Is Ibuprofen safe? Are steroid injections safe? Read what rheumatologist Dr Benji Shcreiber says
Are ibuprofen tablets safe to self-medicate with? Are steroid injections safe? Senior BOOST Physiotherapist Jolene Sher asks Consultant Rheumatologist, Dr Benji Schreiber, these questions in this consultant Q&A. Also questions about vitamin D and exercise. Dr Schreiber is a Consultant Rheumatologist at the Royal Free Hospital and is practices privately at he Garden Hospital in Hendon and The Wellington Diagnostic Unit in Golders Green. His website is http://drschreiber.org/
BOOST PHYSIO: Is self medicating with ibuprofen an effective way to deal with swollen painful joints?
Dr Schreiber: In the past patients have been encouraged to use non-steroidal anti-inflammatory drugs such as ibuprofen quite liberally. We now know that these drugs can cause stomach ulcers, raise blood pressure, damage the kidneys and – with long term use – increase the risk of heart attacks. In addition, they are really just painkillers and do not address the underlying inflammation. Swollen painful joints are often indicative of an underlying inflammatory arthritis which requires more specific treatment to settle the inflammation and reduce long term joint damage.
BOOST PHYSIO: Would you say corticosteroid injections are a safe treatment option?
Dr Schreiber: In good hands, by and large, yes. However, not all steroid injections are the same. The safety and indeed the efficacy of injections depends on the site of injection and on the reason for the injection. Injections into large joints such as the shoulder and knee are most common and safe. Steroid is also frequently injected at the elbow (for tennis/golfers elbow) and into the wrist for carpal tunnel syndrome. Injections in some places have been found not to be of benefit – so for example the Achilles tendon and the heel (for plantar fasciitis) are now rarely injected. One should follow the instructions for care of the joint after an injection. Generally speaking there are small risks which need to be understood and discussed prior to injection, but serious complications such as a joint infection are extremely rare (1 in several thousand). If one has severe pain after injection with worsening redness and warmth one should seek urgent medical attention.
BOOST PHYSIO: Does vitamin D deficiency play a role in musculo-skeletal pain?
Dr Schreiber: Severe vitamin D deficiency causes osteomalacia. This literally means softening of bone which increases the risk of hip fractures and vertebral (spinal) fractures. However, it also causes generalised pains and muscle weakness. It is clear that vitamin D can improve bone health in this setting, but effects on muscle strength and pain are not proven. There are many claims that vitamin D can improve all sorts of things – from cancer to heart attacks – but these remain unproven. A recent report from the prestigious Institute of Medicine in the USA will provide more information for those who are interested (http://www.nap.edu/catalog.php?record_id=13050).
BOOST PHYSIO: How important is exercise prescription for you in the treatment of your patients?
Dr Schreiber: Exercise is absolutely crucial for at least four reasons. Firstly, exercise helps cardiovascular fitness and weight loss. This is particularly important in older patients who lead a more sedentary lifestyle. Patients who are wide at the waist and don’t move much urgently need to be doing more exercise!
Secondly, in people with musculoskeletal symptoms of stiffness or pain, exercise can play a crucial role in helping recovery by increasing muscle strength and bone health. Without exercise it is often very difficult to regain the function that is lost as a result of pain and stiffness.
Thirdly, exercise will prevent the stiffening which often leads patients into a vicious cycle with prolonged stiffness and pain in a joint and reducing joint function. A trained therapist will identify which movements the patient is avoiding and identify where they are restricted without even noticing it.
Finally, exercise has tremendous personal and psychological benefits in promoting a ‘can-do’ approach and overcoming low mood. It empowers the patient to work on their own recovery and to take an active role in remaining healthy.
A good physiotherapist can often help a patient to recover quickly. Scientific studies have shown that specific exercise regimens are beneficial in many conditions, including for example back pain and shoulder pain. In some studies, including rotator cuff tendinopathy at the shoulder, knee pain from osteoarthritis and tennis elbow, a properly followed exercise regimen has been shown to be as effective as surgical intervention.
BOOST PHYSIO is experienced in dealing with musculo-skeletal problems, injuries and rheumatological conditions.
BOOST PHYSIO is a private physiotherapy clinic with High Street Branches in North West London (Hendon NW4) and North London (East Finchley N2). For details about our clinics you can look here. or you can call us direct on 020 82017788.
Our East Finchley Physiotherapy clinic is at 200 High Road, East Finchley N2 9AY.
Our Hendon North West London physiotherapy clinic is BOOST PHYSIO 16 Parson St, Hendon NW4 1QB