NHS waiting list figures are at a record high with over 7.4 million people awaiting treatment and 830,000 waiting for trauma and orthopaedic (T&O) treatment, such as hip or knee replacement, in England alone.

Waiting times are at peak levels across the UK, with 62% of people waiting more than a year to be admitted for T&O surgery in Northern Ireland, so pain management techniques are more urgent than ever for those living with arthritis and waiting for surgery. 

Lack of support to prepare for surgery

Hip and knee replacements have some of the longest waiting times in the UK, and many people have reported their conditions worsening while they wait. While the NHS is in this critical condition, people must be better supported to manage their pain and be ready for surgery when called. Yet, according to our research, half (51%) are receiving no support at all. 

There are a range of movements that can be done at home and outdoors to keep the joints moving, ease symptoms and reduce pain. 

What to do before surgery

It’s important to try to stay as fit and healthy as possible when waiting for surgery. Exercise, at the right level, reduces surgery complications and improves heart and lung health — and is also associated with faster recovery times.  

People with arthritis can often find it hard to keep going with regular physical activity and exercise, and a lack of movement can actually increase symptoms such as stiffness and pain. Not only will movement assist in pain reduction but it also increases the range of mobility, improves joint function and keeps the muscles strong, which will help protect the joint. Exercise can also have a positive impact on our mental health and wellbeing as it is a proven mood-booster. There are a range of movements that can be done at home and outdoors to keep the joints moving, ease symptoms and reduce pain. 

Learning how to exercise safely

Many of us, especially people living with the pain of arthritis, need support and guidance to exercise safely. This year, off the back of our popular ‘Let’s Move’ exercise programme, Versus Arthritis has created a bespoke toolkit to support the growing number of people waiting for, or undergoing, joint replacement surgery.

This new online toolkit offers a variety of exercises that can help people with arthritis prepare for and recover from surgery. In the future, we want everyone waiting for a joint replacement to have access to these types of programmes, ensuring the best surgery experience, which in turn supports our national health service. 

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Many people will be familiar with the word migraine. However, there is a high level of misunderstanding about what a migraine actually is and what it means to live with it.

A migraine is more than ‘just a headache.’ There is a common misconception that someone with migraine will need to take paracetamol or lie down for an hour and then be fine. Instead, living with a condition like this can have a significant impact on a person’s ability to carry out day-to-day tasks.  

Know the migraine symptoms 

The symptoms of migraine attacks can include head pain; problems with sight, such as seeing flashing lights; being very sensitive to light, sounds and smells; fatigue; feeling sick and being sick. Migraine attacks usually last for between four hours and three days and can be incredibly debilitating. As well as the physical symptoms, living with migraine can affect other aspects of life including mental health, relationships and working life. 

Approximately 190,000 migraine attacks happen
every day in the UK — equivalent to about 396
attacks a minute in the average working day.

Discrimination at work

Lack of understanding about migraine means that, worryingly, a third of people with migraine have felt discriminated against at work. Almost half report not being believed or taken seriously, and a quarter have faced disciplinary action. A third have had to leave their jobs altogether. 

Approximately 190,000 migraine attacks happen every day in the UK — equivalent to about 396 attacks a minute in the average working day. Despite being such a common experience for so many people of working age, employees with migraine are simply not receiving adequate support. 

Migraine-friendly workplace environment 

For the vast majority of people with migraine, their condition should not be a barrier to finding and retaining employment. However, from time to time, it may have an unavoidable impact at work. There are some solutions employers can implement to support staff with migraine. This includes regular screen breaks, softer lighting, flexible working hours and quiet spaces. Asking employees what they need to help manage their migraine in the workplace can help provide a safe and supportive environment to start conversations.  

One in seven people in the UK live with migraine. By understanding what it means to live with migraine, we can ensure they can live better.

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Older people often see pain as a natural part of ageing, but this is a misconception. They should not have to live in pain, especially if it is serious and chronic. Older people must have access to treatment and support.

Cultural, spiritual and social factors can influence the experience of pain, which may also change over time. Untreated pain can feel and be exhausting and frustrating, especially when everyday activities — such as washing and dressing, shopping and food preparation — become a challenge and sometimes avoided. Finding yourself in this position is particularly frightening if you are living alone.  

Importance of pain intervention for older people 

Uncontrolled pain is serious for older people. Under-reporting, under-recognition and under-treatment by healthcare professionals are sadly common. The knock-on effects can include delayed recovery from illness and the need for more GP and hospital visits.  

Pain can lead to depression and anxiety, lack of sleep, undernutrition and dehydration, which in turn increase the risk of falls, fractures and further deterioration and difficulties in managing long-term conditions. Pain can also increase the risk of loneliness and impact negatively on wellbeing more generally.  

Non-pharmacological interventions can help
some older people to manage their pain.

Factors that affect pain management 

Older people with dementia or cognitive impairment may find it difficult to express their pain. Health and social care professionals should have the communication skills to draw out a verbal response. If that is not possible, they must have training and access to validated tools to help measure the experience of pain in another way.   

Pain management in older people is often challenging and can become more difficult. This is partly because some find it hard to explain the quality and intensity of their pain and its impact on their lives but also because of the greater likelihood of adverse drug reactions, whether due to taking multiple medications reacting badly with each other or analgesic side effects.  

Medication and non-pharmacological interventions 

Non-pharmacological interventions can help some older people to manage their pain. They include exercise and stretching, aromatherapy, mindfulness, heat and cold. Some older people prefer a self-managed programme while others like the active support of family and friends.  

Medication and non-pharmacological interventions help some older people gain better control over their pain and enjoy a better quality of life. Certainly, older people, families and carers should ensure that all pain is assessed by a healthcare professional and that any prescribed medications are available and do not run out.  

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Patients with arthrofibrosis — a debilitating condition characterised by excessive scar tissue around the knee joint — suffer from loss of motion, stiffness and sometimes significant pain.

Arthrofibrosis (commonly known as stiffness) poses challenges in treatment, as conventional physiotherapy typically falls short, offering limited appointments. Home exercises lack the necessary intensity required to break down dense scar tissue, the cause of the problem.

Knee device for severe stiffness and pain 

Dr Sara Aspinall, a specialist knee physiotherapist, has introduced a groundbreaking solution for knee replacement patients suffering from stiffness. Her innovation offers hope to the approximately 20% of knee replacement recipients who are left dissatisfied. 

Dr Aspinall’s research has led to the development of the STAK (Self-Treatment Assisted Knee) — a medical stretching device designed to empower patients with high-intensity stretching that can be performed in the comfort of their homes. This novel approach restores the knee’s range of motion and enhances overall quality of life. 

Improving range of motion 

In an eight-week clinical trial published in the Bone & Joint Journal, patients using the STAK achieved a remarkable 30° increase in range of motion on average, compared to just 8° for those receiving standard physiotherapy. When the standard treatment group incorporated the device for an additional eight weeks, they saw an additional mean increase of 20°. 

Patients report immediate benefits,
with increased mobility and comfort
after their initial session.

Feedback from professionals 

The device has earned widespread praise from leading surgeons, physiotherapists and patients throughout the UK. Professor Robert Ashford, from UHL NHS Trust, describes it as: “A simple yet highly effective daily routine with really excellent functional results.” Fellow consultant orthopaedic surgeon Steven Godsiff lauded it as a: “Fantastic, low-cost and highly effective alternative treatment.”  

Liz Jacobs and Jack Codd, knee specialist physiotherapists at the Royal Devon and Exeter Hospital, highlight the device’s user-friendliness and convenience. “Patients can control the stretch intensity, track their progress, ensuring a safe, effective and motivating rehabilitation process.” 

Professor Andrew Toms, National Clinical Lead for Revision Knee Surgery, highlights the importance of addressing stiffness in knee replacements. “Our role as surgeons, physios and researchers is to keep innovating to help solve this difficult multifactorial problem. The STAK tool gives us a new approach and has the advantage of being an active technique, with a prolonged flexion stretch.”  

Benefiting patients with severe knee stiffness 

Sara explains: “Patients report immediate benefits, with increased mobility and comfort after their initial session.” Gillian, 67, shared after her first session: “It feels as if I’ve loosened something off, and I can bend my knee more already!” Rhiannon, 73, expressed joy after four weeks of treatment: “I’m really happy I’ve got back to full life, and I feel 10 years younger.” With this device, there is hope for a pain-free future for patients who have endured the challenges of stiffness for too long.  

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A device to relieve severe lower back pain effectively helped a patient who says it enabled her to return to marathon running.

Just over a decade ago, Kate Riley had a busy job and vibrant social life and ran marathons. That came to a halt after she developed a kidney problem, which did not respond to antibiotics and resulted in nerve damage — leaving her with severe lower back pain. “It literally changed my life. I could not do anything I wanted to do,” says Kate, 36. “Running was out of the question. I could just about walk, but I was in ridiculous amounts of pain.”

Navigating the pain pathway

Having little success with current NHS treatments, she was referred to Dr Vivek Mehta, a consultant in pain medicine at St Bartholomew’s Hospital in London. Initial treatment consisted of nerve block medication (Botox). “But then ReActiv8 happened,” says Kate. The ReActiv8 implant was fitted in the lower left side of her back in July 2017 and works by stimulating the nerves that connect to the multifidus muscles, which have a significant role in stabilising the spine. Once the muscles are reconditioned, the patient feels better.

Prior to ReActiv8, I had numerous days off
work, but I have not had a day off since.

How ReActiv8 works

By October, she was walking properly again. “From then on, it felt like I was back to my normal life,” says Kate. “In April 2018, I ran the London Marathon and had zero pain.” The device, which remains in her back, is activated by a remote-controlled sensor. “For 10 seconds, it feels like a deep tissue massage for my spine and then relaxes it for 20 seconds and does that for 30 minutes twice a day.”

Returning to normal life

Kate is again enjoying an active social and work life and is planning more marathons and sporting challenges. “Prior to ReActiv8, I had numerous days off work, but I have not had a day off since. Before, I thought I was going to be in pain for the rest of my life,” she adds, recommending it to people experiencing severe back pain. “For me, it is a miracle cure.”

Patients should consult with their physician to discuss whether ReActiv8 is appropriate for them. Individual patient results may vary.

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An electronic implant is bringing relief and improved muscle function to long-suffering back pain patients as evidence reveals some are now virtually pain-free.

Restorative neurostimulation is an emerging therapy for multifidus dysfunction, a primary underlying cause of chronic mechanical low back pain. According to Consultant Dr Simon Thomson, Consultant in Pain Medicine at Mid and South Essex NHS Foundation, it is having a major impact on sufferers by treating the underlying cause of their low back pain, not just managing their pain or treating their symptoms. “The effects, I would say, are profound; in many cases, patients who had years of chronic back pain are now virtually pain-free.”

Implant gives more than just back pain relief

Dr Thomson is an expert in spinal cord stimulation who founded the Neuromodulation Society of the UK and Ireland in 2000. For the past five years, he and his research colleagues have provided clinical evidence that underpins this new therapy.

ReActiv8 — produced by Mainstay Medical, a global medical device company — is a revolutionary device that consists of a small electronic implant designed to interrupt the cycle of low back pain, and is controlled twice daily by the patient. Rather than just covering up symptoms, ReActiv8 addresses the underlying cause of back pain by improving the function of the multifidus muscle.

Dr Thomson explains: “Often, those of us who treat pain are criticised by colleagues for not having the sort of copper-bottomed evidence base; but with this, we are doing really well. We have conducted a sham-controlled randomised study. We also have a new clinical effectiveness study coming out, which will look at using the ReActiv8 therapy in conjunction with the current standard of care, versus the current standard of care alone.”

When the pain becomes chronic and persists,
palliative treatments such as targeted injections
or radiofrequency ablations are frequently used.

Lasting pain and treatment options

Multifidus dysfunction usually stems from some sort of overload on the back, such as lifting something heavy or a flexion-extension injury. Dr Thomson explains that while back pain itself is very common and most people get over an episode, some end up with chronic pain that lasts for six months or more.

Current standard-of-care treatments consist of conservative options such as pain medication and physiotherapy. However, when the pain becomes chronic and persists, palliative treatments such as targeted injections or radiofrequency ablations are frequently used. Unfortunately, these treatments often do not provide lasting relief and require repeat interventions over short periods of time.

Reducing the burden of pain

From a societal economic point of view, the costs of healthcare burden are significant. Moreover, time taken off work by patients, as well as mental health impacts and effects on families, are substantial.

The post How a revolutionary implant for chronic low back pain is bringing relief to patients appeared first on Health Awareness.

Deborah Eastwood

President, British Orthopaedic Association

For those waiting for a joint replacement or similar procedure, here are some tips to help you manage your pain while you are waiting.

The latest Government figures show that over 800,000 people are on orthopaedic waiting lists, with 25% of these awaiting an operation. Living with joint pain and stiffness is challenging. The symptoms significantly limit your ability to take part in simple activities and reduce your quality of life; it can seem impossible to climb a flight of stairs or make a simple meal.

Follow recommendations and move in moderation

Firstly, your GP should offer guidance on pain management strategies that align with your specific condition and medical history. They may recommend certain medications, physical therapy exercises or other interventions tailored to your needs. Overall, moderation in all things is the key to controlling your symptoms. Do exercise in moderation but also take simple analgesics, and remember that relative rest from painful activities is sensible.

Take the right medication

Simple pain relievers or non-steroidal anti-inflammatory drugs (NSAIDs) help with mild to moderate joint pain. However, do follow your doctor’s advice/packet information regarding dosage and duration. Be mindful that there can be side effects.

Over 800,000 people are on orthopaedic waiting lists, with 25% of these awaiting an operation.

Hot and cold therapy

Applying heat or cold to the affected joint can provide temporary relief. Cold packs reduce inflammation while hot packs or warm baths help relax muscles and ease stiffness.

Engage in gentle exercise

It’s important to keep mobile, so low-impact exercises like swimming, walking or stationary cycling are helpful and don’t strain joints unnecessarily. They reduce fatigue and make it easier to walk a little further or a little longer.

Manage your weight

Adopting a balanced diet and maintaining a healthy weight is crucial, as excess weight exacerbates joint pain.

Practice mindfulness

Practices such as meditation, deep breathing and mindfulness help manage pain by promoting relaxation and reducing stress. Activities that keep you mentally busy distract you from the physical discomfort.

Seek emotional support

Dealing with joint pain and the wait for surgery can take an emotional toll. Get support from friends, family or a mental health professional to manage anxiety and maintain a positive outlook. The charities Arthritis Action and Versus Arthritis have a wealth of information on their websites. They also highlight local support groups that can help.

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Ten million people in the UK live with osteoarthritis, although only half are diagnosed. One in two of us will experience the condition in our lifetimes, with 350,000 people newly diagnosed each year.

Osteoarthritis occurs when the body can no longer properly maintain and repair one or more joints, which causes the cartilage to become thin and uneven, leading to pain, stiffness, swelling and deformity in the joint. Arthritis isn’t an inevitable part of ageing, and joints are not like car tyres destined to wear down and be replaced; they are made of complex living tissue that our bodies constantly repair and maintain.

Effects of osteoarthritis and treatment options

The pain and fatigue of osteoarthritis can dominate significant aspects of life, including mental, financial and social wellbeing. Treatment focuses on things people can do for themselves, such as being more physically active or maintaining a healthy body weight, which can be difficult.

Medicines for osteoarthritis include tablets and creams to help with pain and steroid injections, which often only provide short-term improvement. If these measures are not helpful enough, then surgery can be an option, including total joint replacements. While this is usually very effective, it is not suitable for everyone and is only recommended for people with severe pain.

We need better treatments to prevent, detect
and treat osteoarthritis quickly and accurately.

Developing improved osteoarthritis treatments

We need better treatments to prevent, detect and treat osteoarthritis quickly and accurately. Versus Arthritis is funding research that will help develop viable treatment options, help clinicians spot osteoarthritis faster and offer vital support sooner to prevent the debilitating pain and disability of this condition.

Researchers, such as Dr David Wilkinson, are improving our understanding of the condition and aiming to develop new treatments. Dr Wilkinson is studying the way the cartilage — a smooth cushioning substance that coats the ends of bones — becomes thinner in osteoarthritis. This loss of cartilage is an active process driven by enzymes called proteases. He is looking at which proteases have the most important role to play in these joint changes, hoping that they can ultimately be targeted with new therapies.

The process of cartilage loss in osteoarthritis is an active one, which gives us hope that something can be done to stop it in its tracks or at least slow down its progression. Versus Arthritis will continue to invest in research to allow everyone with arthritis the opportunity to live the life they choose, with real hope of a cure.

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My immediate perception of pain was that it would be there for the short term, I would receive treatment and then have total relief. Unfortunately, this was not the case.

At 23 years old, having lived with long-term pain for seven years, my hopes and dreams look very different. I had to change my expectations and work with what I had: severe fatigue, constant pain in my back and leg and restricted mobility. All of these caused new difficulties I never thought I would have to tackle at a young age. Everyday tasks became hurdles.

Finding a place considerate of pain conditions

I have always been ambitious; this has been a blessing and a curse. The biggest issue I faced was how to progress and move forward knowing that my body would always be trying to catch up with my mind. I needed to work remotely and for an organisation that would be considerate of my condition.

I chose to join Pain UK CIO as a volunteer administrator to give to a cause I cared deeply about, and this is where it all started. Shortly after being in this role, the Board of Trustees elected me as a Trustee, and I became part of the team responsible for Pain UK CIO. Although it took more out of me, doing my degree, tutoring mathematics and being a trustee of a charity, it helped me to cope.

There are days I work entirely from my bed,
days I stay in bed with nothing more to give
and better days where I ‘appear’ normal.

Everyone experiences pain differently

I knew that this awful experience of developing such a painful condition at this age, recovering from failed surgeries, programmes and procedures couldn’t all be for nothing. I grew more invested in the charity. Shortly after, I was voted into the Chair-Elect position with the plan to take over as the Chair in November 2022. As of writing, I have been in the Chair position for nine months, and it has truly been the most rewarding and challenging opportunity. There are days I work entirely from my bed, days I stay in bed with nothing more to give and better days where I ‘appear’ normal.

Managing pain is a unique and personal experience — one which many, fortunately, never have to experience or understand. But, for those who have no choice, it can be incredibly difficult and life-changing to adapt to your new normal. To anyone living with pain: that pain is personal, and your path in life may look a little different from everyone else. Pain isn’t always what it ‘appears’ to be.

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A knee brace has been specifically designed to ease pain caused by osteoarthritis, a condition that afflicts millions of people — helping them to lead normal, active lives.

Osteoarthritis (OA) is the most common type of arthritis in the UK, affecting about 8 million people. Among the most affected joints are the knees. Giles Leeming is the Senior Clinical Specialist for Össur Academy, a global Prosthetic and Orthotic company that develops non-invasive mobility solutions. 

Knee brace for unicompartmental osteoarthritis 

Unicompartmental OA affects the cartilage within the knee joint. There are two surfaces in the knee — medial and lateral sides— that take the load when you are standing.

Giles says an unloading knee brace can manage pain in OA patients. Össur’s Unloader® One X has been specifically designed for OA sufferers. It features a unique, patented and clinically proven ‘3-point Leverage System.’ It is lightweight and easy to wear.

If it weren’t for these knee braces, it
is a certainty I wouldn’t be running at
any level — let alone a half marathon.

Alan Henshall

Lasting support for osteoarthritis patients

The brace is designed to address the loads that go through the knee and isn’t just for temporary relief. “Historically, if you went to the doctor, the mainstay of treatment for arthritis and associated conditions for the knee has been pain medication.”

“While this is very effective and a good part of treatment, it is only addressing the symptoms and affecting the perception of pain rather than changing the mechanical reason as to why the pain is there.” With proper use, it can allow patients to live more freely and do activities that the osteoarthritis would normally stop them from doing.

Runner and user of the Unloader One X, Alan Henshall, completed the Liverpool half marathon this year. He shares: “If it weren’t for these knee braces, it is a certainty I wouldn’t be running at any level — let alone a half marathon. My braces allow me to carry on with the activities that I love doing, like running, even with the osteoarthritis and meniscal damage in my knees.” 

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