ABSTRACT
The role of the family physician in managing knee pain is expanding as recent literature supports nonsurgical management for many patients. Effective treatment depends on the etiology of knee pain. Oral analgesics-most commonly nonsteroidal anti-inflammatory drugs and acetaminophen-are used initially in combination with physical therapy to manage the most typical causes of chronic knee pain. The American Academy of Orthopaedic Surgeons recommends against glucosamine/chondroitin supplementation for osteoarthritis. In patients who are not candidates for surgery, opioid analgesics should be used only if conservative pharmacotherapy is ineffective. Exercise-based therapy is the foundation for treating knee osteoarthritis and patellofemoral pain syndrome. Weight loss should be encouraged for all patients with osteoarthritis and a body mass index greater than 25 kg per m2. Aside from stabilizing traumatic knee ligament and tendon tears, the effectiveness of knee braces for chronic knee pain is uncertain, and the use of braces should not replace physical therapy. Foot orthoses can be helpful for anterior knee pain. Corticosteroid injections are effective for short-term pain relief in patients with osteoarthritis. The benefit of hyaluronic acid injections is controversial, and recommendations vary; recent systematic reviews do not support a clinically significant benefit. Small studies suggest that regenerative injections can improve pain and function in patients with chronic knee tendinopathies and osteoarthritis.
Subject(s)
Acetaminophen/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Family Practice/standards , Knee Joint/physiopathology , Osteoarthritis, Knee/complications , Pain/drug therapy , Pain/etiology , Adult , Aged , Aged, 80 and over , Analgesics/therapeutic use , Education, Medical, Continuing , Exercise Therapy , Female , Humans , Male , Middle Aged , Pain Management/methods , Physical Therapy Modalities , Practice Guidelines as Topic , United StatesABSTRACT
This study examined the influence of relationship-specific dimensions of social support (i.e., support, depth, conflict) on nocturnal blood pressure (BP) dipping and mental health (i.e., satisfaction with life, stress, and depression) among 303 normotensive and un-medicated hypertensive males and females ages 20-68. Results revealed that support was associated with better, and conflict with poorer, mental health; however, neither was associated with BP dipping. In contrast, relationship depth was associated with greater life satisfaction and greater systolic and diastolic BP dipping, and the effect on dipping was independent of sleep quality, age, hypertensive status, marital status, and level of perceived network support. Relationship conflict was moderated by marital status and gender. Low conflict for females, or with one's spouse, is associated with greater nocturnal diastolic BP dipping. Overall, this study found an association between close relationships and BP dipping, thus identifying one virtually unexplored mechanism by which close relationships may have a protective influence on health.
Subject(s)
Blood Pressure/physiology , Circadian Rhythm/physiology , Hypertension/physiopathology , Hypertension/psychology , Social Support , Adaptation, Psychological , Adult , Aged , Blood Pressure Monitoring, Ambulatory , Depression , Female , Follow-Up Studies , Humans , Hypertension/epidemiology , Male , Marital Status , Middle Aged , Personal Satisfaction , Quality of Life , Risk Factors , Sleep/physiology , Stress, Psychological , Young AdultABSTRACT
BACKGROUND: Having close social relationships and being married specifically have been reliably associated with health benefits including lower morbidity and mortality. PURPOSE: The purpose of this study was to examine the influence of marital status, relationship quality, and network support on measures of psychological and cardiovascular health. METHOD: We examined ambulatory blood pressure (ABP) among 204 married and 99 single males and females (N = 303). RESULTS: We found that both marital status and marital quality were important. Married individuals had greater satisfaction with life (SWL) and blood pressure dipping than single individuals. High marital quality was associated with lower ABP, lower stress, less depression, and higher SWL. Importantly, contrasting those who are unmarried with those in low-quality marriages, we find that single individuals had lower ABP-suggesting that single individuals fare better than their unhappily married counterparts. Likewise, having a supportive network did not moderate (i.e., buffer) the effects of being single or unhappily married. CONCLUSIONS: Findings indicate being married per se is not universally beneficial, rather, the satisfaction and support associated with such a relationship is important. However, marriage may be distinctive, as evidence further suggests that support from one's network does not compensate for the effect of being single. These results highlight the complexities in understanding the influence of social relationships on long-term health, and they may help clarify the physiological pathways by which such associations exist.
