Non-invasive treatment provides relief for osteoarthritis pain

Patricia Abrego's journey to a clinical study using radiation therapy to relieve osteoarthritis joint pain began when she was 10 years old.

Like most children living in a state where snowy winters were a norm, Abrego was doing what most kids do: playing.

"The leaves were covered with snow, and they made good bumps to skid on," she said. "I skidded on one and tore my meniscus in my left knee," said the 69-year-old semi-retired nurse and amateur artist.

Rather than visiting a doctor, her mother helped her relieve the swelling, and the pre-teen went on with her active life. At 12, during a softball game, she was picking up a ground ball, and the already injured meniscus tore further.

The meniscus is two C-shaped pieces of cartilage that provide cushion between the shinbone and the thighbone. According to the Centers for Disease Control and Prevention, tearing the meniscus is one of the most common injuries to the knee.

For the next 34 years, Abrego lived with the pain and discomfort of the tear. At 46 years old, she underwent a complete knee replacement on the left knee. However, Abrego said that her right knee was damaged by taking over the work of the injured left knee. In 2016, she underwent a complete knee replacement of the right knee.

"But that one never worked correctly," she said. "So I've been dealing with pain for a long time."

She tried various prescription and over-the-counter drugs to relieve the pain. After briefly using hydrocodone for pain relief, she chose to wean herself off the opioid and began a drug regimen of 1,000 milligrams of ibuprofen three times a day. Then, one of her physicians told her about a study by a colleague, Neil Newman, MD.

Newman, a radiation oncologist for Mays Cancer Center, home to UT Health San Antonio MD Anderson Cancer Center, joined a national study on the use of radiation to relieve joint pain and eliminate the use of pain medications.

"We are studying the use of very low doses of radiation, which is not invasive, to stop some of the inflammatory pain," he said. "We are including patients who are 50 or over and have a pain score of at least four out of 10 and above."

Newman said most patients with osteoarthritis, a degenerative joint disease impacting more than 33 million adults across the country, use over-the-counter anti-inflammatory medications to relieve pain. As the disease progresses, however, treatment can include opioids or steroid and gel injections.

"But those injections must be repeated multiple times and can be quite an unenjoyable experience," he said.

Newman said the use of radiation to treat joint pain is nothing new. It was used in the 60s and 70s in the United States, but was replaced by medications and steroid injections.

"I think, culturally, the use of radiation, unfairly, had a negative connotation. I think it led to a big fear that we should use radiation for cancer only, even though it does have some benign uses," he said.

While doctors in the U.S. stopped using radiation as a treatment for joint pain, European doctors continued to use it, especially in Germany, Newman said.

"What is great about that is now we have a lot of data for at least 30 years proving two key points. No. 1 is that radiation can help with pain, take people off pain medications, and provide relief," he said. "And, most importantly, we know that low doses of radiation in an older population will not increase the risk of a secondary cancer from radiation."

Newman said the dose of radiation used during treatment is 40 times lower than he would use with a patient he's treating for cancer. During the treatment, patients receive six seconds of radiation treatment on the joint two to three times per week on nonconsecutive days. Then, patients have follow-up visits for six months. The treatment can be done on joints in the knees, hips, elbows, shoulders, fingers and ankles.

After receiving treatment, Abrego said the pain in her right knee did improve.

"I've noticed that at three months, my pain was at a five, but it had gotten down to a two or one. The left knee is at a four," she said, referencing the 0-10 pain scale frequently used in health care. "I'm not taking high doses of ibuprofen. I'm only taking 1,000 milligrams of ibuprofen a day, and some days, I don't take it at all."

Newman said that while Abrego and others are participating in the study, receiving the treatment is not contingent on participation. However, Abrego highly recommends participating.

Abrego said her younger sister, who would have turned 65 this year, passed away at 47 years old after a diagnosis of chronic myelogenous leukemia with the Philadelphia-chromosome. With very little hope of survival, her sister chose to participate in a clinical trial for Imatinib, a medication now commonly used to treat the cancer.

"It bought her seven years. She left a 10-year-old daughter behind instead of a three-year-old. I consider her my hero," she said.

To request an appointment at Mays Cancer Center, call 210-450-1000or visit MaysCancerCenter.org/Appointments.

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