bone directly underneath the cartilage) and Hoffa's fat pad in the knee.

Inflammation of these structures (called synovitis) can be painful.

Systemic inflammation happens when pro-inflammatory cells are released into the bloodstream and your immune system becomes constantly activated. This can lead to joint degeneration, organ damage, chronic pain, fibromyalgia and autoimmune-related diseases.

Certain metabolic conditions are strongly associated with systemic inflammation and chronic pain, such as obesity and type 2 diabetes. 

Before you dash off to stock up on meds, some recent studies are showing elevated levels of lipopolysaccharides (LPS) in the blood following higher dosages of Ibuprofen (a commonly prescribed non-steroidal anti-inflammatory drug). 

LPS is a marker of gut health. Higher levels of LPS in the blood is a red flag for intestinal damage (so-called 'leaky gut'). The immune and digestive systems are intimately connected, so when one is compromised the other is inevitably adversely affected too. LPS can also cross the blood-brain barrier, leading to neuroinflammation which disrupts how the entire body functions.  

Inflammation can be reduced with consistent lifestyle choices, such as:

  • Improving sleep quality and increasing your hours of restorative sleep each night
  • Regular physical activity (and this doesn't mean thrashing your body with daily high intensity workouts!)
  • Nutrition, avoiding overly-restrictive diets and long fasting windows. Instead focus on eating more fresh foods, reduce intake of processed foods and any foods that cause a cross-reactive response in your body.
  • Having effective stress management and nervous system regulation strategies in place

2) Muscle Tension

Pain and stress can lead to muscles bracing and tensing as a protective mechanism. 

This restricts your movements, making you feel stiffer and less mobile.

If your muscles stay in a constant low level of contraction, your brain stops registering this activity. This is called sensory-motor amnesia (SMA). SMA leads to a loss of conscious awareness and control of the affected muscles.

Over time, your posture and movement patterns change. You start using your body differently, leading to tension, stiffness and pain.

3) Nervous System Sensitisation

Chronic pain is a product of the nervous system, and stops being an accurate indicator of physical damage or injury.

A neuropeptide highly associated with chronic pain, called Substance P, is produced in your spinal cord, peripheral nervous system and immune cells.

Substance P amplifies signals and sensations from the cells so they're registered as painful by your brain. For example, a sensation that might be noticed as a light touch by someone without a history of injury is felt as painful pressure by someone who has chronic pain. This type of sensitisation is called pressure hyperalgesia.

Central sensitisation is where the brain and central nervous system misinterprets sensory signals as indicators of danger, and sounds the alarm in various ways, including pain, dizziness, nausea and anxiety.

Elevated levels of Substance P  have been shown to be associated with chronic inflammatory conditions such as fibromyalgia, rheumatoid arthritis, eczema, IBS (Irritable Bowel Syndrome) and IBD (Irritable Bowel Disease). Patients with clinical depression, anxiety and PTSD can also have higher than usual levels of Substance P.

4) Mindset and Beliefs

A BIG elephant in the room that very few people bring up when discussing pain and injury is the person's mindset and beliefs around their condition.

A lot of people I speak to have been diagnosed with osteoarthritis based on an X-ray or MRI scan. They believe that their pain is caused by the structural changes seen on the scan images, and their condition will only get worse over time. 

It's a pretty bleak outlook, isn't it?!

No wonder, so many people feel hopeless and depressed!

This catastrophisation (thinking the worst), increases stress and anxiety, fanning the flames of inflammation. They may stop exercising or playing sports in an effort to slow down the perceived damage to the joints. Over time, this leads to loss of mobility, strength and function. Their worst fears are realised.

Telling someone they have osteoarthritis can be more detrimental to their health and wellbeing than the actual condition itself!

Takeaways

  • Osteoarthritis and joint wear and tear aren't the same conditions
  • Osteoarthritis involves cartilage degeneration, bony changes and local inflammation (synovitis)
  • Cartilage breakdown isn't painful as cartilage doesn't have pain receptors, nerves or blood vessels.
  • The degree of cartilage degeneration doesn't accurately reflect the amount of pain reported by the patient
  • The pain felt with osteoarthritis is more complex and likely involves inflammation (local and systemic), muscle tension, a hypersensitive nervous system, sleep quality, stress levels, depression, anxiety, mindset beliefs (catastrophising) and other metabolic conditions, such as obesity and type 2 diabetes.
  • Cartilage damage may not be reversible, but you can work on the other factors linked with chronic pain to improve your mobility and quality of life.

WAYS TO WORK WITH ME

1) Unlock Your Body breakthrough session

This is a powerful 1:1 session designed to help you find the root drivers behind a persistent pain or injury. You'll leave with a deeper understanding of what's triggering pain in your body, and a clear action plan to get lasting relief. 

I have 4x Unlock Your Body breakthrough sessions in September, as well as very limited availability for 3 or 6 month 1:1 coaching.

Apply HERE  and I'll be in touch to arrange an initial complementary consultation to discuss which option will be a good fit for you.

2) Mindful Movement for Lower Back and Sciatic Pain Relief Workshop

Next date: Sunday 20th October, 1.15pm to 2.45pm (7x spaces available). **Bookings opening now**

Angmering Village Hall  (The Kings Suite)

A friendly and inclusive small group workshop where you'll discover the common causes of lower back and sciatic pain, why you're not getting the results you desire even if you've tried the usual treatments, and how to find lasting relief.

The session will be a blend of informal group discussion and a mindful movement session, where you'll practice gentle exercises that effectively release muscle tension and show you new ways to move without pain.

After the workshop, you'll have lifetime access to a simple home programme to relieve lower back and sciatic pain in just 10 minutes a day. 

Click HERE to read all the details and how to book your place.

Other ways you can find help with managing pain or an injury are:

  • Book into a Stretch or Pilates class with me - these are a good introduction to the movement explorations of The Befriend Your Body (BYB) Method  for pain relief and relaxation.
  • Get your copy of my free E-guide "How to Get Relief From Back Pain and Muscle Tension in just 10 mins a Day". This introduces the 3x universal stress responses that can keep you stuck in pain, and explains the 4x pillars of The BYB Method. There's also 2x 10 mins video tutorials showing you how to release muscle tension from the front and back of your body in the comfort of your without expensive equipment. Download for instant access HERE
  • Subscribe HERE to receive "The Movement Chronicle", a weekly e-newsletter delivering mobility and pain reduction tips directly into your inbox every Monday morning,

You can connect with me through any of these channels:

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