Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.
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What's The Best Pain Management For Arthritis?

Wednesday, 21 Jul 2010 04:10 PM

Question: I am a 67 year old female who has suffered from joint pain, inflammatory pain in knees, toes, and right hand for years. I’ve gone to several different doctors and have received advice ranging from arthritis therapy and aqua therapy, pain medications, and anti-inflammatory medication. None of the medications seem to help any longer, and the pains have increased to the point that I can't sleep. The last recommendation was that I should have both hip replacements, both knee replacements, etc. How can a doctor know all these facts by just doing X-rays on my hips and knees? I am not ready for the nursing home.

Dr. Hibberd's Answer:

I agree with you. You deserve an aggressive investigation that should include blood and x-ray studies and appropriate scanning to qualify your condition. Arthritis pain as severe as yours deserves aggressive management. I recommend you seek a rheumatology consultation, and push your regular doctor for a more aggressive treatment and pain management plan.

There is no reason to be as uncomfortable as you describe with the wide variety of arthritic interventions available today. Arthritic damage to joints is visible by regular plain x-ray imaging, but of course it is like viewing a hockey game from the back row . . . it lacks the fine detail of CTT or MRI. CTT or MRI imaging offers better images of joint and soft tissue damage, cartilage and disk injury, as well as superior imaging of ligament and tendon tissue injuries and defects.

Plain films are usually sufficient to identify involved joints and associated degenerative changes that are often specific to different arthritic and rheumatologic disorders. Some arthritic disorders such as rheumatoid arthritis and psoriatic arthritis require disease modifying agents and immune suppressant treatment in addition to ant-inflammatory treatment to effectively control and limit joint destruction. Infections and crystal induced diseases need aggressive identification. Have your arthritic disorder re-evaluated, and, hopefully, you can defer surgical replacement once your pain and inflammation is correctly diagnosed and aggressively treated.


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