Pain Management & Keeping Your Joints Healthy

Deborah Howell
This is “Weekly Dose of Wellness”. Brought to you by MemorialCare Health System. Here's Deborah Howell. Welcome to the show. I'm Deborah Howe, and today we'll be talking about pain management and what you can do to keep your joints healthy. Our guest is Doctor Albert Tsai, a board certified orthopedic surgeon at Memorial Orthopedic Surgical Group in Long Beach. Welcome Dr. Tsai.

Dr. Tsai
Good morning. Thank you for having me.

Deborah Howell
I'm looking forward to this. So, what is the role of joints in our bodies?

Dr. Tsai
So, joints are the parts of your body that connect the bones together. So we have simple hinge joints like the elbow and the knee. We have more complicated ball and socket type joints like the shoulder and the hip. The muscles in the tendons around the joints really provide us with mobility and allow us to be active.

Deborah Howell
Great. And what causes joint pain?

Dr. Tsai
So, what causes joint pain is damage to the cartilage. So, we're talking about the articular cartilage. So for example in the knee there's the meniscus cartilage which is kind of like the shock absorbing cushion. What we're talking about is that hard white articular cartilage that cap the ends of the bone. So damage to that is what causes pain. There's inflammatory types of arthritis, like rheumatoid arthritis and lupus. [...] psoriasis. There's post traumatic arthritis. For example, if you've had an injury and fractured your tibia, you can get post traumatic arthritis. But mostly what we're dealing with is garden variety wear and tear osteoarthritis.

Deborah Howell
Okay. And are there some steps you can take to keep your joints healthy?

Dr. Tsai
Well certainly maintaining a healthy weight is going to be important. I mean, your knees can see up to 4 or 5 times your weight if you're running. But you know, to be fair, there are some people that run marathons all their lives and they never get arthritis. So there's definitely going to be a genetic component as well. But the type of activities and definitely maintaining a healthy weight is beneficial.

Deborah Howell
Okay. And if you have joint pain, what can you do to reduce the strain on your joints?

Dr. Tsai
So, one of the things that I mentioned is really modifying your activities. So, if you do have hip or knee pain for example, the type of exercise you want to be partaking in is probably not the high impact variety. So you're not going to be a runner or doing high impact aerobics or Zumba or playing basketball. You're going to want to swim and bike and do the elliptical and yoga, low impact type sports. So that's definitely going to be a key. And then also maintaining a healthy weight as we said.

Deborah Howell
Okay. And what role do psychological factors play in the response to pain?

Dr. Tsai
Ooh. So, I'm not sure I'm the most qualified to answer that. But certainly in the past year with Covid and the pandemic and being isolated, I would say that the level of stress in everybody is probably higher. And certainly if you have other stressors in your life, it's going to be harder to deal with, you know, chronic pain. But again, probably not my area of expertise.

Deborah Howell
Yeah, I think we all sort of know that stress plays a role in inflammation. So, you know, and it's all diet and environment. And like you said just an extra stress put on by the pandemic. Are there non-surgical approaches to treating joint pain?

Dr. Tsai
So, definitely the first thing is to modify your activities as we said and watch your weight. But then even in that situation when everything is ideal, if you still have pain, the baseline treatment is going to be an anti-inflammatory. So, it's reasonable to take some over-the-counter Advil or ibuprofen or Motrin. There are all sorts of cartilage supplements that may be helpful in some cases. There's something called glucosamine sulfate. These are over-the-counter supplements. People swear by things like tumeric and CBDs. So all of those things are possibilities. But when even those aren't enough, then we start thinking about doing more invasive things. So when somebody sees me and they've already optimized things that they can control, then we start talking about injections. And so there's different types of injections. There's cortisone of course, which is a steroid. It's not fantastic for you. It's not healthy for the good cartilage that's still in your joint. But it does help with the pain and inflammation. So for example, patients that have bad knee arthritis, they're having difficulty walking. They come in and say, well I'm going on a long trip. I really just want to enjoy my trip. How about a cortisone injection? That's reasonable and I give you a couple of months of relief. It's not going to fix anything. There's other types of injections. There's something called there's a broad class of injections called just go supplementation. So different types of patients call these the jell shots. So it's either a one time shot or sometimes it's a shot every week for three weeks in a row. And these help to lubricate the joint. They help with the symptoms of arthritis. But again, it's not fixing anything. And then after that we start thinking about surgery.

Deborah Howell
I was going to ask, at what point should joint replacement surgery be considered?

Dr. Tsai
So, that's a great question. And it's going to be different for everybody. I mean, some people are really nervous about surgery and really will let themselves get in severe pain before they consider it. And other people are not as apprehensive. A little bit of apprehension about surgery is healthy, I think. I mean, bad things can happen when you have surgery these days. Knee replacement and hip replacement surgery is very routine, so the chances of something bad happening are small but not zero. I think it's reasonable when you start finding that you're choosing not to do things because of the pain. So when I was a resident, which that was a long time ago, we would tell patients, just wait as long as possible. You're too young. It's only going to last so long, you're going to have it redone. And so that was the philosophy back then. But really that's asking people to sacrifice quality of life. Now just because they're worried about what might happen. So nowadays I think the philosophy has changed. And we think, okay, well when you find that you're choosing not to go to Disneyland with the grandkids or not go on vacation or not go hiking or not go shopping or whatever it is you want to do when you find yourself choosing not to do those things because of the pain, then I think surgery is reasonable. So the joints we did 20 years ago last about 20 years, presumably the ones we're doing today are better and may last 30 years or plus. And if it has to be redone, we can do it. You know, we have the technology. So, I think surgery is reasonable for those situations.

Deborah Howell
And, you know, gone are the days my mom had her knees done three times replaced. And so I don't think we're doing that anymor, right?

Dr. Tsai
Well, I mean certainly things can go wrong. And so you know, worst case scenario after surgery I think we stay up night worrying about an infection. So it's rare, but it can happen. And if you get an infection then you know, you have to go in and you have to take it out, wash out the knee and then you have to go back and redo it so those things can happen, but they're rare.

Deborah Howell
I think it's more in her case, it was because, you know, her first set was in her 50s and that was a long time ago. And I just think the technology is so much better now.

Dr. Tsai
Oh for sure. So the materials are better, you know, ceramics and polyethylene and metal alloys. The techniques are better with surgery. There's a lot of robotic assisted surgery these days. And surgery isn't quite the same as when your mother had her knee replaced. She probably stayed in the hospital. And nowadays, I would say the majority of total knees and hips that I do are outpatient. You know, a lot of people will go home the same day. Anesthesia techniques are better. The nerve blocks are better after knee replacement. So it's definitely possible to have a procedure and go home the same day.

Deborah Howell
And get up and walking shortly after, right?

Dr. Tsai
Ideally we have patients get up with physical therapy the same day of surgery. So, you know, if you stay one night in the hospital a couple of hours after surgery, if as soon as the anesthesia has worn off or you're up with physical therapy, you're walking, you're you're again moving.

Deborah Howell
And the reason for that is to prevent scar tissue from forming.

Dr. Tsai
Yes. Definitely helps. You know, the knee especially you really want to get the range of motion going right away. And it just helps just overall, you know, having the patients get up and walk and work on strength and balance, you feel better.

Deborah Howell
So, if your knees, your hips, your joints are bothering you to the point of where you're not going to Disneyland with the grandkids, what would you tell everybody, Dr. Tsai?

Dr. Tsai
Well, I mean, it's certainly worth looking into seeing an orthopedic surgeon and getting an evaluation and see what your options are.

Deborah Howell
And you can learn more about joint replacement care at MemorialCare.org/LBJointReplacement. Thank you so much, Dr. Tsai, for your time and expertise today.

Dr. Tsai
Oh, it's my pleasure. It was nice being here.

Deborah Howell
And we enjoyed having you with us. For more info or to listen to a podcast of this show, please visit MemorialCare.org. That's MemorialCare.org. That's all for this time. I'm Deborah Howell. Have yourself a terrific day.