No role of Opioids in reducing pain and disability in chronic osteoarthritis

Opioids provided no clinically relevant pain relief and no clinically relevant reduction in disability compared with placebo in chronic osteoarthritis pain (hip, knee), according to a recent study published in the European Journal of Pain. 

Osteoarthritis (OA) is the most common form of arthritis which has become one of the leading causes of disability in older adults. It occurs due to the break down of cartilage, causing the bones within the joints to rub together causing pain, stiffness, and other symptoms.

OA occurs most often in older people, although it can occur in adults of any age. OA is also called degenerative joint disease, degenerative arthritis, and wear-and-tear arthritis. 

The major treatment hurdle for osteoarthritis is the absence of any good disease-modifying drugs for this disease. Without effective treatment, physicians are left to manage patients symptomatically and the most common thing done by them is to manage their pain. One of the main culprits [driving opioid use] are chronic pain patients and one of the most highly prescribed conditions for opioids is osteoarthritis.

This updated systematic review by Winfried Häuser, Health Care Center for Pain Medicine and Mental Health, Saarbrücken, Germany, and colleagues, evaluated the efficacy and safety of opioids compared with placebo for chronic osteoarthritis pain. 

For the purpose, the researchers searched the online databases from October 2013 to July 2019. Randomized controlled trials comparing opioids with placebo and at least 4 weeks double‐blinded duration were analyzed. A total of 22 studies with 8,942 participants were included in the meta-analysis. Study duration ranged between 4 and 24 weeks.

Primary outcomes were pain relief of 50% or greater, disability, tolerability and safety. Key findings of the study include: 

Based on very low– to low‐quality evidence, opioids provided no clinically relevant pain relief of 50% or greater and no clinically relevant reduction in disability compared with the placebo. 

There was clinically relevant harm related to the dropout rate due to adverse events. 

The frequency of serious adverse events did not differ from placebo. Enriched enrolment randomized withdrawal design: 

Based on very low– to low‐quality evidence, opioids provided no clinically relevant pain relief of 50% or greater and no clinically relevant reduction in disability compared with placebo.
 Dropout rates due to adverse events and frequency of serious adverse events did not differ from placebo. 

"Tolerability of opioids is low and efficacy is not clinically relevant in controlled studies from 4 to 24 weeks for osteoarthritis pain," wrote the authors. 

The study, "Opioids for chronic osteoarthritis pain: An updated systematic review and meta‐analysis of efficacy, tolerability and safety in randomized placebo‐controlled studies of at least 4 weeks double‐blind duration," is published in the European Journal of Pain.

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Rheumatology- All That One Nees To Know

A rheumatologist is a medical doctor that specializes in diseases of the joints, in other words, they specialize in arthritic problems. Rheumatology is noted for its diagnosis and treatment of systemic, autoimmune and inflammatory forms of arthritis. Rheumatologists treat joint diseases in a similar way to orthopedists, but they don’t actually perform surgery. Some 54.4 million are affected by rheumatic diseases in the United States, according to the doctors. It strikes people of both genders and occurs in people of all races and ages. Some 300,000 children in the United States are afflicted by a rheumatic disease.

Although it isn’t every rheumatic disease that affects the spine, the ones that do can be extremely difficult to live with. The most common is osteoarthritis, which occurs when both the cartilage and bone begin to deteriorate.
Another group of rheumatic conditions that affect the spine includes spondyloarthropathies. It includes inflammatory conditions such as ankylosing spondylitis and axial spondylitis. Some types of spondyloarthropathies also affect the joints.
Ankylosing spondylitis, for example, affects the lower back most, but it can also affect hips, shoulders, and knees. Psoriatic arthritis can affect the spine, but it doesn’t in certain instances. With that being said, it always tends to affect the ends of fingers and toes. These are just two types of spondyloarthropathy that exist which are capable of damaging the spine as well as other areas of the body.

You should see a rheumatologist when your joints hurt, or if there are signs of inflammation such as redness, swelling, pain, stiffness, and loss of joint function that lasts for two days or more. You’ll likely need to see your primary care doctor before seeing a rheumatologist for a referral. Keep in mind that the earlier you see your primary care doctor, the sooner your ailment can be treated.
The rheumatologist warns that autoimmune disorders and rheumatic diseases actually run in families. If your family members, regardless of whether they are immediate family member or not, have or had an autoimmune disorder or rheumatic disease, then you should definitely see a rheumatologist sooner rather than later.
Note that medications given to you by your primary care doctor will temporarily improve things, but that doesn’t mean that your symptoms won’t return. If this occurs, then you also need to see a rheumatologist.

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The Health Benefits of Black Salt

Salt is one of the many substances that humans depend upon, not only for its taste, but also for its health benefits and its ability to preserve food. The Indian black salt, also known as kala namak, is a popular variety of Indian volcanic stone salts. It is used extensively in India, Pakistan and internationally, by those who know how to make proper use of its benefits. Its unusual color comes from the presence of tiny amounts of iron and other minerals.
This unique salt is found in the Himalayan mountain ranges, and has some excellent health benefits that you really should know about. In India, black salt is often prescribed for patients with high blood pressure or those who require a low-salt diet. Why? Because black salt is low on sodium, and so doesn't raise the blood pressure like normal salt does. It is also a popular treatment for heartburn and intestinal gas. In short, it provides a boost to the digestive system. 
Types of Black Salt
There are actually 3 distinct types of black salt – Indian black salt, black lava salt and black ritual salt – all of which are very different from one another. First of all, there is Indian black salt (kala namak), which has an incredible amount of uses, and which shall be the sole focus of this guide.
Then there’s black lava salt, which is black in color due to it being a mixture of regular sea salt and activated charcoal. It is typically used by chefs to finish meals, since it has quite a particularly earthy flavor, and is often labeled as Hawaiian black salt.
Finally, there’s black ritual salt, which is used in Wiccan spells and rituals to drive away evil spirits and negative energy. This type of black salt is usually made by mixing regular rock salt with charred pieces of ash, iron and herbs.
What Is Black Salt Composed Of?
Indian black salt consists mainly of sodium chloride and trace impurities of sodium sulfate, as well as sodium bisulfite, sodium bisulfate, iron sulfide, sodium sulfide, and hydrogen sulfide.
The iron sulfide provides kala namak with its dark color, while the sodium chloride gives it its salty taste. All of the sulfurous compounds present give it its savory taste, as well as its unique, eggy aroma.
Even though hydrogen sulfide is known to be toxic in large amounts, the amount usually used in recipes is nowhere near enough to be harmful, and thus any potential negative health issues stemming from the use of this type of salt are practically negligible.
Health Benefits of Black Salt
1. It Treats Joint Disorders
Black salt can be used to loosen the muscles and reduce the amount of pain you  feel in your joints. To treat your joint problems, simply place a cup of black salt into a piece of cloth and make a poultice. Then, dry heat it in a pan, being careful not to burn it. When it’s hot, take it out of the pan and press it against the affected area. This procedure can also be reheated and used once again later on in the day if necessary.
2. It Reduces Bloating and Constipation
Black salt is often a core component in many natural digestive pills. This is because it comes with an innate ability to ward off an upset stomach, constipation, bloating, as well as many other stomach problems. Start making a point of adding black salt to your meals if you want to avoid a load of post-meal problems.
3. It May Cure Respiratory Illnesses
Many people who suffer from respiratory disorders, such as asthma, allergies, sinus issues, or even the common cold, have benefited greatly by making inhaling black salt. To give yourself some respiratory relief, simply add some black salt to an inhaler, and use it twice a day.
4. It Helps You Lose Weight
Kala namak is highly effective at helping people lose weight, since it has a disintegrating and dissolving effect on lipids and enzymes. Simply start replacing regular salt with black salt when you’re cooking, and then sit back and watch the pounds shed themselves!
5. It Functions as a Laxative
If you’re looking for an effective laxative, then black salt might just be what you’re looking for. You can make your own laxative paste or drink by mixing some black salt with some pieces of ginger and lemon.
6. It Controls Cholesterol Levels
By replacing regular salt with black salt, you may be able to stabilize your fluctuating levels of cholesterol. This is because black salt ensures proper circulation throughout the body by thinning your blood. This is not only effective for reducing high cholesterol levels, but can also help lower blood pressure, too.
7. It Reduces Heartburn
Heartburn is caused by an excess of acid being present in your stomach. Luckily, black salt is full of alkaline minerals, as a result of its exposure to high temperatures, which helps cancel out the negative effects of your stomach’s acid production.
8. It Gets Rid of Intestinal Gas
Black salt is able to ward off all kinds of gastrointestinal problems, including both acid reflux and indigestion. The best way to do this is by placing a teaspoon of black salt in a copper vessel, and heating it on a low flame. Keep it under the flame until you notice it changing color. Then, extinguish the flame and mix a small amount of the salt with a glass of warm water, and drink immediately.

9. It May Prevent Osteoporosis
Osteoporosis is a nasty disorder that causes your body to start using your own bones as a source of sodium, thereby making them a lot weaker. Thankfully, the high sodium content in black salt can help many people prevent themselves from ever becoming sufferers.
10. It Helps Keep Depression & Insomnia at Bay
Psychiatrists have found that black salt can be very useful in the treatment of certain types of depression and insomnia. This is because it helps to preserve two particular hormones, serotonin and melatonin, both of which are essential for a good night’s sleep.
11. It Controls Diabetes
Studies have shown that black salt has the ability to reduce a diabetic person’s need to take insulin so often, since it contains a unique property that helps the body maintain an appropriate blood-sugar level. Black salt is recommended both for diabetic people, as well as for anyone who is at risk of becoming diabetic.
12. It Relieves Muscle Spasms and Cramps
Kala namak has been found to provide relief to anyone who suffers from muscle cramps and spasms. This is due to it containing potassium, which is a mineral that our muscles need to function properly. Simply start replacing the regular salt in your meals with black salt, and start reaping the benefits.

 Using Black Salt For Healthy Hair

If you're one of many who suffer from a receding hairline, you're probably frustrated by all the supplements and tonics that never seem to work. So try something more natural this time, and start adding black salt to your meals whenever possible. The essential minerals in black salt will boost your hair's natural growth, strengthen it and treat its split ends.
If you have dandruff or acute hair loss, we’d recommend taking black salt with tomato juice at least once a day. Not only will it encourage hair growth and reduce the amount of flakes you produce, but will also thicken your hair, giving it some extra sheen and luster.
Using Black Salt For Smooth Skin

Another use for black salt is in skincare. Instead of chemical peels, special soaps and spas, consider adding black salt to your bath water. It works as an excellent healing agent, and is especially good for cracked and swollen feet, athlete's foot, warts and sprains.
Just sit back and let it heal your pain and relieve your worries while you enjoy a truly refreshing bath. When you come out, your body will feel truly rejuvenated. If your skin is sensitive to irritation, it's best not to make the water too hot, or you may incur some itchiness.

Cooking With Black Salt

Black salt is commonly required to prepare certain types of Indian dishes, particularly ones found in the country’s northernmost regions. It is typically used as a condiment, and is often added to raita or chutney.
When shopping for black salt, make sure that there is no moisture in the packet and that it is properly sealed, since exposure to the elements may make your black salt go lumpy. We find it best to buy a number of small packets rather than one big one to avoid hydrating them too much once opened.

THIS IS ONLY FOR INFORMATION, ALWAYS CONSULT YOU PHYSICIAN BEFORE HAVING ANY PARTICULAR FOOD/ MEDICATION/EXERCISE/OTHER REMEDIES.                                                                                                                                                                                                      PS- THOSE INTERESTED IN RECIPES ARE FREE TO VIEW MY BLOG-                                                                                           https://gseasyrecipes.blogspot.com/   
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Bone marrow lesions can predict joint disease

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 Bone Marrow Lesions (BMLs) are likely to help predict a swiftly progressing joint disease, says a study.

The research shows lesions -- seen on MRI scans as regions of bone beneath the cartilage with ill-defined high signal -- can help identify individuals who are more likely to suffer from the rapidly progressing osteoarthritis.

Osteoarthritis -- the most common type of arthritis in the UK -- can cause the joints to become painful and stiff.

Almost any joint can be affected, but it most often causes problems in the knees, hips, and small joints of the hands. It can progress at varying speeds.

"Osteoarthritis causes a significant burden to individuals and the healthcare system as a whole," said Mark Edwards, Clinical Lecturer at the University of Southampton in UK.

Individuals with BMLs lose the space within the joint at a rate that is 0.10 mm per year faster than those without BMLs, the findings showed.

The SEKOIA study, a major international osteoarthritis disease-modifying trial, carried out MRI scanning on the knees of 176 men and women over 50 years old. 

They were then followed up for an average of three years with repeated knee x-rays.

Individuals with bone marrow lesions (BMLs) on their MRI scan were found to have osteoarthritis that progressed more rapidly than those that did not.

Whereas, individuals with abnormalities on the MRI scans at the first appointment were compared to those without to examine the effect on disease progression.

The study has been published in The Journal of Rheumatology.