• Hip Pain Success with Prolotherapy
  February 5, 2012
• Prolotherapy for Tendinopathy
  February 4, 2012
• Epidural Steroid Injections for Low Back Pain
  February 3, 2012
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In 2006, the Center for Disease Control combined data from the National Health Interview Survey years 2003-2005 Sample Adult Core components to estimate the average annual arthritis prevalence in the U.S. population aged 18 years and older. Overall, 21.6% (46.4 million) of adults reported arthritis or another rheumatic condition diagnosed by a doctor, with 27 million Americans having osteoarthritis, up from 21 million in 1990.^{27, 28} By the year 2030, an estimated 67 million (25% of the projected total adult population) adults aged 18 years and older will have doctor-diagnosed arthritis with two-thirds of those with arthritis being women. (See Figure 6.) The impact of this arthritis on individuals is significant. Almost 41% report severe limitations in their usual activities and 31% report being limited in work due to the arthritis.²⁹ (See Figure 7.) The average direct cost (medications, assistive devices) of OA is approximately $2,600 per year per person living with OA, but the total annual cost (including lost wages, loss of productivity) of OA per person living with OA is at the low end $5,700 but in the high end over $10,000.30-32 The question remains as to why is there this alarming increase in osteoarthritis to the point that between 1997 and 2005 the number of knee surgeries climbed by 69% from 328,800 to 555,800, hip replacements rose 32% from 290,700 to 383,500, and spinal fusion surgeries increased by 73% from 202,100 procedures to 349,400 per year?³³

 

Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly used classes of medications. Ibuprofen was the first NSAID available by prescription in the United States in 1974, under the brand names Motrin and Rufen. It rose to be the fifth-largest selling prescription drug and in 1984 was the first new entrant in the non-prescription pain reliever market in nearly 30 years. For the last thirty plus years, NSAIDs are among the most frequently used drugs in the United States. From 1973 to 1983, for instance, the number of NSAID prescriptions dispensed by retail pharmacies tripled, rising from 28 million to around 70 million by the early 1980s. (See Figure 8.)

What are the long-term effects of this NSAID use? Could it be that the massive widespread use of NSAID twenty and thirty plus years ago is the reason that there is currently an epidemic of disabling osteoarthritis resulting in a slew of spine and joint replacement operations? By 1983, five of the 50 drug products most often dispensed were NSAIDs, representing over 4% of the total prescription market.³⁴ To put a practical visual on these numbers in percentage terms, enough NSAIDs were purchased in the United States by drugstores and hospitals to treat 1.29% of the entire civilian population each day in 1983. The number one use for these NSAIDs in 1983 was osteoarthritis. While the prescribing patterns for specific NSAIDs have changed over the years, as drugs like ibuprofen and naproxen became available over-the-counter, an NSAID is still the number one medication prescribed by physicians for osteoarthritis. For instance, 80% of rheumatologists noted they frequently prescribe NSAIDs for symptomatic hip and knee osteoarthritis, while for the same group of clients, 65% of primary care physicians use an NSAID.^{35, 36} Even when physicians were educated on guidelines based on the European League Against Rheumatism, American College of Rheumatology, and The Arthritis Society guidelines for OA treatment, limiting NSAID use, NSAIDs were still prescribed over half the time for patients with knee OA.³⁷ These prescribing patterns are confirmed in the numbers. For instance, in 2002, the prescriptions for generic ibuprofen and naproxen exceeded 500 million per year, with over 45 million prescriptions written for cyclooxygenase-2 (COX-2) inhibitors.³⁸ Realize, these numbers do not include all of the over-the-counter NSAIDs that have been consumed over the last thirty plus years. According to the National Consumers League survey conducted in 2002 on the public’s use of and attitudes toward NSAID medications, 83% of the respondents had used an over-the-counter pain medication, with 15% using it daily.³⁹ When this survey was combined with The Roper National Survey of the over-the-counter pain reliever users, 38% used both prescription and over-the-counter pain relievers, and 44% consumed greater than the recommended dosages. The average length of the prescription drug use was 6.6 years.⁴⁰ In respondents who had arthritis pain, 85% used over-the-counter pain relievers. What this data means is that 36 million Americans are using over-the-counter pain medications daily, with roughly 23 million using NSAIDs. Other surveys have confirmed that a high percentage of the U.S. population (17% or greater) routinely uses over-the-counter NSAID medications.^{41, 42} In a study of 2433 patients attending an outpatient physical therapy unit, 79% reported using either over-the-counter or prescription anti-inflammatory pain medication during the week prior to the survey.⁴³ In data that we have published concerning unresponsive neck, knee, hip, and temporomandibular joint pain, the average person experienced pain for over five years and was taking one or more pain medications at the time of their first Prolotherapy visit.^44-47 This epidemic NSAID prescribing and consuming for osteoarthritis is seen in most developed countries where 20-30% of elderly people (age>64 years) with up to 40% of some populations receiving NSAIDs.^{48, 49} (See Figure 9.) The question begs to be asked, “Could the use of these NSAIDs be the cause of the incredible rise of osteoarthritis and need for subsequent musculoskeletal surgeries, such as knee and hip joint replacements?”