Ask the Doctors March 2010 Issue

Ask The Doctors: March 2010

Cold-Laser Therapy . . . Chest Pain and Arthritis . . . Making Bones Stronger

Q. I have arthritis-related pain in my neck. My doctor suggested cold-laser therapy. What is it and does it work?

Cold-laser or low-energy laser therapy has been promoted to relieve pain and improve function in patients with a variety of conditions.

A few small studies have shown some effectiveness in decreasing the pain of knee arthritis, and some studies have shown that it can relieve morning stiffness and pain in the hands of patients with rheumatoid arthritis (RA) for up to four weeks. More recent, better designed studies, however, have found no benefits in using low-energy lasers to relieve pain in people with RA or other musculoskeletal conditions. Although those earlier studies showed some positive results, it wasn’t clear that the pain relief achieved was enough to have either clinical significance or to replace conventional therapies.

Most insurance companies consider cold-laser therapy experimental because there is inadequate evidence of its effectiveness. No adverse side effects have been reported with its use. We suggest you talk with your physician first about standard treatments that can effectively lessen your neck pain.

Q.

I recently experienced severe chest pain and went to the ER. The final diagnosis was arthritis. Can arthritis cause chest pain? Arthritis, especially rheumatoid arthritis (RA), can cause inflammation around any joint in the body. Costochondritis, an inflammation of the junctions where the upper ribs join with the cartilage that holds them to the breastbone, or sternum, is a frequent problem for people with arthritis. It causes localized chest pain that you can reproduce by pushing on the cartilage in the front of your rib cage.

 

Costochondritis usually, but not always, involves one side of the breastbone. Often the pain can extend to the shoulder or arm on the involved side. While there is no specific treatment for costochondritis, nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, often are prescribed to reduce pain and inflammation. Application of heat to the area also may be helpful.

 

The symptoms of costochondritis generally resolve gradually over a period of four to eight weeks. Pleurisy (inflammation of the lung lining) also can be associated with RA and can cause sharp, shooting pains in the chest, especially when breathing deeply or coughing. Pleurisy caused by RA will usually subside when the RA flare-up passes, but your doctor may prescribe specific medications to help with the pain.

 

Q.

I take calcium and vitamin D. Are there other things I can do to make my bones stronger?

In addition to the supplements you’re taking, you should exercise regularly, eat a healthy diet, maintain a healthy body weight, and avoid tobacco and excessive alcohol use.

Your exercise routine needn’t be complicated. Walking and running are better for building strong bones than other activities, including working out on step-climbing machines or stationary bikes. One study has even shown that women over age 50 who did yard work regularly had greater bone density than those who jogged, walked, or swam.

Just getting enough sunshine can help strengthen bones. Sun exposure of 10 to 30 minutes a day may significantly increase your vitamin D level. If you have a family history of skin cancer, avoid sun exposure and stick to supplements.

Make sure you follow a diet that includes fruits and vegetables high in essential minerals and vitamins, as well as fish and dairy products.

Although some studies have indicated that moderate alcohol intake is associated with increased bone mineral density, excessive alcohol use results in decreased density.