New Paths of Pain in Deforming Arthrosis

Deforming arthrosis of the joints is one of the most widespread disorders in the world; approximately 12-15% of the world’s workforce suffers from this pathology. The percentage of older adults that suffer from deforming arthrosis is significantly higher, due to the fact that the locomotory system is subject to substantial changes during the aging process. This trend is well reflected in the statistics obtained in an epidemiological study of the populations of large cities across the planet (data from the World Health Organization). They show that approximately 30% of persons age 50 to 60 years suffer from osteoarthrosis, while more than 90% of persons age 60 or older suffer from the disorder.

Pain syndromes and functional disorders are the calling card of osteoarthrosis in any localization. Nevertheless, the greatest suffering is experienced by patients with lower limb joint pathologies. The load placed upon these joints is significantly greater than that placed upon the upper limbs. The tragedy of such patients lies not only in their constant pain, but also in the implacable reduction in locomotory capability of their lower limbs due to the increasing deformity of their joints. Without understanding the nature of pain phenomenon, medicine was unable for many years to ease the suffering of patients in pain. Though very late in the game, the truth revealed itself.   

What is the nature of the breakthrough? Indeed, practice has shown that the various means of conservative therapy for this pathology have not met with great success. The turning point in the treatment of this disorder has come as a result of re-examination of commonly held views that arthrosis of the joints is a manifestation of local pathology. As it turns out, the disorder is not limited to the pathological changes occurring in the joint. An important role in the clinical manifestations of osteoarthrosis belongs to the extrasynovial changes in the musculoskeletal system, which are responsible for the formation of pain sensations originating in various tissue structures of the damaged limb (periosteum, endosteum, fascia, muscles, ligaments, synovial membranes). I will note that the treatment of pain syndromes in deforming arthrosis has never been approached from such a standpoint, which is why many other sources of pain originating outside the joints have been ignored. Hence, the inevitable results of traditional conservative therapy conducted without consideration of the above circumstances: treatment is incomplete, which is the cause of the high percentage of treatment failures, driving patients to despair.

Without a doubt, it would be ideal to eliminate both synovial pain and locomotory disruptions simultaneously. However, in reality, such rehabilitation of patients is possible only in the earliest stages of osteoarthrosis, when structural changes in the joint are of a reversible nature. In later phases of the disorder’s development, these changes become irreversible, due to the appearance of osseous accretions on the joint surfaces, which do not respond to conservative treatment. Therefore, the primary imperative in the treatment of patients suffering from deforming arthrosis is considered to be the elimination of pain and stabilization of changes taking place in the damaged joint. In cases when this is done consistently and fully, a sufficient range of motion in the damaged joint can be successfully preserved for many years, providing the patient with a quality of life without substantial limitations or significant difficulties. Thanks to such measures, patients in this category are able to feel practically healthy.

There is yet another condition that is able to provide a substantial increase in the efficacy of conservative treatment of deforming arthrosis: refusal to employ a chaotic, template approach to patient treatment. The arsenal of conservative therapy methods for this pathology is quite considerable. However, this does not mean that they should be prescribed arbitrarily, without a defined system. The physician must wield this variety of treatment options based on the specifics of the pathological process taking place in the damaged joint.

Pain syndromes arising from deforming arthrosis have a significantly more complicated origin than was previously believed. The formation of such syndromes involves tissue structures related to both the damaged joint and the surrounding muscle, ligaments, tendons and bone tissue elements. The sequence of the appearance and the clear interrelation between various types of pain, each of which has its own anatomical and morphological substrate, attests to the orderliness of the processes leading to the formation of pain syndromes. Synovial (arthrogenic) and extrasynovial sources are the two distinct components of pain syndromes arising from deforming arthrosis.

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