Ask the Doctors March 2008 Issue

Ask The Doctors: 03/08

A friend tells me that there is a pacemaker-like device that can give people relief from back pain when other treatments donít work. Is this true? If so, how does it work?

Your friend is probably referring to a treatment called neuromodulation. The device is sometimes called a spinal cord stimulator. It is surgically implanted and delivers a low-level electrical stimulation to selected nerves in the spinal column. While itís not entirely clear how it works, neuromodulation may "override" painful nerve impulses, decreasing pain. Spinal cord stimulators are somewhat more effective in relieving sciatic (leg) pain than lower back pain. A trial of neuromodulation may be considered for people with persistent back and leg pain despite medical and even surgical treatment.

I am a 75-year-old woman and for the past two years have been experiencing intense pain in my rib cage. My doctor says I have costochondritis. I stopped taking Tylenol because of the danger to my liver. Iím now taking Vicodin, three times daily, but I still have pain. Is there a cure for costochondritis? If not, what can I do for relief?

Costochondritis is pain arising from the attachment points of the ribs to the sternum (breastbone). Initial treatment includes an anti-inflammatory medication such as ibuprofen and physical therapy to stretch tight muscles and improve posture. If these treatments arenít sufficient to relieve symptoms, the attachment points (costochondral joints) can be injected with a small amount of cortisone-like medication. With appropriate treatment, costochondritis can usually be resolved.

Iíve been experiencing a shooting pain in my lower back in recent weeks that radiates down the back of my leg, and the pain is at its worst when I sit. My doctor says I have sciatica and that it will eventually go away, but he wasnít specific on how long it would take. How long does this condition normally last? Is there anything I can do in the meantime to ease my pain?

Your doctor is correct. Leg pain (usually greater than pain in the back) that radiates below the knee is commonly called sciatica. The most common cause of sciatica is a "pinched nerve" in the spinal column, often as a result of a bulging or herniated disc. Typically, sciatica from a herniated disc is worse when sitting. About 80 percent of sciatica from disc herniation eventually improves without the need for surgery. Good treatment includes an anti-inflammatory medication and an individualized physical therapy exercise program which effectively "unpinches" the nerve. For severe leg pain, a spinal injection ("nerve block") is performed for temporary relief. With appropriate treatment, most people are much improved within six weeks.

Iíve read that "combination therapy" is the best treatment for improving symptoms and slowing joint damage caused by rheumatoid arthritis. What can you tell me about it?

Combining a lower-cost synthetic disease-modifying anti-rheumatic drug (DMARD) such as methotrexate (Rheumatrex) with one of the new biologic drugs is believed to work better than using methotrexate or a biologic DMARD alone. It is considered a beneficial treatment for RA patients, particularly for those who are otherwise healthy and in the early stages of the disease. The drug combination appears to work best for reducing joint swelling and tenderness. It also should be emphasized that while such combinations appear to be quite safeóno toxicity or significant drug interaction has been reportedóthe use of biologic DMARDs and methotrexate can increase the risk of serious infection.