She has severe arthritis — bone rubbing on bone in her hip because the cartilage is gone, and her sciatic nerve is being pinched. She has spinal stenosis and fibromyalgia as well, as far as we can tell.

She’s tried things from your column from time to time. She’s been to pain doctors, had five shots, acupuncture, seen a chiropractor and has had physical therapy. We rub her down with different things. She sparingly takes pain medication, which doesn’t always work, applies ice for 20 minutes once or twice a day and still is in severe pain most of the time. She cannot walk due to it.

I keep thinking surely there is something that can help other than surgery. She’s not interested in that option because of her age and her negative reactions to anesthesia and many drugs. Is there a noninvasive procedure that can help, a cream she can use, a specialist she can see or a pill she can take? I find it so hard to believe that in this day and age someone has to be in such severe pain. A once very active woman has been all but stopped.

DEAR READER: As with any medical condition and possible options, a physician must look at the whole picture. The thing that stands out is her age. Most people don’t respond as well to surgery at 92 as they would when younger, recuperation is longer than in a younger person and, as you pointed out, she has had negative reactions to anesthesia.

I cannot comment on her macular degeneration other than to recommend she see a top-notch ophthalmologist if she hasn’t already done so.

Osteoarthritis, sciatica, spinal stenosis and fibromyalgia have one symptom in common — pain. There are options for relief.

Initially, I might suggest massage by a therapist. You might check with her physician or your local hospital for recommendations. If you are fortunate enough to have a visiting nurse’s facility in your community, they will likely make house calls.

Purchase a whirlpool insert for her bath tub or obtain a chair for the shower that will allow soothing water to help ease her pain.

Instead of ice, consider a warming topical ointment such as Castiva or another over-the-counter product that has a castor oil base plus capsaicin to provide relief from the pain. If you can’t find any product at your local independent store, ask them to order it for you.

Make an aromatherapy “hot-pack” of sorts from an old pillowcase cut down to about 8 inches in height. Fill it with dry white rice and lavender or chamomile. Stitch up the fourth side to prevent the contents from spilling out. At appropriate times, pop it into your microwave for about 30 seconds to warm. Wrap it around her neck. The scent may lessen her pain by providing soothing relief as she inhales.

Speak with her physician about modifying her medication. Sometimes when one drug in a specific class isn’t adequate, another is. Also, be sure you run my rather benign suggestions past him or her before initiating them.

To give you related information, I am sending you copies of my Health Reports “Understanding Osteoarthritis” and “Fibromyalgia.” Other readers who would like a copy should send a self-addressed, stamped No. 10 envelope and a $2 check or money order for each report payable to Newsletter and forwarded to PO Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title(s) or print out an order form from my website www.AskDrGottMD.com.

Her only complaint is the nonstop abdominal pain. She’s currently taking 300 milligrams of gabapentin three times a day and 20 milligrams of omeprazole twice a day. She says the only difference she notices is that when the pain is really bad, the gabapentin gets her back to base quickly, but she doesn’t get any better.

I would appreciate your thoughts on her condition. You always have thoughtful and helpful advice. Thank you.

DEAR READER: It appears you have taken a great deal of time and expended a great deal of effort in seeking relief for your daughter. I’m not sure that I can add too much more, but I’ll try.

Possibilities include irritable bowel syndrome, abdominal migraines, lactose intolerance and the use of aspirin or ibuprofen taken for the pain. I’m reluctant to mention stress, peer pressure, poor diet or lack of support because your note is so supportive, and your daughter appears well-rounded; however, if she has dark or bloody stools, a change in bowel habits or constipation she hasn’t mentioned, we might have a basis from which to begin. You might ask her physician whether he or she believes a CT scan or MRI might shed some light onto the problem. You also might consider a second opinion with another specialist. This is no reflection on her physician, but sometimes different views help. Keep me posted.

My ANA test for three years has come back normal, but I continue to get lesions, my hair falls out, and I get sick easily. I have been to two rheumatologists. Both say I do not have SLE, but my family doctor feels I do. What do you think?

I was also told that because I only have discoid lupus, this would not cause any health problems other than with my skin and hair. So why do I have it in my nose and inside both ears? I’m now 33, my bones are brittle, and I have osteoarthritis in my hands and fingers. Help!

DEAR READER: Whew, where to start? Some children have impaired immune systems, making them subject to numerous disorders. My guess is that you were unfortunate enough to fall into that category.

There are a number of forms of lupus, which is an autoimmune disease. Lupus can affect joints, skin, kidneys, brain, heart, lungs and other parts of the body. Common symptoms include skin rash, kidney problems, arthritis and unexplained fever.

Discoid lupus is a chronic skin disorder that shows as a raised red rash that ordinarily appears on the face and scalp but can appear in other areas of the body, including the nose and ears. The lesions may last for days or years and can recur. Some people diagnosed with discoid lupus may develop systemic lupus erythematosus (SLE) at a later date.

Because arthritis is a common complaint, it’s not at all surprising that you have been diagnosed with fibromyalgia, chronic pain in muscles and ligaments.

Pleurisy is swelling of the lung linings that causes pain and breathlessness during inhalation and exhalation. Causes include acute viral infections, such as influenza, and can be the result of autoimmune disorders, such as lupus.

Kidney stones and related infections have numerous causes, including dehydration, obesity, genetic factors and a diet high in protein/sugar/sodium.

Vertigo can be caused by an inner-ear disorder, migraine headache, acoustic neuroma and other causes.
Depression and anxiety can be caused by lupus, fibromyalgia, kidney stones and vertigo. You have a lot on your plate, and it has obviously resulted in a lot of stress. Osteoarthritis, a breakdown of cartilage, causes pain and stiffness of affected joints. The condition is commonly associated with the aging process, but at 33, you are far from old. Treatment is geared toward controlling pain through medication, rest, exercise and protection of the affected joint(s).

Because so many of your symptoms involve pain, I’m inclined to suggest that you be referred to a pain clinic for control or request a referral to a larger diagnostic center, such as the Mayo Clinic. You will learn methods for reducing the level of pain you presently experience that may include water aerobics and yoga. Appropriate medication might be ordered. Once you get that aspect under control, the anxiety and stress levels you are under may be reduced.

To provide related information, I am sending you a copy of my Health Report “Fibromyalgia.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

Ten months after the original diagnosis, an aggressive tailgater crashed into the back of my car, causing the RSD to spread from my lower right extremity to my entire body. To be involved in two accidents in 10 months was unimaginable to my family and me.

The pain gets so bad that no one understands it unless they have this ugly disease! I’ve become disenchanted with the medical community. I’m sent from doctor to doctor because of their lack of knowledge and/or treatments. I’ve been on so many medications in the past 17 months that I feel like a guinea pig. I know that the doctors are trying to find a proper medication for me, but what I am worried about is long-term damage to my organs.

I’ve had 18 ganglion blocks in a two-month span, being put under each time thinking that we could put this disease back into a remission of sorts. There is a small window to treat this disease — smaller than what doctors report. There is a lack of communication between offices so I carry all of my medical records so I don’t have to sound like a broken record. Now I am a candidate for Ketamine infusions.

I recently went into a pain management/surgical center. I was supposed to see a certain MD. This MD was unavailable, so I saw an associate. He looked at me and said there was nothing they could do for me and placed me on Kadian. This made me feel so bad that I stopped taking it after five days. I called the center and asked to talk about the medication. I was fortunate enough to speak to the MD whom I was originally there to see. He also suggested Ketamine infusions.

This is my last chance at getting some sort of hold on the RSD. Is there some sort of protocol that a doctor should perform before the infusions? I had a psych work-up and then a cardiac clearance. Should all doctors who treat patients with RSD follow this protocol? The doctor who originally told me about this treatment is a long distance away. However, there is a closer doctor, but the girls in his office know nothing about this protocol. What I have been told so far is that I will be in a recliner for four hours a day for 10 days, similar to a chemo patient, but without all the chaos that chemo brings. I don’t know if there is biofeedback, but I will be asking.

On a happier note, after my first accident, I was in a pool playing with my kids and supervising them. I was in the pool for four hours and found myself going off on my own a lot. I started doing kickless laps using “noodles” and stretching my aching limbs. I think this has helped me a lot, but my problem now is finding a pool where I can do these exercises.

I have one last shot with the Ketamine and I have hope. If it doesn’t work, I will have to find a pool and I know that will help me feel better.

DEAR READER: RSD is a complex pain disorder. Many of the things you are feeling commonly accompany any disorder that causes chronic pain. Depression, anxiety, feeling helpless or a burden, and others lead to more stress that can, in turn, worsen symptoms.

I have chosen to print your letter with slight modifications owing to length restrictions because it not only offers a glimpse of life with a chronic pain disorder; it shows that holding on to hope is still possible. Despite your difficult situation, you have found a way to ease your pain in a medication-free way and are unwilling to give up when things get tough. If hydrotherapy provides relief, I highly endorse it. Check with your local community center, hospital physical-therapy department and other locations for the nearest location to you. I applaud your outlook and offer your letter as inspiration to others.

To provide related information, I am sending you a copy of my Health Report “Managing Chronic Pain.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

Let’s first discuss a bit about what FMS is considered to be. FMS was first recognized by the American Medical Association as a diagnosis in 1987 even though it has been around for much longer than that. The name “fibromyalgia” implies pain and inflammation of the muscles and connective tissues of the body but this is an inaccurate label because there aren’t any actual problems in these particular structures, they just happen to be where the patient “feels” the pain and discomfort. On biopsy of these tissues in a patient considered to have FMS they do not show any inflammatory changes. Also, FMS symptoms do not respond well to anti-inflammatories e.g. prednisone as again these structures are themselves not inflamed. Much like having a pinched nerve in the neck or lower back that sends the pain down the arm or leg; the pain is only felt there, the problem is in the spine itself. The “problem” in FMS appears to be in the central nervous system. The problem in the central nervous system is in the area that controls the bodies sensitivity to pain. The ability to filter or dampen the nerve impulses for pain is impaired and thus stimuli that would not normally be interpreted by the body as painful are. No one knows for sure why this breakdown occurs but it is thought that this part of the central nervous system becomes “burned out” from the body dealing with significant stressful situations. This can be in the form of physical and/or emotional stress. Physical traumas such as auto accidents, which have seemingly been the trigger for some of my patients, or having to deal with stressful family or personal situations over a long period of time can be the underlying cause of this “burn out” situation in the central nervous system. Thus, FMS can be considered to be a post traumatic stress disorder or PTSD.

Patients that have FMS usually have a wide range of symptoms the most common of which are- hurt all over, insomnia, fatigue, depression and anxiety. Many also complain of difficulties with concentration and memory and may experience what many refer to as “fibrofog”. The list of symptoms that have been associated with FMS can be quite lengthy and can almost seem like any symptom you have can be attributed to FMS. Herein lies the biggest problem with a fibromyalgia diagnosis. Because that list of symptoms is so wide ranging someone who has been labeled as having FMS will just assume that any symptom they have is due to it. This can be dangerous as those symptoms may well be from some other underlying illness that is now going to be ignored as the patient assumes that they already know the reason for it. Even the more common symptoms associated with FMS may well be from some other illness or condition. Thus a diagnosis of FMS is usually arrived at through the process of elimination of all other possible causes of the patient’s problems. Other conditions that could give similar symptoms include- hypothyroidism, anemia, Lyme disease, rheumatoid arthritis, hormonal imbalances, allergies as well as numerous other illnesses. That is why it is extremely important to rule out other conditions first as they may be treatable and would therefore go untreated ultimately leading to other health problems if it is just lumped in as a “fibro” symptom. Thus, the person who self diagnoses as having FMS, is doing the worst injustice to themselves as they may have some other treatable condition that is just going to worsen over time. Once all other possible causes are eliminated then a diagnosis of FMS can be considered. The standard accepted criteria for diagnosing FMS, after the elimination process, is having widespread pain in all four quadrants of the body for a minimum of three months and must also have pain in at least 11 of 18 tender points in specific body locations on the application of pressure.

Now, lets get back to the original question, “how can chiropractic help me with my fibromyalgia?” First of all, as stated above, a patient should not just assume that any symptom they have is due to FMS. I have many patients say “there is nothing you can do for me my pain is from fibromyalgia”. Even though you may have FMS you are still entitled to good old-fashioned neck and back pain that may be from sprain/strains, disc related problems or even arthritis. All of which have nothing to do with FMS and can most certainly be treated in my office. They may also have an underlying carpal tunnel syndrome, tennis elbow, bursitis, and many other pain producing conditions not related to FMS that also respond well to chiropractic care. If it is determined that the problems with which the patient presents are indeed related to fibromyalgia and not from other causes then here is what I can do to help them. First of all, as a chiropractor, my number one form of treatment is spinal or extremity manipulation. Manipulations help to restore mobility to joints that may have been lost or reduced due to the tightness of the surrounding muscles as a response to the underlying pain feelings that the patient has. All joints are designed to move and to lose even some of that mobility can cause them to experience discomfort which just adds to that experienced from FMS. I usually also recommend 5-Hydroxytryptophan to help with sleep. Loss of sleep from FMS is the proverbial chicken or the egg scenario. It’s not really known if the lack of good sleep is a trigger for FMS or if having FMS affects the patient’s sleep. Regardless of which comes first to help the patient to have improved restorative sleep is certainly a plus. Also, along the lines of nutrition I recommend taking Magnesium and Malic acid as well as Omega-3 fatty acids all of which has shown some promise for relieving FMS symptoms. Further, a change in diet shifting from processed foods to eating whole foods and preferably organic (without additives, pesticides, hormones or antibiotics) is helpful not only for FMS but for your general overall health. Exercise is also important. Typically, a lot of physical exercise can be aggravating to a FMS patient so I usually recommend low impact type exercises e.g. water exercises, Pilates or especially Yoga which is very good for helping the joints of the body to keep mobile.

In summary, you always want to make sure that you have eliminated all other possible causes of your symptoms before accepting a diagnosis of FMS. Then, once it is established that you have true fibromyalgia, then it would behoove you to seek out natural treatment alternatives such as chiropractic. All you really have to lose is your pain.

David D. Godwin, D.C.
Salisbury Chiropractic
www.salisburychiropractic.us
Salisbury, NC
704-633-9335

My problem now is that the only doctor who will agree to do my revision surgery (the one who did the original replacement) is not a provider with my insurance. I have consulted two other physicians, and they both tell me that I need to wait because the plastic ball part of the prosthetic is not worn enough to warrant having the surgery. At the same time, they tell me that they can’t say for sure what is going on until they open me up.

I have had every scan/test and blood test that I know of to check for low-level infections, but all came back negative. There is one other local surgeon I can consult with, but I feel he will concur with the other two doctors and tell me to hold off on surgery.

I am currently taking 500 milligrams of naproxen twice a day and extra-strength Tylenol along with Vicodin to try and combat the pain, but it is becoming a losing battle.

Do I just pack it in and have the original doctor perform the surgery for my hip and possibly go bankrupt? Or should I wait and suffer until one of the other doctors thinks it is time for surgery? I understand that revisions always come with risk and less chance of success than the previous surgery, but I can’t take much more and am ready to give the procedure a shot.

DEAR READER: A typical prosthetic hip can be expected to last 10 to 20 years. Factors such as weight and activity levels can have a bearing of success. People who play strenuous sports, perform heavy lifting or hard manual labor, or are overweight are not as likely to have as good of an outcome as those with moderate lifestyles and average weight.

You had your hip replacement 12 years ago, around age 27. This is a young age to have required hip replacement. You do not say what necessitated this surgery; however, at this point, it is not a concern.
Given your level and frequency of pain, I believe that your hip is simply wearing out and needs to be replaced. Your young age is another factor in this decision. You still have a lot of life left to live, and that should be quality time. You are likely a good candidate for the surgery.

I don’t believe that you should go bankrupt in the process of improving the quality of your life, so I suggest you either return to one of the orthopedists who accepts your insurance to discuss why they don’t think you are a candidate, given your age and pain level, or request a referral to the final local orthopedist for another opinion. You may also benefit from reviewing nonlocal physicians who accept your insurance, including those associated with a teaching hospital or a major medical center.

To provide related information, I am sending you copies of my Health Reports “Managing Chronic Pain” and “An Informed Approach to Surgery.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order per report to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title(s) or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: Reflex Sympathetic Dystrophy (RSD), today more commonly known as Complex Regional Pain Syndrome, is thought to be a chronic pain dysfunction of the central or peripheral nervous system. No single cause is known; rather, multiple causes appear to produce similar symptoms. Triggers can include infection, injury, heart disease, degenerative arthritis of the neck, stroke, thyroid disorders, shingles, specific medications and more. There is no specific blood or diagnostic test for confirmation. Treatment consists of physical therapy, exercise, medication, spinal-cord stimulation and more. Trials of Botox are even being considered for pain control.

I suggest you join a local support group or contact the RSDSA at P.O. Box 502, Milford, CT 06460; (877) 662-7727; info@RSDS.org.

Despite regular yoga, chiropractic care and massage, I wake up stiff and uncomfortable. It lasts all day. The left side of my back from my shoulder to the mid-back is also noticeably more developed or pronounced than the right side. A few years ago, a physician diagnosed me as having notalgia paresthetica.

What are your thoughts on this situation? Where should I go from here?

DEAR READER:
Notalgia paresthetica is defined as a chronic, localized itch that usually affects patches of skin on the upper back. It can occasionally affect the shoulders, upper chest and other portions of the back.

Symptoms include itching, tingling, prickling, and/or numbness, usually on one side of the back. The cause is unknown, but is thought to be the result of nerve damage.

Upon presentation to a physician, the affected areas are often hyper-pigmented (darkened), scratch marks are present and in some cases, scarring is also due to chronic scratching. Little treatment is available but some physicians have had success using topical capsaicin or certain types of botox.

That being said, this condition sounds nothing like what you are experiencing. I recommend you speak to your primary care physician or an orthopedic specialist. You may need imaging studies of your neck, back and hips (to get a full view of your entire spine).

Your back pain may be the result of a herniated disc, degenerative changes in the spine or more. You have taken appropriate steps by seeing a chiropractor, massage therapist and keeping physically fit and limber with stretching exercises. However, with little or no results to show, it is now time to move on to more aggressive testing and diagnosis.

In the meantime, I suggest you try using over-the-counter pain relievers such as acetaminophen or ibuprofen. Hot and cold packs may also be of benefit.

To give you related information, I am sending you a copy of my Health Report “Managing Chronic Pain”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

My son has incurred a large amount of debt from doctor visits, testing and treatment. He has seen neurologists, orthopedic specialists, pain specialists and chiropractors. He has tried acupuncture, exercise, prednisone, Oxycontin, Percocet, injections into his spine, and others. The narcotics helped the most but he does not want to be on them again because they caused severe withdrawal symptoms which he does not want to go through again.

None of his physicians have given him any hope. He has spinal stenosis, calcification of the thoracic region and bulging discs at L4 and L5. He has numbness in parts of the legs and the soles of his feet. He cannot sit for more than 20 minutes without pain. Even the slight bending caused by shaving or brushing his teeth is agony for him. Oddly, however, bending so far as to touch his toes is not painful. He doctors say he is not a candidate for surgery but don’t give him any reason or alternative options.

I have heard about a new procedure that involves injecting pig fat into the areas, but don’t know much about it. It breaks my heart to see my son in so much pain all the time. I hope you can help him or point us in the right direction.

DEAR READER:
Your son appears to have run the gamut on non-surgical treatment for his pain. Based on your note, he obviously has nerve involvement, likely caused by the bulging discs. This is what is causing the numbness of his legs and feet. Slight bending such as that you mentioned is probably causing the discs to move further out of place causing worsened pain. He may be experiencing relief by touching his toes but the vertebrae are being pulled apart allowing the discs to then slip back into their proper place.

You say your son is not a surgical candidate but has been given no reason why. I urge him to speak to his physician about this or to seek out an orthopedic or spinal surgeon who can review his chart and tests. This is your son’s best bet as to a definitive answer about surgical repair. The surgeon may even be able to offer suggests for minimally invasive surgical procedures or non-surgical treatment options that may benefit your son.

As for the pig fat injections, I am unaware of any new procedure but cannot imagine how this would help him.

To give you related information, I am sending you a copy of my Health Report “Managing Chronic Pain”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Two years ago I started developing pains that seem to travel and throb from my sinuses to my head and from my buttocks to my legs. About a year ago I went for a physical and blood tests. The doctor told me I had probably picked up some strange virus while traveling.

In January of this year my ears started sounding muffled with a humming noise so I went to a naturopath. She told me to eliminate dairy products from my diet. The muffled humming stopped after I took her advice but these mysterious pains are still present.

The pain lasts for about two days, stops for a day or two and then comes back. I have also started losing my hair. Any advice you can give would be greatly appreciated.

DEAR READER:
I am not sure I can provide you with anything beneficial but I will try. You have not given your age, where you traveled, when the pain started in relation to your travel, your general health status, any medications you are taking, or other relevant information. I only know you are a female because you signed your letter.

The first thing that comes to mind is a possible spinal issue. Pain beginning near the buttocks that travels down the legs is often the result of pressure on the sciatic nerve. This can be due to a herniated, bulging or dried vertebral disc.

Disc herniation can also occur in the cervical spine (neck) causing your head pain. You could also have sinus headaches or an allergy. If you traveled out of the country, a virus or parasite may be to blame, but in my opinion this seems unlikely.

I urge you to return to your physician or find a new one. Explain your symptoms in detail (date of onset, travel destinations, etc.) and request testing. This should include blood work and stool samples to check for parasites and viruses as well imaging studies such as X-rays, CT scan or MRIs to check for disc problems, tumors or other lesions.

It has been two years since your symptoms began, therefore the cause is most likely benign. However, in my opinion, you need to know what is causing your pain so you can treat it properly.

While waiting for your appointment there are a few things you can do to try to narrow down the cause. You could try antihistamines for a possible allergic connection. Stretching and NSAIDs, such as ibuprofen, may help if it is a spinal issue. I also recommend that you write down anything important about your symptoms as well as everything you have tried to relieve the pain. Bring the information to the appointment. In this way you can ensure you have reported everything that may be relevant. Let me know how things turn out.

To give you related information, I am sending you copies of my Health Reports “Managing Chronic Pain” and “Headaches”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).