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Monday, 25 November 2013

Osteoarthritis Treatments In conventional medicine perspective

Osteoarthritis (OA), a form of arthritis, is defined as a condition of
as a result of aging causes of wear and tear on a joint, affecting over 25 million people in the United States in alone.
Treatments
A. In conventional medicine perspective
A.1. Medication
The aim of the treatment is to relieve symptoms of the diseases
1. Acetaminophen
a. Acetaminophen such as Tylenol can help to relive the pain of Osteoarthritis. In the study to compare the efficacy of tramadol 37.5 mg/acetaminophen 325 mg combination tablets (tramadol/APAP) with that of nonsteroidal anti-inflammatory drugs (NSAIDs) as maintenance therapy following tramadol/APAP and NSAID combination therapy in knee osteoarthritis (OA) pain, showed that overall adverse event rates were similar in both groups. Tramadol/APAP add-on significantly improved knee OA pain which had been inadequately controlled by NSAIDs. In those subjects who showed favorable response to tramadol/APAP and NSAID combination therapy, both tramadol/APAP and NSAIDs were effective at maintaining the pain-reduced state and there was no significant difference in efficacy between tramadol/APAP and NSAIDs(61).
b. Side effects if overdose are not limit to
b.1. Nausea and vomiting     
b.2. Appetite loss     
b.3. Sweating     
b.4. Diarrhea     
b.5. Irritability
b.6. Abdominal pain
b.7. Etc.


2. Nonsteroidal anti-inflammatory drugs (NSAIDs).
a. In the observation to  investigate the cost effectiveness of cyclo-oxygenase-2 (COX 2) selective inhibitors and traditional non-steroidal anti-inflammatory drugs (NSAIDs), and the addition of proton pump inhibitors to these treatments, for people with osteoarthritis, indicated that Prescribing a proton pump inhibitor for people with osteoarthritis who are taking a traditional NSAID or COX 2 selective inhibitor is cost effective. The cost effectiveness analysis was sensitive to adverse event data and the specific choice of COX 2 selective inhibitor or NSAID agent should, therefore, take into account individual cardiovascular and gastrointestinal risks(62).
b. Side effects are not limit to 
Dr. Bjarnason I, and the research team at King’s College School of Medicine and Dentistry, in the study of Side effects of nonsteroidal anti-inflammatory drugs on the small and large intestine in humans, showed that Ingested NSAIDs may cause a nonspecific colitis (in particular, fenemates), and many patients with collagenous colitis are taking NSAIDs. Large intestinal ulcers, bleeding, and perforation are occasionally due to NSAIDs. NSAIDs may cause relapse of classic inflammatory bowel disease and contribute to serious complications of diverticular disease (fistula and perforation). NSAIDs may occasionally cause small intestinal perforation, ulcers, and strictures requiring surgery. NSAIDs, however, frequently cause small intestinal inflammation, and the associated complications of blood loss and protein loss may lead to difficult management problems. The pathogenesis of NSAID enteropathy is a multistage process involving specific biochemical and subcellular organelle damage followed by a relatively nonspecific tissue reaction. The various possible treatments of NSAID-induced enteropathy (sulphasalazine, misoprostol, metronidazole) have yet to undergo rigorous trials(63).
3. Narcotics
Narcotics are natural opioid drugs derived from the Asian poppy may provide relief from more severe osteoarthritis pain., but with additive effect
b.Side effects are not limit to
b.1. Risk of dependence
b.2. Dizziness and drowsiness
b.3. Nausea and vomiting
b.4. Headache and fatigue
b.5. Etc.
4. Etc.

A.2.. Non medication therapy
Non medication therapy depending to the individual needs, including Patient education and self-management programs, weight loss if patient is overweight, physical therapy such as  muscle strengthening, aerobic conditioning and tai chi exercise, occupational therapy for joint protection, etc.

1. In the study of What are the effects of strength training alone, exercise therapy alone, and exercise with additional passive manual mobilisation on pain and function in people with knee osteoarthritis compared to control? What are the effects of these interventions relative to each other? showed that Exercise therapy plus manual mobilisation showed a moderate effect size on pain compared to the small effect sizes for strength training or exercise therapy alone. To achieve better pain relief in patients with knee osteoarthritis physiotherapists or manual therapists might consider adding manual mobilisation to optimise supervised active exercise programs(64)
2.  In the study to determine if manual therapy improves pain and/or physical function in people with hip or knee OA.other suggested that manual therapy is more effective than exercise for those with hip OA in the short and long-term. Due to the small number of RCTs and patients, this evidence could be considered to be inconclusive regarding the benefit of manual therapy on pain and function for knee or hip OA(65).
A.3. Surgery
1. Arthrocentesis plus corticosteroid
Arthrocentesis is a medical procedure to remove joint fluid with a sterile needle to remove joint fluid for analysis and then injection of corticosteroids into the joints to relieve pain, swelling, and inflammation. The number of cortisone shots is limit every year as overdoses the medication can cause joint damage.
2. Arthroscopy 
Arthroscopy is a minimally invasive surgical procedure to examine the abnormalities of and damage to the cartilage and ligaments through the arthroscope and treat the disease. it is said that patients can recover from the arthroscopic surgery much more quickly than from open joint surgery.
3. Lubrication injections
Injections of hyaluronic acid derivatives (Hyalgan, Synvisc) are recommended only to patients who have not found adequate pain relief from more conservative treatment options by offering pain relief.
4. Realigning bones
Osteotomy is a surgical procedure used to Realigning bones and cartilage and reposition the joint to reduce knee pain by shifting your body weight away from the worn-out part of your knee. 
5. Joint replacement
Joint replacement is a surgical procedure of orthopedic surgery to remove the damaged joint surfaces and replaces them with plastic and metal devices called prostheses. Joint replacement is considered as a treatment only for patient with severe joint pain or dysfunction that can not be alleviated by other less invasive treatments.
6. Etc. 

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Sources
(61) http://www.ncbi.nlm.nih.gov/pubmed/21811797
(62) http://www.bmj.com/content/339/bmj.b2538
(63) http://www.ncbi.nlm.nih.gov/pubmed/8500743