Ask The Doctors: July 2012
Q Five years ago my orthopaedic physician, after MRIs and observations of my walking and balancing, said I have severe stenosis in the neck and recommended surgery. However, all my pain is in my lower back, where I have only moderate stenosis. So I decided not to have the operation. Could neck surgery help with pain relief?
A The first sign of cervical spinal stenosis in some patients is a change in the way they walk. Pressure on the spinal cord in the neck can affect the nerves and muscles in the legs, causing weakness and clumsiness when walking. Pain related to cervical spinal stenosis generally occurs in the neck, shoulder, and arm, and it is unlikely that your chronic lower back pain is caused by the cervical spinal stenosis. Therefore, an operation on your neck is not likely to have any effect on your pain. It is possible that the stenosis in your lower back has progressed over the past five years and is the cause of your pain. Before you decide on any treatment, especially surgery, you should consult with your physician to obtain a complete evaluation of your spine to determine the cause of your back pain.
Q I have osteoarthritis of the hip, causing muscle pain in my groin as I walk. I’ve had steroid shots in my hip socket, but the relief only lasts a day or two. Can an injection be made into the groin in the area of my pain? Are there other methods that might help? How about TENS therapy?
A Injections into the hip joint are more complicated than in other joints such as the knee or shoulder, but this is where the arthritic inflammation occurs and where therapy should be aimed. Changing the location of the steroid injection is unlikely to be of any benefit. There are several other non-surgical options you might try. Gentle physical therapy, including swimming, water aerobics, or cycling, has been shown to help reduce pain and improve strength and motion, but try to rest your hip during bouts of intense pain. If you are overweight, losing just 10 percent of your body weight can reduce the load on your hip joint and reduce pain. Nonsteroidal anti-inflammatory medications, over-the-counter or prescription, often are helpful. Hyaluronic acid injections, though not as beneficial as in knee arthritis, have been reported to help some patients. Similarly, TENS (Transcutaneous Electrical Nerve Stimulation) therapy is helpful for some patients, but the amount of pain relief varies widely from person to person. If pain becomes severe despite non-surgical measures and interferes with your daily activities, you may want to discuss the option of total hip replacement with your orthopaedic surgeon. Before deciding on any treatment, it is important to be sure that your groin pain is caused by hip arthritis and not something else. Discuss your symptoms with your physician, and ask what examinations are needed to rule out other causes of your groin pain.
Q Recently I read in a health publication that white rice is bad for patients with osteoarthritis. Is this true?
A Although a number of health publications have claimed that avoiding highly refined products—such as white rice, white bread, white pasta, and foods that contain trans-fatty acids—are beneficial for osteoarthritis (OA), there is no medical basis for this claim and no scientific evidence to support it. A diet in which these foods are eliminated or kept to a minimum may result in weight loss, which does have a beneficial effect on osteoarthritis. However, there has been no valid research linking diet directly to the development or progression of osteoarthritis.