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25/Jun/2020

Living with a chronic musculoskeletal condition costs us physically, mentally and emotionally. But what many people don’t understand are the substantial financial costs associated with having chronic conditions. They’re expensive 😒

Healthcare costs

These are the most obvious. Medications, lots of trips to your doctor, your specialist/s, allied health professionals, tests, exercise classes, surgery, orthotics….they all add up. A lot!

People who don’t have a chronic condition may assume that a lot of this is covered by government subsidies, GP Management Plans, health insurance, the Pharmaceutical Benefits Scheme, with a little sprinkling of magical fairy dust to cover the rest. Depending on a person’s situation some of this may be covered. But much isn’t.

There’s significant cost in seeing allied health professionals such as physiotherapists, podiatrists, occupational therapists, hand therapists, dietitians and psychologists. While GP Management Plans assist with the cost, there’s mostly only five visits provided and these are used up very quickly. There may also be a gap payment over the Medicare Rebate. And there are also often considerable out of pocket expenses to see a specialist privately or longer waits when you see them publicly.

This can put a significant strain on a person’s finances.

Employment

Living with a chronic musculoskeletal condition is varied and episodic. That means you often don’t know how you’ll wake up. Your pain and stiffness may have been under control and manageable for some time, but then one day you wake up feeling crap. Your joints are swollen, it hurts to move, and you’re soooo exhausted. This makes it difficult to get up and move around, let alone get to work and put in a full day, as well as all the other things you have going on – family, friends, studying, chores, and a social life.

This may lead to time off work, and using up all your sick and personal leave. But if the situation (or workplace) becomes unmanageable it may result in someone having to permanently reduce their hours, change jobs, become unemployed or retire early.

Any of these things will obviously affect your everyday finances. However it can also affect your future finances as superannuation is impacted by reduced or lost income.

Wow. This became really depressing really quickly 😒.

The good news is there are services to help you if you need to change careers, or need financial assistance while you re-evaluate what you can or can’t do. We’ve added a bunch of these to the More to Explore section below.

And while we know none of these services are perfect, they can provide you with many of the tools and resources to help you through this tough time.

Hidden costs

Lost employment and medical costs – check. They’re probably the most visible costs. But there are many hidden costs. We’ve listed just a few.

  • Home and car modifications – so that you can continue to do the things you want and need to do as easily and pain-free as possible you may need to make changes to your home and/or car. They may be simple and relatively inexpensive – e.g. adding a swivel seat to your car to help you get in and out, or more complicated and pricey – e.g. installing a chair lift to help you get up and down the stairs in your home. An occupational therapist can help you work out what modifications will assist you, and can also advise you of any available schemes or assistance programs you may be eligible for.
  • As well as changes to your home or car, you may also need to buy various gizmos and gadgets that: protect your joints (e.g. tap turners, pick-up reachers), help you manage your pain (e.g. heat packs) and generally make life a little easier (e.g ergonomic mouse for your computer, walking aids). Again these can range in price.
  • Getting out and about if you’re in pain, or dealing with serious brain fog, can be tricky if you don’t feel up to driving. It’s only made worse with the COVID pandemic, when many of us feel vulnerable catching public transport. So you might have to resort to catching a taxi or using a rideshare company. But over time this does add up. You may be eligible for a taxi subsidy – each state/territory has their own scheme – so it’s worth checking to see if you can access this.
  • Food, glorious food 😋. Let’s face it there are many times you feel flattened by your condition and cooking is the last thing you want to do. And now with the convenience of delivery apps, you can get almost anything delivered to your door. Unless like me you live in an outer suburb in which case it’s fish n’ chips, pizza or burgers – yum, but not the healthiest options 😁 These deliveries can be a lifesaver, but the cost can also very quickly add up.
  • Events and holidays. This’s a tough one. Because of the nature of chronic conditions and often not knowing how you’ll feel from day to day, you can pay for future events and then have to cancel or change at the last minute. Like tickets to a concert (remember those??) – you often buy them so far in advance and you’re excited for literally months! And then the night comes and you know you can’t go – you’re too tired, too sore, too whatever. So you have to forfeit your ticket, or give it away to a friend. Or you’re on holiday, but you end up having to pay to make changes because you’ve had a flare and you need an earlier flight home, or you need to catch more taxis than you’d planned to, or you need to buy a pillow because the one at your hotel is a rock. It’s the crazy, unpredictable stuff like this that’s hard to plan for and adds to financial stress.

Pandemic pain

And then came COVID.

Many of us are having to manage to do more on less, with fewer hours, less pay, or no pay. It’s the unpredictability of this pandemic that adds to financial stress, especially if things were already tight before COVID came along.

The best thing to do if you’re feeling anxious about your financial situation is to be proactive and sort it out ASAP. Ignoring the problem won’t make it go away, and may make the situation worse. Choice has written a useful article that provides lots of handy info and tips: Making the right financial moves during the COVID-19 coronavirus outbreak.

And check out the More to Explore section below for more resources to help you.

Contact our free national Help Line

If you have questions about things like COVID-19, your musculoskeletal condition, treatment options, telehealthmanaging your pain or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

More to explore


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04/Jun/2020

The opium poppy is such a pretty, delicate looking flower. And humans have been actively growing them and enjoying their medicinal benefits since at least 3,400 B.C. The Sumerians referred to it as Hul Gil or the “joy plant.” 😉

It’s from these delicate plants we get opioids, a group of medications with which we have a long and complex relationship. They can provide great pain relief, but can also cause great harm.

That’s why on 1 June 2020 the Australian Government introduced some changes which affect how we use and access opioids. So let’s look at what opioids are, how they work, and why these changes have been brought in.

What are opioids?

Opioids are pain relieving medications that come in a variety of formulations, dosages and strengths. They include: tramadol, codeine, morphine, oxycodone and fentanyl. You need a prescription from your doctor to buy any medications containing opioids.

Opioids may be:

  • natural – created using the milky substance found inside the pods of the opium poppy, or
  • synthetic – created in a lab to have a chemical structure similar to natural opioids.

How do they work?

Opioids attach to opioid receptors in brain cells and dull our perception of pain. The pain isn’t gone, nor is the cause of the pain. It’s simply been dampened so that we can function with less discomfort. They also cause the brain to release the hormone dopamine, which can make us feel happy or relaxed.

Opioids are used to treat severe pain associated with cancer or for acute pain – e.g. following surgery.

They’ve also been used for many years to help people with severe, persistent non-cancer pain, like the pain associated with musculoskeletal conditions. However their long-term benefit is controversial for persistent pain or chronic pain. This is mainly due to the large body of evidence that shows that opioids have a limited effect on this type of pain. In addition they can also have serious side effects particularly with long term use, including breathing difficulties, addiction, overdose and death.

We also know that our body adapts to opioids when we use them long-term. We have to increase the dosage to get the same effect, and an increased dose brings an increased risk of harm.

Every day in Australia there are nearly 150 hospitalisations and 14 emergency department admissions due to opioid use, and three people die from drug-induced deaths involving opioids. (1)

Because of these alarming statistics the Australian government has been changing the way we access opioids. Last year we saw all opioids, even the lowest dose available, requiring a prescription from your doctor. You can no longer buy them over-the-counter.

The latest changes are a continuation of this plan to reduce the harm that opioids can do, and ensure that we use them cautiously and safely.

What’s changing?

From 1 June 2020 changes include:

  • smaller medication packs containing fewer opioids will be provided for short-term opioid use – for example after surgery or an injury,
  • improvements in medication information so people are better informed about the potential risks of opioids and how to reduce them, and doctors are following best-practise when prescribing opioids,
  • updating prescribing ‘indications’ (or when they’re used) to ensure opioids are only prescribed where the benefits outweigh the risks. (2)

Can I still use them for my musculoskeletal pain?

If you’re using opioids to manage the pain associated with your musculoskeletal condition, continue taking them as prescribed and talk to your doctor.

We do know some people experience pain relief using opioids for persistent pain, so if they’re proving to be clinically effective for managing your pain, your doctor will be able to continue to prescribe them. However these new changes will require your doctor to weigh the risks and benefits of these medications, and to explore possible alternatives with you, including enrolling in a pain management program. Also, where opioid use exceeds twelve months or is expected to exceed this time, a second opinion will be required to renew ongoing prescriptions.

Opioids aren’t a magic bullet and should be used in conjunction with other pain management therapies such as physiotherapy, exercise, weight management, cognitive behavioural therapy and mindfulness.

What now?

Living with persistent pain is exhausting. And the possibility of changing your medication can be stressful, especially if you feel like you’re managing your condition and your pain effectively. If you’re worried about these changes, talk with your doctor. Be honest about how you feel, but also be open to the possibility of trying new things to manage your pain. The aim is to keep your pain at a level that allows you to live your life and do the things you want and need to do. Opioids may be part of that, or they may be something that you’ll be able to phase out. It’s something that you and your doctor will need to discuss so that you get the best and safest outcomes.

Contact our free national Help Line

If you have questions about things like COVID-19, your musculoskeletal condition, treatment options, telehealthmanaging your pain or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

More to explore

References

(1) Prescription opioids: What changes are being made and why
Therapeutic Goods Administration, 29 May 2020 

(2) Prescription opioids: Information for consumers, patients and carers
Therapeutic Goods Administration, 29 May 2020 


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21/May/2020

At the moment there’s no treatment for COVID-19.

Wow, that was blunt. I probably should have eased you into it, but unfortunately that’s the truth. Regardless of what you may see on social media, or what a certain President might say at a press conference, we just don’t have a treatment for COVID-19 yet.

Doctors can treat many of the symptoms people are experiencing, but there’s no specific treatment for SARS CoV-2 (severe acute respiratory syndrome coronavirus-2), the virus that causes the disease we know as COVID-19. There’s also no specific treatment for the severe complications that some people experience which has led to thousands of deaths worldwide

The reason for this is that it’s a new virus, one we’ve never encountered before. That’s why it’s referred to as novel coronavirus – it’s brand new so we have no immunity to it.

We have nothing in our medicine cabinet specifically designed to deal with this virus. Antibiotics don’t work – because it’s a virus and antibiotics only work against bacterial infections.

What we do have in our favour are the efforts of the world’s scientific and medical community working tirelessly to find ways to safely treat this disease. We also have the work that was done at the time of the previous coronavirus outbreaks.

In 2003 we saw an outbreak of SARS (severe acute respiratory syndrome) and in 2012 we saw MERS (Middle East respiratory syndrome). These coronaviruses are closely related to SARS CoV-2.

While a treatment for SARS or MERS didn’t make it to large, human trials, there were promising results in labs tests, animal studies and small clinical trials. These drugs were some of the first to be studied for use in COVID-19.

Medications currently used to treat other conditions, for example hydroxychloroquine which suppresses an overactive immune system in people with lupus and rheumatoid arthritis (RA), are also being investigated. If we can repurpose an existing drug it’s hoped that we may have a treatment sooner rather than later.

So let’s have a quick look at some of the treatments being investigated

Anti-virals

Viruses, like the one that causes COVID-19, have only one job – to make more of themselves. They get into the cells of bacteria, animals and people, hijack them, and turn the cells into virus making factories.

Anti-virals stop them from making more copies of themselves.

Researchers are currently investigating several anti-virals including those used to treat viruses such as Ebola and HIV (human immunodeficiency virus).

There have been some early trials, using small numbers of people with COVID-19, that have had mixed results.

For example, remdesivir wasn’t effective against Ebola, but it had been effective against SARS and MERS in the lab and in animal studies. However we don’t yet have enough information to know if it will work in humans with COVID-19 or not.

Repurposing other drugs

As well as looking at ways to disable the virus and prevent people getting sick, researchers are also looking at medications we currently use for other conditions, to see if they’ll help people manage complications of the infection, especially those that affect the lungs and other internal organs.

The most widely talked about drug, hydroxychloroquine, works well to suppress the immune system in people with RA and lupus. However there’s limited evidence that it works for people with COVID-19. Trials are ongoing, including COVID SHIELD, a new trial being conducted at the Walter and Eliza Hall Institute in Melbourne.

Other drugs that suppress the immune system are also being investigated including the RA drug baricitinib.

The focus on immune suppression is to help manage the “cytokine storm” that some people with severe COVID-19 experience. This is when the immune system releases too much of an immune protein (cytokine) into the blood. This causes a high fever and inflammation, and in severe cases it can lead to multiple organ failure.

However there’s concern that treating people with an immune suppressing drug when their body is fighting an infection may be dangerous. We need more information from large, randomised controlled trials before we know if these drugs will help or harm people.

Other therapies

As well as going through our medicine cabinet and looking at old drugs to treat a new virus, researchers all over the world are looking at other ways to treat COVID-19.

They include plasma therapy, a process that involves taking the blood plasma from someone who’s recovered from COVID-19 and transferring it to someone who has the disease; stem cell therapy to treat people experiencing acute respiratory distress and the gene-editing technology CRISPR to find antibody targets for the disease.

These are just some of the innovative therapies that are being investigated to treat COVID-19.

Lots of work to be done

While a lot has been achieved in a short amount of time, we need to remember that with all of these trials we’re still very much in the early stages. We just don’t have enough data to know if the drugs or therapies work and if they’re safe.

We can feel confident though that the world’s scientific and medical communities are making great progress in their efforts to find safe and effective ways to treat COVID-19. But it will take time, both to come up with a vaccine and to find a treatment that we can produce in sufficient quantities to deliver on a global scale.

So we need to continue with our physical distancing, maintain good hygiene, stay activeeat well  manage our mental health and follow the restrictions that are in place where we live. This will eventually pass, but it will take some time.

More to explore


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13/May/2020

Just the shot in the arm we need?

It’s seems crazy when you think about it, COVID-19 has had such a life changing effect on us, but unless you’re a healthcare worker, you probably don’t even know someone who’s had it. Yay for the success of our pandemic plan, but it also means most of us are still susceptible to it.

But we can’t stay in iso forever. Apart from all of the obvious reasons, we’ve run out of jigsaws, eaten all of the banana bread and we’re over video chatting to our friends about doing nothing 😒

It appears that the only way we can get back to our normal lives is if there’s an effective vaccine against COVID-19. So far the info we’re hearing from scientists developing vaccines these vaccines is encouraging. We’re even hearing that one may be available as early as September this year! But what are vaccines, how do they work and what are the chances we’ll have a vaccine for this virus any time soon?

Your immune system

To understand how vaccines work, it’s important to understand a little about your immune system. It’s designed to protect you against harmful diseases and infections caused by foreign bodies (also called pathogens) such as viruses, bacterium and other microbes. When your body detects the presence of a pathogen, your immune system mounts an attack to try to defeat it.

Side note: For those of you who have an autoimmune condition like rheumatoid arthritis, lupus or ankylosing spondylitis, your immune system has gone a little bonkers and has attacked your own body instead of a potentially harmful pathogen. This really sucks. But we can help. Contact our Help Line on 1800 263 265 weekdays.

Vaccines

Vaccines work by introducing your immune system to a virus or bacteria. This allows it to learn how to protect you from the pathogen before you meet it out in the world. A vaccine is a weakened or inactivated version of the pathogen. It causes your body to create antibodies – these are the soldiers in the battle against the foreign invader. They have one target and one target only…the specific virus or bacteria that you were vaccinated against. If it ever encounters it, it latches on and destroys or disables it.

Well that’s the immune system and vaccines in the smallest of nutshells. Watch this short video How do vaccines work? for more info.

Now it’s time to look at COVID-19 and the efforts to create a vaccine against it. You may be wondering why a vaccine rather than a treatment? That’s a good question, and there’s a LOT of work going into finding effective treatments for COVID. But to treat someone, they already need to be infected. And because this virus is highly infectious, that person can go on to infect many others. So it’s preferable that we prevent this and any subsequent spread of disease is prevented altogether.

We know a lot about COVID-19

Even though there are still so many unknowns, we do know a lot about this virus. If you compare it to other new viruses or disease outbreaks, we’re so much further ahead, which is really good news. We knew the genetic makeup of this virus within a couple of months of the outbreak. Researchers used this info to develop tests for diagnosing COVID and to start working on potential vaccines and treatments. So we’ve come a long way in a very short time.

Types of vaccines

Just as there are different types of pathogens, there are different types of vaccines. The type of vaccine developed will depend on characteristics of the pathogen and how it affects people

Types of vaccines include:

  • A weakened, live version of the virus. We use this type of vaccine to prevent diseases such as measles, mumps, chicken pox and rubella. Note: people who have suppressed immune systems can’t use live vaccines.
  • An inactivated vaccine (e.g. flu vaccination). Chemicals are used to destroy the virus before being injected however it’s not as effective as a live vaccine, which is why we have regular boosters.
  • Vaccines that target specific parts of the virus, rather than the whole thing. This is used for diseases such as shingles, whooping cough and tetanus.

Creating a vaccine

A great article by The Conversation (31 March) outlined the steps involved in creating a vaccine for COVID-19:

  1. Basic understanding of the virus.
  2. Scientists decide which approach to use from the list above – i.e a live vaccine, an inactivated vaccine etc.
  3. Initial safety testing is carried out in animals to help us understand how it may affect people.
  4. Clinical trials being using people. There are three phases:
    • Phase I – testing on a small number of people, to see how safe it is, and if it has any side effects,
    • Phase II – testing on several hundred people to test for efficacy – or see if it works how it’s meant to work
    • Phase III – testing on several thousand people for efficacy and safety.
      If the vaccine can show it’s safe and provides effective protection against the virus, it will then go on to the next stage.
  5. Regulatory approvals.
  6. Production. This will involve a lot of work to create the quantities of vaccine we need to vaccinate large populations, and to ensure the vaccines are produced safely and with great attention to quality control.

For more information read: Coronavirus vaccine: here are the steps it will need to go through during development.

And….after all that we need to actually vaccinate people on a global scale! – which will take a great deal of planning and coordination.

So when will we have a vaccine?

The short answer is we don’t know. Most scientists say between 12-18 months. There are some who are more optimistic and say by the end of the year. With over 100 vaccines being researched around the globe, it may well be sooner rather than later. However we need to be mindful that we can’t rush this at the expense of safety.

So until a vaccine does appear we need to get comfortable with our new normal. We need to continue with our physical distancing, maintain high levels of hygiene, stay active, eat well, managing our mental health and follow the restrictions that are in place where we live. This will eventually pass, but it will take time.

More to explore


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07/May/2020

Hands up if you’re feeling tired at the moment? Or if you’re too weary to raise your hand, just a brief nod will do it 😉 It seems like we’re a nation of tired people at the moment (😪).

Why is this? We’re not going out like we used to, to the movies, restaurants, family gatherings, to see friends, sports events, or take the kids to all of their extra-curricular activities. We should be swimming in time and feeling relaxed and rested, right?

Ah, no.

We’re stressed

Stop me if you’ve heard this before but we’re going through unprecedented times. This pandemic is causing massive disruptions to our lives, our families, our work and our routines. This constant uncertainty causes us to feel stressed. All the time.

When we’re stressed our bodies release adrenaline. It’s so we can react to a crisis, the old ’fight or flight’ response. But when the stress is constant, as many of us are feeling at the moment, this has an effect on our health – including making us feel physically and mentally tired.

There are lots of things you can do to manage stress. By understanding what’s causing your stress, you can start to manage it. This may include things like developing a new routine (and sticking to it), exercising, talking with your family about how you’re feeling, finding ways to relax, making sure you’re eating a healthy diet and drinking enough water, getting a good night’s sleep and avoiding excessive use of alcohol and other drugs.

We’re staying indoors more

Because of restrictions we’re staying inside our homes more. So we’re not getting exposed to as much sunlight as we normally would. A lack of sunlight causes the brain to produce more of the hormone melatonin, which makes us sleepy.

To deal with this, schedule time every day to go outside for a walk or stroll in your yard, open your blinds or curtains as soon as you get up and expose yourself to as much sunlight as you can. It’ll help you feel more awake and improve your mood. Just think how much better you feel after being stuck indoors when you get out into the sun. It makes you feel so much more energetic and alive! So this one’s a no brainer. We just have to make time to do it.

We’re sleeping less (or more) than usual

Let’s face it, since this all started our usual everyday routines have been shot to pieces. Work, home life, family, socialising, shopping – it’s all so different at the moment. When you add stress to the mix, our sleep is often affected.

You may find you’re sleeping less than usual because you’re working long hours to catch up on work after spending the day home schooling the kids, or you’re watching more TV and spending more hours online, or stress is causing you to feel more pain and you’re having issues sleeping through the night.

Or you may be sleeping more – trying to rid yourself of this constant feeling of tiredness, or because you’re bored, or because it’s cold outside and you’re feeling cosy and warm indoors, or because you’re feeling sad. Not enough sleep, too much sleep and poor quality sleep will all increase how tired you feel.

That’s why it’s important that you stick to a sleep schedule – even on the weekends. Get out of bed in the morning and go to bed at night, at the same time every day. Your body needs this regularity for your internal clock to function properly, and to help you fall asleep and wake up more easily and feeling more refreshed.

And if you’re regularly finding it difficult to sleep or get out of bed because you’re feeling really sad or down, it’s a really good idea to talk with someone about this, whether it’s family, a close friend or your doctor. Please don’t ignore this.

We’re exercising less

Many of us are finding we’re exercising less because we don’t have access to our warm water exercise classes, tai chi, gyms and exercise groups. Not getting enough exercise can make you feel sluggish and tired. If this continues for some time, we start to get out of shape and feel less inclined to exercise. So it’s really important to make exercise – whether it’s online videos and apps, walking, dusting off your old exercise DVDs, or dancing around the living room – an essential part of your everyday routine. And get the family involved. Everyone needs to be exercising and staying active for our physical and mental wellbeing. If you’re home alone, use a video app to call a friend and exercise together. You’ll find you’ll feel more energised and happier when you’re exercising regularly.

We live with chronic conditions

Apart from all of above affecting how tired we’re feeling, we live with chronic musculoskeletal conditions and other health issues. These often cause us to feel fatigued. Many of our medications and living with chronic pain can also make us feel excessively tired. When you add a pandemic on top of that, the unique issues you’re facing – how the virus may affect you, worry about being more at risk, how to safely access your healthcare team, navigating telehealth – it can heighten you’re feelings of fatigue.

Many of the things we’ve looked at – such as establishing a routine, getting adequate sleep, eating well, exercising and staying connected with your family, friends and work colleagues will help you with some of these issues.

You can also get help from your GP and from the nurses on our Help Line. Contact a peer support group or go online and connect with others dealing with similar things. Even just talking with others who know exactly how you’re feeling can help you feel less isolated.

We may need to talk with our doctor

Finally if you’re concerned that your tiredness is due to more than just the reasons listed above, it might be worth talking with your doctor about it. Your tiredness may be caused by other things like vitamin deficiency (for example iron and vitamin D), side effects of your medications, feeling sad, anxious or depressed or it may indicate another health issue. So make an appointment to discuss it with your doctor – either in person or via a telehealth consultation.

Contact our free national Help Line

If you have questions about things like COVID-19, your musculoskeletal condition, treatment options, telehealthmanaging your pain or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

More to explore

Photo by Tracey Hocking on Unsplash


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25/Mar/2020

Does anyone else feel like things are going slightly pear shaped at the moment? The COVID-19 pandemic has really thrown us for a spectacular loop.

It’s understandable that a lot of us are feeling anxious, worried and scared – it’s a pandemic for goodness sake, it’s normal for us to be feeling this way. However some people are taking it to the extreme and stockpiling loo paper, food, soap and now medications.

While it’s important to ensure you have your prescription/s filled, and that you have enough of the usual over-the-counter medications you would normally have headaches, sore throats etc, there’s no need for us to lose our minds and go overboard.

Stockpiling – it’s just not necessary

Panic buying has led to certain medications – both prescription and over-the-counter – having limits placed on them to ensure that we don’t run out. Common medications such as paracetamol, asthma puffers, insulin and EpiPens are now restricted

The Therapeutic Goods Administration (TGA), which is responsible for regulating the import, supply and manufacture of therapeutic goods in Australia, have stated that “as of 6 March 2020, the TGA has not received any notifications of medicine shortages in Australia that are a direct result of COVID-19. Therefore, while it may be appropriate for individuals to ensure that they have at least two weeks supply of prescription medicines in the unlikely event they are quarantined, any stockpiling of medicines is unnecessary.”

So please everyone, breathe. Make sure you have what you need, but don’t take more than that. There’s just no need for it. Let’s all take a deep breath and remember we’re all in this together.

The problem with hydroxychloroquine (Plaquenil)

Unfortunately, there’s one medication we know has become difficult to access in Australia. Hydroxychloroquine (Plaquenil) is used by people with rheumatoid arthritis, lupus, juvenile idiopathic arthritis and other autoimmune diseases. There’s been a rush to access this prescription-only medication after US President Trump mentioned that it was a “game changer” in the treatment of COVID-19.

Sadly, there have been reports from overseas that people taking these medications, to treat/prevent COVID-19, have become seriously ill. One man has died.

Thankfully on 24 March, the TGA announced that they were placing new restrictions where “only certain types of specialists will be able to prescribe hydroxychloroquine to new patients”. This is great news as it will help to ensure hydroxychloroquine is available for people with musculoskeletal conditions who need it to keep their symptoms under control.

And then there was ibuprofen

Common brands include Nurofen, Advil, Celebrex, Naprosyn and Voltaren.

There’s been quite a bit of confusion about the anti-inflammatory medication ibuprofen, which is used by many people with musculoskeletal conditions.

Initially the World Health Organization (WHO), stated that ibuprofen could make some symptoms of COVID-19 worse. This was based on a study published in The Lancet. But that’s been debunked

The WHO had to do a backflip stating that “based on currently available information, WHO does not recommend against the use of ibuprofen…we are consulting with physicians treating [COVID-19 patients] and are not aware of reports of any negative effects, beyond the usual ones that limit its use in certain populations”.

In Australia the TGA has stated that “there is currently no published peer-reviewed scientific evidence to support a direct link between use of ibuprofen and more severe infection with COVID-19. We will continue to monitor this issue”.

So at this stage, if you’re currently taking ibuprofen, or another NSAID, as prescribed by your doctor, don’t stop taking it without discussing with your doctor.

What if you can’t get out to get your medications?

If you’re self-isolating, sick or just can’t get out to get your medications, there are options for you.

  • Call your family, friends, neighbours. If they’re able to get to the pharmacy for you, that’s great. Remember to keep your distance – practise physical distancing (for example, arrange to leave your prescription, list, money etc in a certain place so they can pick it up without having direct contact with you). Wash your hands thoroughly before you handle the items you are leaving to be picked up, and after you handle the items that have been delivered.
  • Many pharmacies offer home delivery – so be sure to give them a call too.
  • As part of the National Health Plan, telehealth can now be bulk-billed and Electronic Prescribing is being fast-tracked. There are options immediately available to support telehealth services so you can get medicine sent directly to you at home.

Please stay calm

I know this is easier said than done, but pharmacies are an essential service, and remain open after many other (non-essential) businesses were required to close on 23 March 2020. So you can still access your local pharmacist – in person, over the phone, via a family member/friend or through other technology – and get the information, medication and support you need.

And while there is a lot of confusion in our community about so many things at the moment, the government, at all levels, is trying to keep us safe and healthy, but these are extraordinary times. So we need to remain calm, work together and stay kind. We will get through this.

More to explore


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12/Feb/2020

The jury is no longer out – the evidence is in

For many years, glucosamine has been one of the most commonly used supplements for osteoarthritis (OA). And even though the jury has been out on how well it works, it has been considered safe to use.

When it comes to glucosamine, there’s been a lot of conflicting research with some studies showing positive results and some showing no effect. To add to the confusion, studies have used different preparations of glucosamine – for example glucosamine sulfate, glucosamine hydrochloride, glucosamine sulfate with chondroitin etcetera – and different dosages. Which makes it difficult to determine how effective glucosamine really is for treating the symptoms of OA.

Until recently, despite the evidence indicating that glucosamine has little, if any benefit for people with OA, it’s been seen to be relatively safe for most people.

Now, a recent study has raised some serious concerns about the side effects of glucosamine for people with shellfish allergy.

What is glucosamine?

At the ends of most of our bones we have a slippery cushion called cartilage. It absorbs shocks and helps our joints move smoothly. Glucosamine is a naturally occurring substance found in our cartilage.

For people who have osteoarthritis, this cushiony cartilage becomes brittle and breaks down. Some pieces of cartilage may even break away and float around inside the joint causing inflammation and pain. The cartilage no longer has a smooth, even surface, so the joint becomes stiff and painful to move.

Treating osteoarthritis

Until recently, treatments for OA have focused on managing the symptoms – controlling pain and reducing inflammation. Medications included analgesics – e.g. paracetamol – and anti-inflammatories – e.g. ibuprofen (*see note). Along with exercise and weight management, these were the mainstays of osteoarthritis treatment. There has been no silver bullet or treatment that worked quickly and effectively.

So when glucosamine first came on the market, with positive reviews, many people were excited at the prospect of this new, ‘natural’ treatment and began taking glucosamine regularly. Glucosamine seemed to provide pain relief for many people with osteoarthritis and improve their joint function.

However over the years as more research has taken place, the evidence for the use of glucosamine has come under more and more scrutiny. Earlier, positive research was mostly funded by pharmaceutical industry, and later research, that showed glucosamine provided limited improvements, was publicly funded. This called into question the potential for bias in the earlier reporting of the benefits of glucosamine.

The peak bodies respond

Based on recent independent evidence, the American College of Rheumatology (ACR) and the Australian Rheumatology Association (ARA) have both responded publicly.

In their latest guidelines for treating OA, the ACR “strongly recommend against” using glucosamine for osteoarthritis. And the ARA has stated that this new information highlights growing evidence that glucosamine doesn’t help people with OA and it‘s a reminder that people with a shellfish allergy shouldn’t take glucosamine.

Safety concerns

It’s been known for some time that glucosamine can interact with blood thinners such as warfarin, and that it may raise blood sugar levels in people with diabetes. Glucosamine may also have a negative effect on cholesterol and chemotherapy drugs and has been linked to worsening asthma

However it’s not been widely known to the general public that many glucosamine supplements are made from shellfish and can cause serious allergic reactions.

Recent research from the University of Adelaide investigated “spontaneous adverse drug reactions [or side effects]…to glucosamine and chondroitin in the Australian population between 2000 and 2011, with a primary focus on hypersensitivity reactions.”

They found that during that period, the Therapeutic Goods Administration (TGA) was notified of 366 recorded adverse reactions. This is more than the combined adverse reactions of other supplements such as echinacea, valerian, black cohosh, ginkgo and St John’s wort. However, hundreds of thousands of people also took glucosamine during that time with no ill effects, highlighting that the risk of a severe reaction was still very low.

A major issue raised is the labelling of glucosamine. Labelling must report that it contains seafood, but not specifically shellfish. And this information is often in small writing. So people who are aware that they have a shellfish allergy may not realise that they’re taking something that’s harmful to them.

In 2016, the TGA changed the rules for this, and required manufacturers to be clear if products contain shellfish. And this information must be easy for consumers to find. However they also gave manufactures until August 2020 to do this. So many products publicly available may still not may it clear to consumers if the product contains shellfish.

So what should you do if you currently take glucosamine?

  • If you have a shellfish allergy stop taking glucosamine immediately and discuss with your doctor.
  • If you have taken glucosamine for some time and haven’t had any negative side effects, and want to continue taking it, then you can do so under the advice of your doctor.
  • Talk to your pharmacist about any potential interactions with other medicines you may be taking.
  • Talk with your doctor about other treatment options – including exercise, weight management, pain management techniques.
  • Call our MSK Help Line weekdays on 1800 263 265 or email helpline@msk.org.au and talk with our nurses about OA and ways you can manage it without glucosamine.
  • Stay up-to-date. As well as being painful, living with a chronic musculoskeletal condition can be confusing and frustrating, especially with so much conflicting information circulating through the news, social media, and our network of family, friends and acquaintances. Follow us on Facebook and sign up for our eNewsletter to stay informed about the latest information, research, events and much more.

* Note

We now know that these medications provide very little benefit for managing the ongoing symptoms of OA. Currently the best evidence is for weight management (maintaining a healthy weight or losing weight if you’re overweight) and exercise. Treatments such as massage, heat and the short term use of anti-inflammatories may provide temporary relief, but the evidence is not as strong.

References


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22/Jan/2020

Written by Steve Edwards

“A cortisone injection? You want to stick a needle in my sore foot?”

Your health care clinician has suggested you have a cortisone injection into your foot. As with any medical procedure, both of you are best advised to discuss the benefits and risks before proceeding. It helps to know what cortisone is, what it does, and why it’s been offered to you.

Cortisone is an anti-inflammatory medication that’s often used to treat musculoskeletal conditions. It’s a synthetic version of cortisol, a hormone that naturally occurs in your body. Injected into the affected area, cortisone can lower inflammation and pain, remove fluid, and thin scar tissue or adhesions. So if your clinician diagnoses a musculoskeletal condition affecting your foot or ankle – such as arthritis, bursitis, neuroma, or tendinitis – a cortisone injection is commonly raised as an effective treatment option.

Cortisone injections also contain a local anaesthetic. For certain conditions an injection can be painful, so the anaesthetic may be injected separately before the cortisone to block this pain.

The clinician may or may not use ultrasound technology to guide the injection. For pain relief in the foot or ankle, research finds no statistically-significant difference between procedures conducted with or without ultrasound. Interestingly, trials on cadavers injected with dyed cortisone show how it rapidly spreads from the injection-point to adjacent tissue, indicating that pinpoint accuracy is not key to effectiveness.

There are several types of cortisone. In most cases the clinician will administer a long-duration cortisone, taking effect within 1-3 weeks, with benefits lasting between 1-9 months, depending on the condition and its severity. There’s a clinical consensus that no more than 3 injections should be administered to the same body-part within a 12-month period, though there’s no research literature to clearly support this belief.

After the injection, you can quickly return to most activities. The clinician may recommend you avoid strenuous physical exertion such as gym workouts or running for a few days, so the cortisone isn’t displaced from the target tissue.

As for risk-factors, there’s been research into whether the injection may risk tearing tendons in the target area. There’s no recorded case of this in human trials, though it has occurred in trials on dogs and horses. There were cases of more general tissue damage recorded in early trials on American gridiron players, but various factors could have produced this result – the needle used, the amount of fluid injected, and the subjects receiving multiple injections within a short period.

No medical procedure has a 100-percent success rate, but a single cortisone injection administered by a trained clinician is both safe and effective in providing medium-term pain relief. Side effects are minimal, and the benefit to your musculoskeletal condition is potentially vast. And for some foot-specific conditions – such as a neuroma (pinched nerve), or plantar fasciitis (heel pain due to scar tissue) – a cortisone injection can often be a cure.

Our guest blogger

Steven Edwards is a trainee foot and ankle surgeon with the Australasian College of Podiatric Surgeons. He also teaches pharmacology and foot surgery to undergraduate podiatry students at La Trobe University.


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27/May/2018

A book by people like you

Chronic pain is a common and complex problem that affects 1 in 5 Australians.

It’s exhausting, a bit tricky and hard to know where to start.

Fortunately, with our book Managing your pain: An A-Z guide you can start anywhere!

Medications, sleep, laughter, fatigue, breathing. Think of it as a ‘choose your own adventure’ to getting on top of your pain.

The book emphasises practical strategies tried and tested by people like you – consumers living with musculoskeletal conditions. There are also a bunch of quotes and useful insights to keep it real.

You might also like…

We also have a helpful kids pain book called The worst pain in the world. It’s beautifully illustrated and loaded with practical advice for children living with pain (not just those with arthritis). It also gives kids who don’t live with pain an understanding of what their friends or family are going through.




Musculoskeletal Australia (or MSK) is the consumer organisation working with, and advocating on behalf of, people with arthritis, osteoporosis, back pain, gout and over 150 other musculoskeletal conditions.

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