News & Events: Member Articles

Knee Pain - A Potential Treatment Dilemma
By Dr. Ronald Shapiro

For twenty-three years, 56-year-old Patty had managed her insulin dependent diabetes mellitus (Type I) quite well except for the dilemma of gradual weight gain. At 5’ 4” tall, she weighed 172# and over the last year developed pain in both knees occurring when standing up and walking. She obtained partial relief from using ibuprofen (Motrin) and Naprosyn.

As a nephrologist (medical kidney specialist), I saw her in consultation for extreme weakness, heart irregularity, and severe swelling. Her workup showed that the severe weakness and heart irregularity was due to a high potassium level in her blood, the swelling (edema) was due in part to a low blood albumin level (blood protein) and a high urine protein level.

These new debilitating and potentially critical changes in Patty’s condition were the direct result of using NSAIDs (non-steroidal anti-inflammatory drug ), in her case – Motrin and Naprosyn. Because of her diabetes, Patty was more susceptible than the non-diabetic to this class of drugs; however the same effects may occur in patients without diabetes.

Pain is a widespread symptom. There are many medications used for pain control; however, the medical community has been aware for some time of the undesirable and potentially harmful effects of these medications. For years is has been known that the NSAIDS can produce gastrointestinal pain, bleeding and perforation – 3-4 times the risk compared to not taking the drugs. Most recently, the newer NSAIDs (Cox 2 inhibitors) Celebrex and Vioxx developed to reduce the GI effects, have become implicated in increasing the risk of stroke, heart attack, blood clots, deep vein thrombosis, pulmonary embolism and death. Aleve, a common pain reliever may also be associated with similar risks.

Fear, frustration, and resignation to “live with the pain” are becoming more common. To protect the public, recommendations from governmental agencies and physicians suggest using less potent substances such as aspirin and Tylenol, lower doses of worrisome drugs, being more selective in prescribing these drugs, and improving and expanding drug investigation.

Knee pain affects a significant portion of our population. It is reported to affect between 10-25% of the US population. Fortunately, there are now alternative modalities that are available to complement traditional approaches to managing knee pain.

Acupuncture may be useful and it has been reported to be effective in a recent study performed at the University Of Maryland School Of Medicine. I have been fortunate to develop an effective needless technique, which was reported in Medical Acupuncture, Vol. 15, No. 2, January 2004.

A non-invasive medical device, The MedLite, is also useful in treating knee pain. A recently completed medical study showed the device to be better than over the counter Motrin or placebo in relieving pain and improving mobility and function.

People at risk like Patty or individuals who prefer a non-medicinal approach have alternative methods available to them to reduce their knee pain. However, it is essential to stress the importance of comprehensive medical evaluation, sound medical treatment including appropriate physical therapy, and getting to and maintaining ideal body weight.

Ronald Shapiro M.D., Ph.D.
Academy of Medicine of Toledo and Lucas County