by Dr. Iain Corness
The Go-Go dancer’s knee
While thinking about joint pains, there is an old orthopedic
surgeon’s joke which goes: “What’s a nice joint like you doing in a girl like
this?” However our joints certainly give us lots of problems, especially as we
The joints to give us the most worries are knees, ankles, fingers, shoulders and
hips in around that order. All of them are joints you use and need frequently.
For many of the joints it is a simple case of wearing them out. This is
especially so with the weight bearing joints as the knees, ankles and hips. In
the perfect body scenario, your joints are designed to last you about 80 years,
hold your bottom off the ground for 80 years and move smoothly for 80 years.
Overload these joints and they wear out quicker. Consequently, if they have
become knackered by the time you are 55 then you have another 25 years of aching
joints to look forward to. Of course, the quickest way to wear out your poor old
joints is to be overweight.
In the past week I have had a couple of people come to see me to ask about their
pains. However, this is not surprising, as pain is often the presenting symptom
for many illnesses and physical conditions. For example, the symptom of a
fractured rib is pain on deep breathing, coughing or sudden movement.
In fact, our skeletons are responsible for many of our pains. Fractures and
degenerative conditions such as osteoarthritis are certainly high in the list of
likely suspects. Gout, which produces an arthritis in the joint in the big toe
gives exquisite pain - just ask anyone who has had it!
Is it not possible to be pain-free, in today’s Android world? Unfortunately, the
chemicals that are strong enough to mask the pain are also strong enough to
render your brain inoperative when taken over a long period.
I do also realize that there are times when you want “temporary” respite from
pain. The footballer with a fractured finger can have local anesthetic injected
into the fracture so that he can do the two 45 minutes halves plus injury time
and penalty shootout. That’s it. Not tablets for the next three weeks!
So why do we have “pain”? Pain is actually inbuilt into our systems for an
important purpose. Damage control! Pain is what stops us damaging our bodies
even further than they are damaged already. Let’s go back to the broken rib
scenario. Most fractured ribs are “cracks” along the long axis of the bone, not
a complete break right through, so that the ends are flapping around in the
breeze. The pain stops the unfortunate person from doing too much and breaking
it totally right through. Pain has a protective influence. With the person who
has joint pains or gout, the purpose of the pain is to stop further damage to an
already “crumbling” joint or one filled with sharp crystals. Pain makes you rest
it, so that it can heal. When you stop to think about it, pain is good for us.
However, there are also chronic pain situations, and these are harder to deal
with. Particularly when the pain is coming from a permanently damaged skeleton,
or from a condition we cannot “cure”. This is where pain management comes in,
and it is a fairly skillful region of medicine, let me assure you. Practitioners
in this have to really understand what the patient is going through. What
happens is that we (or you) have to maximize an ability of the body’s nervous
system known as “attenuation”. This is where the nervous system receives so much
pain stimuli that eventually the pain receptors “give up” through the overuse.
However, getting to that stage is a long and painful road itself.
Chemical assistance is needed, but it is not just a case of taking big dose
analgesics. In actual fact, much of the work in this area is with taking agents
to slow down nerve transmission and other agents such as anti-inflammatories,
which work with pain killers to make them more potent at a lower dose (so the
brain doesn’t get mussed up)! It’s not easy.
In response to some medical attacks
It has always been the case where
people like to throw stones at conventional clinical medicine. Claims of
over-servicing, over-prescribing and downright fraudulent practices are
thrown about, citing someone whose uncle/friend/mother (delete that which is
inappropriate) suffered at the hands of “bad” doctors.
Now, there are certainly some “bad” doctors out there, just as there are
“bad” lawyers, “bad” real estate agents, “bad” mechanics and just about any
profession you would like to think of. But they’re not all “bad”.
And me? I am a conventionally trained British/Australian style medical
practitioner who has spent a lifetime practicing EBM, otherwise known as
Evidence Based Medicine. Practices that have been proven to work. Call it
“good” medicine, if you like.
I am proud of my training. Six years at an Australian university that had a
good name, and still does, despite undergraduates like me attempting to
besmirch it during the aforementioned six years. I am also proud of my final
exams taken in the Royal Colleges of Physicians and Surgeons in London. I
have the honor to have my name listed in the ‘great book’ with luminaries
such as Hunter, Jenner and Lister. I am also indebted to my tutors during
the 12 months of ‘pre-registration’, where you apply your knowledge under
the supervision of accredited specialists. An arduous road, but one that is
a safeguard for you, the general public.
Another safeguard is called ‘peer review’ which medical doctors have to
undergo. The ‘powers that be’ are also ensuring that we keep up to date with
a process called Continuous Medical Education (CME). That medical education
continues through to today, with CME lectures being attended by my
hospital’s doctors, and myself. Fortunately for me, the slides are in
English, even though sometimes the lecture is not.
Those ‘powers that be’ also try to ensure that we prescribe drugs that are
efficacious, that have been tested, and the evidence points to this. It is
not anecdotal evidence, but true scientific evidence shown by research in
many countries, with hundreds of thousands of patients. It is following that
type of evidence, that I can recommend with all good faith, that 100 mg of
aspirin a day is “good” medicine. I also know that if you are prescribed a
‘statin’ drug it will lower your cholesterol levels. They have been tested.
And these days, very rigorously indeed.
I am also the first to admit that we have sometimes managed to get it wrong.
The Thalidomide story still has living examples of this. However, the
medical world-wide network is cohesive enough to ensure that this drug was
withdrawn. It is the checks and balances system that has kept western
medicine afloat. This is not to be equated with the checks and balances
system that has been incorrectly applied in the banking industry that sees
the institutions on the brink of sinking!
I am often asked my opinion on “alternative” medicine, and all its diverse
areas of ‘specialization’. I try to avoid direct confrontation over this. If
devotees have found that they can diagnose tumors by looking at patient’s
auras through their third eye in the middle of their foreheads, then I am
genuinely pleased, in fact delighted, provided that they have subjected the
method to scientific scrutiny.
If various groups can actually cure cancer, epilepsy, halitosis or lock-jaw
by inserting dandelions into a fundamental orifice, then again I am
delighted. This is a medical break-through, but as such, must be subjected
to medical scrutiny. If the method stands true scientific examination (not
to be confused with anecdotal ‘evidence’) then it will be adopted by
everyone, complete with thanks to those clever people who picked the
dandelions in the first place. After all, penicillin was tripped over, not
designed. But it has had a very rigorous scientific scrutiny since.
As far as the majority of ‘folk’ remedies is concerned, I work on the
principle that if you ‘think’ it is doing you good, then it probably is. But
don’t ask me to endorse something that has not been scientifically tested.
When the ‘alternative’ group spends more time proving their methods, instead
of complaining about non-acceptance, EBM practitioners will give them more