Osteoarthritis Pain Not Related to Structure – Again…

By Chris Centeno, MD /

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osteoarthritis pain

Have you ever seen the movie Groundhog Day? That’s what it felt like when I came across a study this proving – again – that OA pain is not related to structure. At  issue here is the orthopedic paradigm that pain IS related to structure; that MRI findings like meniscus tears and cartilage damage associated with arthritis are the cause of the pain a patient is experiencing.  This study caught my eye because it sought to identify the actual source of osteoarthritis pain, which is something we know well from years of doing the types of exams which actually find the source of pain, and treating osteoarthritis pain successfully without surgery.

I suppose it’s easy to see where this erroneous paradigm comes from. Joints are complex mechanisms full of structural parts which connect one part of a body to another in a way that allows movement. There are ball and socket joints like the hip, hinge joints like the elbow, gliding joints like in the hand and saddle joints like the vertebrae in the spine. What they all have in common are bones, cartilage, fibrocartilage, synovial fluid, tendons, ligaments and muscles….and the nerves which send and receive signals to and from the spinal cord and ultimately the brain which direct what all of the aforementioned parts need to do, and are also the part of the joint which send pain signals. Osteoarthritis is a condition that occurs when the protective cartilage at the ends of the bones in a joint  wear down, whose major symptom is pain. Since it is the cartilage which is damaged, it has been generally assumed that the damaged cartilage is the source of the pain.

What the study out of Paris determined was that Osteoarthritis pain originates in the free axonal nerve endings in the synovium, the tendons, and the periosteum (dense irregular connective tissue covering the bone rich in blood vessels and nerve endings), not the cartilage. They found that OA, or Osteoarthritis pain is a complex issue involving several different types of neuromediators and nerve signals, and is not correlated with joint degradation. Let me restate that – this is one of a bevy of studies where the degree of arthritis on imaging is not related to the amount of pain that patients report. Hence severe arthritis on x-ray doesn’t mean severe pain. The study concluded that because of it’s complex nature, treatment approaches to treat OA pain should be carefully chosen (i.e. not determined by solely looking at an x-ray or MRI image and a quick exam).

The upshot? Despite many recent studies showing that MRI findings of arthritis aren’t correlated to pain, many orthopedic surgeons haven’t gotten the memo. The problem with the orthopedic paradigm that pain is tied to structure is threefold: first, countless unnecessary and damaging surgeries are being done based on MRI findings which have nothing to do with the source of the pain, and second and more importantly, the patient is then left with the future negative consequences of those surgeries. Finally, the patient’s pain wasn’t addressed because the structural problem that was “fixed” had nothing to do with the source of the pain.

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8 thoughts on “Osteoarthritis Pain Not Related to Structure – Again…

  1. Beth

    Thank you so much for all the information you provide. I am trying hard to understand it all. I have medial osreoarthritis and patellofemoral syndrome on both knees. I have been told I need a knee replacement by a surgeon and a stem cell transplant by a non-surgical orthopedist. If I do the stem cell transplant, will it help the kneecap issue? Will I end up with a replacement anyway? What questions should I be asking about this? Thanks for any help!

    1. Regenexx Team

      Beth,
      All more conservative measures should be tried before a knee replacement, as unlike regenerative treatments a knee replacement is irreversible. While could predict the outcome of Regenexx stem cell procedures, we would have no way to predict the outcome of non Regenexx stem cell procedures. Here are some questions to ask of your non-surgical orthopedist: http://www.regenexx.com/blog/top-10-questions-orthopedic-stem-cell-providers/ and http://www.regenexx.com/helping-to-sorting-hype-from-reality-in-knee-stem-cell-arthritis-treatments/ and http://www.regenexx.com/blog/stem-cell-clinic-rating-system/ and http://www.regenexx.com/regenexx-stem-cell-processing-different/

      1. Beth

        Thank you. What outcome could I expect from a Regennex-trained physician if I had a stem cell transplant?

        1. Regenexx Team

          Beth,
          “Stem cell transplant” generally refers to using a donor’s stem cells for the treatment of blood cancers like leukemia, etc. Dr. Centeno dicusses outcome of Regenexx procedures here: http://www.regenexx.com/blog/educated-consumer-outcomes/ Regenexx physician training here: http://www.regenexx.com/blog/trust-regenexx-network-physicians/ and what’s so different about Regenexx here: http://www.regenexx.com/blog/orthopedic-stem-cell-treatment/

  2. Lorri Thanos

    After Arthroscopic surgery to repair a meniscal tear. I was immediately weight bearing and pain free. Completed PT all is well, six months later, no pain, but knee now locks up routinely, at the most inoportune times, like sitting in a chair, walking down stairs etc. my surgeon whom after the surgery last year stated that I had the joints of a 20 year old. Now says that MRI and contrast injected x ray of knee show nothing abnormal? Wants to inject Hylauranic Acid because he claims its arthritis? No pain, no aches, just locking…. is that Arthritis?

    1. Regenexx Team

      Lorri,
      We’d need to take a look, but the most common cause of the knee locking up is the Popliteus muscle not pulling the meniscus out of the way in time, which is treatable. Please see: http://www.regenexx.com/knee-locking-up/

  3. Hemant

    Thanks for wonderful article. My right ankle, knee & calf have pains mostly in morning time. I feel very high discomfort. I posted comment abt my old injury in ankle on your other post. Doctor here done x-ray of right knee and says it is start of arthritis. Will that cause pain in ankle & calf a lot? My age is 36 and I been underweight since childhood. Thank you!

    1. Regenexx Team

      Hemant,
      We can’t diagnose an issue without examining the patient. However, since the leg is a whole unit from the low back to the foot, injury or dysfunction in one area of the “spine-leg”, eventually disrupts the function in other areas of it. Please see: https://regenexx.com/blog/leg-muscle-wasting-age-take-look-low-back-nerves/ and https://regenexx.com/blog/knee-bone-s-connected-to-the-ankle-bone/ and https://regenexx.com/blog/ankle-sprain-knee-pain/

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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