Q. I am a doctor who has had dual meniscus knee surgeries. I found corticosteroid injection therapy useless for my knee pain. Surgery was ineffective in terms of reducing pain and discomfort, and the knee condition worsened after surgery. If this were not a medical procedure, I would have asked for a refund.
I’ve used MSM and glucosamine, but they take a long time before any effect is apparent. For fast results I have found acupuncture to be the gold standard in therapy. Along with ice and medical massage, acupuncture offered me the best result. I was so impressed that I studied acupuncture and now use it in my practice.
A. Your experience is consistent with the results of recent research. A double-blind placebo-controlled study published in JAMA (May 16, 2017) found that the steroid triamcinolone injected into the knee was no better than saline injections for arthritis pain relief. Knees exposed to the steroid lost cartilage more quickly, however.
As for surgery, a recent analysis of previous studies found no long-term advantages over conservative management strategies (BMJ Open, May 11, 2017). A group including surgeons, physiotherapists and patients has just issued guidelines discouraging arthroscopic surgery for knee arthritis and meniscus tears (BMJ, May 10, 2017).
We are glad to hear you have been so pleased with the results of acupuncture. Readers who would like to learn more about acupuncture and other nondrug approaches to managing arthritis pain will find details in our online Guide to Alternatives for Arthritis at www.PeoplesPharmacy.com.
Q. My sister has had a terrible time with hot flashes. She was taking a low dose of a hormone, but her doctor wanted her to stop. He was concerned about possible side effects.
She has tried many over-the-counter remedies with little relief; she cannot get a good night’s rest. The doctor now wants her to try an antidepressant.
I have been on an antidepressant for a number of years; it has helped me with irritability, but I’ve never had hot flashes. However, I know how hard it is to get off the antidepressant. I’ve tried several times and am still trying. That’s why I’m concerned about her starting this medication. My question: Can antidepressants really help with hot flashes?
A. Like your sister, many women find the night sweats of menopause even more debilitating than daytime hot flashes. The Food and Drug Administration has approved the SSRI antidepressant paroxetine as a treatment for hot flashes. The brand name is Brisdelle. A review concludes that it may be effective, but it can cause nausea and dizziness (BJOG, October 2016).
Doctors sometimes prescribe a different antidepressant, venlafaxine, to control hot flashes. Neither of these medications should be discontinued abruptly. Even with gradual tapering of the dose, some people experience unpleasant withdrawal symptoms.
A group of experts in gynecology surveyed the literature a few years ago. They recommend cognitive behavior therapy, clinical hypnosis, weight loss when appropriate and mindfulness-based stress reduction as effective nonhormonal treatments for night sweats and hot flashes (Menopause, November 2015).
Although acupuncture remains controversial, one study found that it reduced hot flashes and improved quality of life (Menopause, June 2016). Perhaps one of these nondrug options will give her some relief.
In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”