Ask The Doctors: June 2012
Arthritis of the Spine...NSAIDs vs. Coumadin...Non-Surgery Options for Thumb OA
Q. I was recently diagnosed with arthritis of the 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?
A. 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-inflammatory 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 your spine. Water aerobics or other forms of exercise in water are beneficial for building strength without putting stress on your 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.
Q. I have arthritis in my knees. I also have a blood-clotting disorder and have been put on Coumadin, which means I can’t take NSAIDs. I take a daily dose of Tylenol, but it doesn’t seem to have much effect. What do you recommend?
A. Taking an NSAID while on warfarin (Coumadin) can be dangerous because NSAIDs increase the risk of bleeding. When Tylenol does not help, other analgesics, such as tramadol (Ultram) or Darvocet (propoxyphene and acetaminophen), are often used. Occasionally, a narcotic may be used if nothing else helps. Topical medications may also be prescribed; capsaicin cream may help when used two times per day. There are also topical NSAIDs, such as ketoprofen gel (20 percent), which is used three times per day. A lidocaine (Lidoderm) patch is yet another option. Although the relief is temporary, injections of steroids into the joint can also relieve pain. Another treatment uses a group of materials called viscoelastic supplements, which are made up of hyaluronic acid compounds. These are injected into the joint weekly for three to five weeks. Lifts in your shoe or a brace on the knee can redirect forces away from an area of arthritis in the knee and provide some benefit. Surgery, a last resort, may be indicated when pain cannot be controlled or your functional ability is impaired.
Q. I have arthritis in both my thumbs, and my doctor suggests surgery. What other options do I have, and what is the surgery’s success rate?
A. Many people with mild symptoms of thumb arthritis improve with a limited period of anti-inflammatory medication and avoidance of painful activities with or without some type of splint. A cortisone injection into the sore area usually is helpful, at least temporarily. Relief usually lasts about two months. One or two injections provide permanent relief for about 50 percent of people with this problem. When conservative treatment is no longer effective, surgery is an option. The most commonly performed surgery for thumb arthritis involves removal of the arthritic surfaces and insertion of a material—your own tendon or a synthetic substance—between the two ends of the bones. The success rate for this procedure is about 90 percent. Another procedure is fusion of the two bones that make up the joint. This generally eliminates the painful symptoms but produces some loss of motion and joint stiffness. Total joint replacements for the thumb have not been as successful as have replacements for larger joints, such as the hip and knee.