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Issue 37 (Autumn 2012)

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Regular Synovium readers will know how we like to feature research that helps the primary care clinician manage common musculoskeletal conditions such as osteoarthritis (OA) of the knee. We feature two studies that inform the primary care management of OA knee in this issue. Our emphasis on this topic reflects the increasing burden of degenerative joint pain as the population ages and not the state of the knees in the editorial office!

Managing chronic pain is another increasingly difficult problem for primary care clinicians and we also review two papers on chronic pain. As is, regrettably, frequently the case we report a study showing the lack of effectiveness of a popular biomedical treatment for a chronic painful condition. Happily we can announce that Arthritis Research UK has this October published a new self-management guide for patients with chronic musculoskeletal pain refractory to medical treatments (available via

Adrian Dunbar, Medical Editor

Osteoarthritis of the knee and MRI scanning

Presentation of knee pain in a middle-aged or older patient often leads to an x-ray of the knee. We know from previous research that knee symptoms correlate very poorly with plain x-ray findings...

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Smoking and chronic pain – a bad combination

In a rather complex study presented at the International Association for the Study of Pain (IASP) 14th World Congress on Pain,1 the association between smoking and pain was explored along with the prevalence of depression and anxiety...

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Pain and varus thrust in OA knee

We have seen above that assessment of the painful knee using imaging is problematical. A small study published in Arthritis & Rheumatism1 suggests that a clinical assessment of varus thrust during gait may help in directing treatment...

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Injection treatments for tennis elbow (lateral epicondylopathy)

Injecting steroids for tennis elbow has been the standard primary care treatment for decades. Only recently has the evidence for their long-term effectiveness been found wanting...

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Epidural steroid injection for chronic lumbar radiculopathy

Chronic sciatic pain is a thoroughly miserable experience that is often refractory to simple physical treatments. Epidural steroid injections have been popular for many years with pain specialists for treatment of chronic sciatic pain...

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