Tendinitis & Bursitis
treatment, prevention and pain relief
CAUSAL FACTORS
TENDINITIS
The cause of tendinitis (tendonitis) is not always obvious. Most cases of tendinitis occur in middle-aged or elderly as the vascularity of tendons attenuates. There is evidence that repetitive micro-trauma may increase injury. Repeated or extreme trauma, strain or excessive exercise is most frequent cause of tendinitis. Tendinitis may also be related to systemic diseases including rheumatoid arthritis, SLE, gout, Reiter's syndrome and diabetes. Excessively elevated cholesterol (Type II hyperlipoproteinemia) is also a cause.
More precise terminology for a chronic tendon condition is tendinopathy (tendonopathy) or tendinosis (tendonosis).
BURSITIS
Bursitis may be caused by trauma, chronic overuse, inflammatory arthritis (rheumatoid arthritis or gout) or acute or chronic infections. It usually occurs in the shoulder (subacromial or subdeltoid bursitis) but is also common in the olecranon (tennis elbow), prepatellar (housemaid's knee) or suprapatellar, and first metatarsal head (bunion).
The symptoms of bursitis and tendinitis are similar: pain and stiffness made worse by movement. Pain may be worse at night. Although tendinitis and bursitis are usually temporary conditions, they may become recurrent or chronic problems.
TREATMENT MODALITIES
Symptomatic relief of tendinitis and bursitis is provided by rest or immobilization (splint or cast) of the affected area, application of heat for chronic inflammation or cold for acute inflammation.
PROLOTHERAPY
Prolotherapy is a treatment in which a solution of simple compounds (usually dextrose or calcium carbonate) is injected at the point of the injury. This triggers an inflammation response that increases the blood supply and delivers the nutrients necessary to promote the growth of new cells and repair damaged connective tissue.
Medications prescribed for bursitis and tendinitis vary according to the patient's individual condition.
Analgesics and Anti-inflammatories
NSAIDs
Non-steroidal anti-inflammatory drugs (NSAIDs) are a group of drugs commonly used to treat bursitis and tendinitis because of their analgesic, anti-inflammatory, and antipyretic properties. NSAIDs inhibit the enzymes Cox-1 and Cox-2 (cyclo-oxygenase), which catalyze arachidonic acid to prostaglandins and leukotrienes. Arachidonic acid is released from membrane phospholipids as a response to inflammatory stimuli. The efficacy of NSAIDs differs from patient to patient. This is likely due to the pharmacokinetic differences among the various NSAIDs.
Through their inhibition of Cox-1 enzyme, NSAIDs can cause stomach irritation, bleeding, fluid retention, and decreased kidney function. Since NSAIDs bind to plasma proteins they may be displaced by or may displace other plasma-bound drugs such as coumadin, methotrexate digoxin, cyclosporine, oral anti-diabetic agents, and sulfa drugs. This interaction can enhance the therapeutic or toxic effects of either drug.
NSAIDs (particularly indomethacin) can interfere with the pharmacologic control of hypertension and cardiac failure in patients who take beta-adrenergic antagonists, angiotensin-converting enzyme inhibitors, or diuretics.
The long-term use of NSAIDs may have a damaging effect on chondrocyte function.
Adverse effects of NSAIDs (which can occur at any time), include renal failure, hepatic dysfunction, bleeding, and gastric ulceration.
Cox-2 Inhibitors
A relatively new sub-class of NSAID, known as Cox-2 inhibitors, work by blocking cyclo-oxygenase 2 enzyme which is involved in the inflammation pathway. By sparing cyclo-oxygenase 1 (Cox-1) enzyme, gastrointestinal toxicity is purportedly reduced. Due to their proclaimed reduction of gastro-intestinal side effects, Cox-2 inhibitors have claimed a large share of the NSAIDs market.
Unfortunately, recent studies have indicated that Cox-2 inhibitors can increase the risk of cardiovascular problems including angina, myocardial and cerebral infarction, thrombosis and sudden death, to four times that of traditional NSAIDs. A review of more than 48,000 patients taking rofecoxib revealed that 0.52% of patients taking an inactive placebo pill had a heart attack each year. The annual rate of heart attack was 0.74% for patients taking rofecoxib. One theory for this holds that Cox-1 enzyme plays a role in preventing the clot formation that leads to cardiovascular problems.
The assertion that Cox-2 inhibitors (rofecoxib, celecoxib) do not induce haemorrhage in the upper gastro-intestinal tract, is also under dispute. While studies confirm that Cox-2 inhibitors cause fewer gastro-intestinal events than traditional NSAIDs in the short-term, it is not yet known what the long-term effects of these drugs will have on the gastric mucosa.
*Important News Release September 2004
Vioxx®, the cox-2 inhibitor made by Merck, has been pulled from the market because of severe lethal side effects due to heart attack and stroke.
Acetaminophen
Acetaminophen is often prescribed to relieve mild to moderate pain associated with bursitis and tendinitis. The drug possesses analgesic and antipyretic properties, but is not an anti-inflammatory. For this reason, it may usually be safely combined with an anti-inflammatory medication to relieve pain.
Overdosing can cause liver damage that may be severe enough to cause liver failure and death.
This damage occurs in a dose-related manner and is the leading cause of rapid onset liver failure in the US, Canada and the UK.
Long term use can result in kidney disease.
For the average healthy adult, the recommended maximum dose of acetaminophen over a 24-hour period is four grams (4000 mg) or eight extra-strength pills. (Each extra-strength pill contains 500 mg and each regular strength pill contains 325 mg.) A patient who drinks more than two alcoholic beverages per day, however, should not take more than two grams of acetaminophen over 24 hours. For children, the dose is based on weight and age.
A single dose of 7 to 10 grams of acetaminophen (14 to 20 extra-strength tablets) can cause liver injury in the average healthy adult. (This amount is about twice the recommended maximum dose for a 24-hour period.) In children, a single dose of 140 mg/kg body weight of acetaminophen can result in liver injury. However, amounts of acetaminophen as low as 3 to 4 grams in a single dose or 4 to 6 grams over 24 hours, have been reported to cause severe liver injury, sometimes resulting in death. Certain individuals, for example, those who regularly drink alcohol or those with hepatitis C, are more prone than others to developing acetaminophen-induced liver damage.
Cortisone
Cortisone may be injected directly into the joint to relieve severe inflammation and swelling. A cortisone injection can provide almost immediate relief for a tender, swollen or inflamed joint. However, since corticosteroids can degrade cartilage and demineralize the bone, they should only be used rarely. Chronic use of corticosteroids may result in weight gain, hypertension, susceptibility to infection, capillary fragility, acne, excess hair growth, cataracts, glaucoma, diabetes, muscular atrophy, accelerated atherosclerosis, menstrual irregularities, irritability, insomnia and psychosis. Since steroids appear to cause premature death of osteoblasts and slow their replacement; osteoporosis and bone damage are of particular concern. Long-term use may also affect brain cells, causing memory loss. Certain side effects such as hypoglycemia, edema and hypertension can be minimized by treatment.
Anti-catabolic Substances
Nutricol®
Available as the OTC supplement Recovery® in many pharmacies, Nutricol® is proposed to reduce the inflammation that accompanies tendinitis and bursitis. This may reduce the likelihood of progression and diminish accompanying pain.
Nutricol® (Recovery®) is an anti-catabolic agent that works at cellular level to help stabilize joint structures. Biomedica Labs also believes that this proprietary blending of plant nutrients naturally increases the cells' receptivity to hormones such as insulin which are required to speed the repair of tissues.
Recovery® contains the active ingredient Nutricol®, a disease modifying anti-catabolic agent (DMAC), which Biomedica Labs is proud to introduce to health care professionals.
Biostructural® Medicine goes beyond simply addressing symptoms and focuses on the degenerative process and optimal healing.
Nutricol® (Recovery®) may be safely combined with other medications or taken on its own to help counter inflammation and improve the quality and rate of healing.
Information for Doctors: Print an 6-page detailed information package that provides the following:
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Click here to view feedback from health professionals and users about the results noted from Recovery® with Nutricol®.