Ask the Doctors March 2006 Issue

Ask the Doctors: 03/06

I was recently diagnosed with arthritis of my spine. I take pain-relievers to alleviate the pain, but I’m wondering if there are other solutions. Is there anything I can do to prevent things from getting worse?

Although there is no known method for preventing the progression of degenerative spinal arthritis, a number of measures can enable you to function well for many years. For a short period of time, you can use anti-flammatory agents, analgesics, and muscle relaxants for acute pain. Physical therapy, heat, electrical stimulation, and other treatments may help control muscle spasm and pain. Physical therapy can also help you strengthen your back and abdominal muscles to lend support to the spine.

Water aerobics or other forms of exercise in water are beneficial for building strength without putting stress on the spine. Exercise in general helps to build strength, flexibility, and increase range of motion. Lifestyle modifications, such as losing weight, quitting smoking, and avoiding heavy lifting, may also be necessary.

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What can you tell me about “stimulators” that help bones heal? In particular, I’m told that damaged bones can be repaired through the use of an ultrasound device called Exogen.

During the past two decades, several methods have been introduced for stimulating bone healing. Two of the more successful methods are electrical stimulation and low-intensity ultrasound.

Electrical bone-growth stimulators may be noninvasive (composed of coils or electrodes that are placed on the skin near the fracture for varying amounts of time each day) or invasive (wires are inserted through the skin to the bone, or a generator is surgically placed under the skin).

The ultrasound device sends out low-frequency sound waves and is applied to the skin through an opening in the cast, usually for about 20 minutes a day. Exogen is one such device developed to deliver these sound waves to injured bones. The exact mechanism through which ultrasound stimulates bone healing is unknown. Reports have described varying success with these devices, although most indicate accelerated bone healing with the use of both electrical stimulation and ultrasound.

The advantage of these bone stimulators is that most are noninvasive and simple to use. Disadvantages are their cost (they are relatively expensive) and their dependence on patient compliance. They often can be used only on certain bones and are difficult to use in obese or very muscular patients. We’ll be reporting in greater detail on electrical stimulators in a forthcoming issue.

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I am currently taking methotrexate for my rheumatoid arthritis, but I’ve heard that it doesn’t interact well with penicillin. Are there any other drugs I should not take while on methotrexate?

There are potential interactions between methotrexate and several drugs. Penicillin has been reported to decrease the renal clearance of methotrexate and increase serum levels, which could increase liver toxicity. Although nonsteroidal anti-inflammatory drugs (NSAIDs) have been reported to increase methotrexate’s liver toxicity, methotrexate has been successfully used with NSAIDs and antibiotics. Most physicians feel they can be used together without incident, but they do require careful monitoring through blood tests that look for increased liver function and blood counts.