One day after getting the dental work done, the pain started going away. After five days, I could run five miles with no pain at all.

The sad part is that everyone else with fibromyalgia could be cured just like me if they had the proper dental care. Dentists are prone to leaving infections going on in a person’s mouth since no one is telling them what harm they are doing. If you could take five people with fibromyalgia to a knowledgeable dentist, I know all five would be cured and you would be a hero to the world.

A: Fibromyalgia is defined as pain and tenderness of a person’s joints, muscles, tendons and other soft tissues. Pain can vary in intensity from a deep ache to something more extreme. The condition has been linked with chronic fatigue, depression, memory problems, paresthesias of the extremities, headaches, irritable bowel syndrome, anxiety, headaches, and insomnia. The exact cause remains somewhat elusive but there are known stressors such as physical or emotional trauma or infections, that may trigger fibromyalgia. It is most common in women between the ages of 20 and 50.

Symptoms are defined by soft tissue tender points in the back of the neck, shoulders, chest, lower back, hips, elbows, knees, and virtually every area of the body. The pain may exacerbate with movement or exercise. In order for an individual to be diagnosed with fibromyalgia, he or she must have a history of at least three months of pain and tenderness in at least 11 of 18 specific areas located on the neck, shoulders, chest, rib cage, lower back, buttocks, thighs, arms, and knees.

Diagnosis is often made by exclusion of other possible conditions with similar symptoms since there is no laboratory or X-ray testing to confirm or rule it out. Because it may dovetail with other medical issues, it may even be necessary for a patient to see more than one physician in order to achieve the correct diagnosis.

Treatment is geared toward reducing the level of pain and other symptoms present. It may begin with physical therapy, an appropriate exercise program, and learning methods of stress relief. Some individuals might even be helped by chiropractic manipulation, Tai Chi, learning better sleep techniques, reducing the amount of caffeine in one’s diet, eliminating foods and drinks with high fructose corn syrup, and more. When these maneuvers fail, a physician might even choose to order a muscle relaxant, sleep aid, or antidepressant.

Now, on to infection. Bacteria can be harbored in the soft tissue around our teeth and it is well known that bad teeth can cause infection to spread throughout the body. When that bacteria is released into the bloodstream during such procedures as a root canal or cleaning, the immune system becomes stimulated sufficiently to cause the discomfort and stress factor that follow. For example, our upper molars are close to our sinuses and routinely cause problems in that area. A simple way around this may be to prescribe antibiotics prior to the procedure in an attempt to control the bacteria present, however this isn’t always done for a variety of reasons. While unconfirmed, more people than I care to count have complained of fibromyalgia-like pain because of dental issues. When the dental problems are under control, the pain virtually ceases. That’s difficult to deny. However, I have not found research that has described this direct link between chronic dental disease and subsequent dental treatment with improvement of fibromyalgia. While proper dental hygiene is vital, including treatment of oral infections, I don’t feel that these are the sole cause of fibromyalgia and therefore, cannot say this will work for all sufferers.

So, thank you for your words of wisdom. Hopefully your letter will help many others.

Readers who would like related information can order Dr. Gott’s Health Report “Fibromyalgia” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Dr. Gott’s Medical Report, PO box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.

When he was younger, he was extremely hyperactive, working from sun up to sun down, but in the last few years he is the opposite: exhausted and chronically fatigued with the ever present pain issues. He has been to many doctors and specialists over the years and had every problem thoroughly checked out. Nothing seems to come of the tests other than a minor problem here or there but nothing that would seem to cause the level of pain he says he experiences on a daily basis. Many family members, including his dad and siblings also have issues with debilitating leg pains.

We have an excellent medical internist but I think over the years she has become frustrated with his roving pain problems and lack of a concrete problem. I have tried to discuss these issues with her but due to confidentiality laws she doesn’t say much.

My husband is still working full time in construction in a supervisor role. Most days he comes home and sleeps on and off all evening. Even on the weekends he takes many naps and lacks energy. Could my husband have a problem with hypochondria? Could the fatigue and exhaustion be caused by the meds he is on? Would acupuncture or a pain clinic help? He is a typical male who complains a lot but doesn’t always do what the doctors suggest. For example, it was recommended he try steroid injections into his back for the pain but he is sure he will become paralyzed so refuses them.

I am at my wits end living with a 58-year-old man who acts like he is 85. I go to the doctors with him but nothing has helped. I doubt you have any solutions for me but it helps to vent. Thank you for your time.

A: I may have a very simple solution for your husband’s fatigue/exhaustion/drowsiness that may even help his pain levels to a degree. He MUST use the CPAP or BiPAP that was prescribed for his sleep apnea.

Although your husband is getting more than adequate sleep time, he is almost assuredly NOT getting adequate quality sleep. Sleep apnea, as you know, causes the sufferer to stop breathing for a few seconds up to a minute or so. This can happen up to several thousand times a night. All these pauses interrupt the normal sleep process usually causing the individual to awaken more tired than when they went to bed.

By using the machine that was given to your husband, these pauses will be eliminated, allowing him to get proper rest which in turn allows the body to repair some of the daily damage that is afflicted. Your husband’s body cannot do this which may, in part, explain some of his roving and chronic pain. In addition, your husband may have a herniated disc or other spinal anomaly that is causing the rest of his back and leg pain. It may even explain his roving pain as the spinal cord sends signals throughout the body and depending on the location of the impingement the legs, arms, or trunk can be affected. Another possibility is fibromyalgia which can cause pain throughout the body.

Your husband needs to follow up on what his doctor and specialists are telling him. If he is nervous about a procedure, he can discuss the benefits and risks, and the approximate likelihood of experiencing those risks, with the physician doing it. For example, the steroid injections don’t go directly into the spinal cord into the spinal canal. There is little risk of paralysis and when done by a competent physician carries very little risk and has the potential for great benefits.

All that said, if your husband is unwilling to take the steps to feeling better, there is nothing you can do, but he should at least have the consideration to stop complaining about his problems when it is his fault that he chooses to do nothing.

Readers who would like related information can request Dr. Gott’s Health Reports “Fibromyalgia”, “Managing Chronic Pain” and “Sleep/Wake Disorders” by sending a self-addressed, stamped number 10 envelope and a $2 (for each report) US check or money order payable to Peter H. Gott, M.D. Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.

I have been to the emergency room no less than four times with chest burning and the doctors there can’t seem to give me an answer. Being a veteran, I have been to VA doctors several times to no avail. I’ve been to a gastroenterologist, physical therapist and a back doctor. Each one I see refers me to someone else. The tests I have had done should have revealed something by now. I have had a stress test, MRI, CT scan, several EKGs, X-rays, a colonoscopy, upper endoscopy and they even sent me to a mental doctor at the VA. I had seven sessions of blood work.

On a daily basis I take Metoprolol tartrate, Levothyroxine, Lisinopril, Simvastatin and hydrochlorthiazide. I’m really getting concerned about all of this. I am a retired 62-year-old male. Other than all the issues I’m having, I seem to be pretty healthy and everyone I have visited doesn’t seem to be concerned.

A: Initially, I’m going to take the easy way out on your symptoms and indicate they may all or in part be directly related to the medications you are taking. For example, while all of the drugs you have been prescribed are well-tolerated by most individuals, Metoprolol can cause chest pain, nausea and headaches. Levothyroxine is associated with headaches, fever and hot flashes. Lisinopril can cause headaches, tingling and fever. Simvastatin can cause muscle pain, nausea and fever. Lastly, hydrochlorothiazide can cause nausea and numbness. I cannot indicate which may be the culprit and, indeed, two or more could cause adverse side effects when taken together. The only way to determine this is with the assistance of the prescribing physician(s) who may be able – based on your medical history – to temporarily or permanently discontinue one at a time to see if any of your symptoms disappear or become less intense. If there is no change with the first (or any medication you currently take), for example, it can either be substituted for another drug in its class or begun with the second being temporarily or permanently discontinued, and so on. Not every drug will affect every person in the same way. We are all different and drug reactions will vary.

Gastroesophageal reflux disease (GERD), cardiac issues, irritable bowel syndrome and other issues appear to have been ruled out; however, has your doctor considered food allergies, kidney stones, Crohn’s disease, ulcers, or gallbladder disease? The latter commonly occurs just after a meal and can present with nausea, vomiting, abdominal or back pain. Perhaps a pheochromocytoma (a rare adrenal gland tumor) or carcinoid syndrome (due to carcinoid tumors) is to blame?

You have already had numerous tests which should have detected abnormalities, but didn’t. As a result, I recommend you request a second opinion from a top notch diagnostician who can categorize your many symptoms and hone in on the most likely causes. Take a copy of your lab work and testing results for his or her review. If deemed necessary, you may have to repeat some of the testing that has already been done.

I am unaware of your insurance coverage, based on the fact that you have been seen by the VA. If you end up back at your nearest VA facility, bring them a copy of my response and ask if you can be seen by someone who can sort things out and get you back on track. Good luck.

Readers who would like related information can request Dr. Gott’s Health Report “Medical Specialists” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order payable to Peter H. Gott, M.D. Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.

My latest problem is spinal stenosis involving C5, C6 and C7. It has been suggested I have injections to block nerves to relieve the pain from the stenosis and I also saw a neurosurgeon whose first question was “how long do you expect to live”? If it’s 10 to 15 more years, I might consider to put plastic pads between my discs. I am almost 78. Friends tell me to see someone who uses Reiki treatments and all my ailments will go away.

I take folic acid and B vitamins along with neurontin (Gabapentin), Plaquenel, MS Contin 60 mg twice daily, Mirapex and amitriptyline at bedtime. Lately when I wake up every morning my right hand is swollen to the point I can hardly close it and it is ice cold.

After writing this, I have to laugh when I remember that doctor asking me how much longer I planned to live. I am not ready to throw in the towel but don’t want to live with this pain.

DEAR READER: Fibromyalgia symptoms can come on gradually, causing widespread musculoskeletal pain, irritable bowel syndrome-like symptoms, fatigue, insomnia, TMJ issues, and more. There is no cure; however, medication and stress-reduction will go a long way toward bring the symptoms under control.

RA (rheumatoid arthritis) is an autoimmune disorder that, again, comes on gradually. Symptoms include joint pain, loss of motion, possible deformity, fatigue, numbness, and sleep difficulties. Life-long treatment includes medication, exercise, physical therapy, and more.

OA (osteoarthritis) is a form of arthritis that signifies inflammation of a joint or joints and loss of cartilage that can result from heredity, hormonal or congenital disorders, trauma, disease, gout, or the aging process. The disorder commonly affects the feet, hands, hips, knees, spine, and is exacerbated by obesity because of the amount of stress placed on joints. Symptoms include pain, stiffness and loss of cartilage cushion between bones. When it presents in the cervical spine, as is your case, severe pain with radiation, numbness, tingling and more can result. Unfortunately, there is no specific treatment that will stop the degeneration of cartilage; therefore, emphasis is placed on reducing pain and inflammation through rest, weight reduction, exercise, physical and/or occupational therapy, and perhaps even with the use of such devices as knee braces.

Sleep apnea indicates pauses in breathing that can last from several seconds to minutes. Sleep is interrupted as a result and the individual will likely suffer from daytime drowsiness. If you live alone, you likely won’t know the condition exists because it occurs during sleep. However, if you have someone sleeping near you, they will be very aware of the occurrence. The condition can affect anyone; however, it is most common in those who have specific medical conditions or are on specific medications. Treatment involves breathing devices such as the CPAP (continuous positive airway pressure) device you are using, a mouthpiece that can be prescribed by a dentist or orthodontist, or surgery. Medication is ineffective. Weight loss, the discontinuation of alcohol and smoking, and sleeping on one’s side may be beneficial.

Spinal stenosis is a narrowing of the spinal column that places pressure on the spinal cord. It generally occurs as a person ages and is linked with long-term inflammation, arthritis, herniated disc, congenital defects, and more. Symptoms include numbness in various parts of the body to include the neck, weakness of an arm or leg, gait abnormalities, and incontinence. Treatment includes physical therapy, medication to reduce the degree of pain, massage, acupuncture and – when all else fails – surgery to relieve the pressure on the spinal cord or nerves.

All in all, you have numerous conditions that cause pain, inflammation, numbness and tingling of the extremities, and your sleep apnea interferes by not allowing a beneficial full night’s rest. I believe you should be seen by a rheumatologist who can prescribe medication that may reduce your pain and swelling. You should also receive physical therapy and see a dietician – the first to work on those painful joints and muscles and the second to assist you in lowering your weight. Your daily exercise regimen might include the use of weights while sitting in a chair, water aerobics, tai chi, bending and stretching, and more. Massage, chiropractic, perhaps Reiki, and stress reduction can be included, as well. Ask your doctor’s office staff to help you with recommendations. It won’t be easy but if you can take it one day at a time under specific guidance by qualified professionals, you will find your pain lessened every day. Then when your doctor asks how long you expect to live, tell him “oh, at least another 10 or more years”.

Readers who would like related information can order my Health Reports “Fibromyalgia” and “Osteoarthritis” by sending a self-addressed, stamped number 10 envelope and $2 US dollars (for each report ordered) to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title(s) when writing or print out an order form from my website www.AskDrGottMD.com.

I have severe rheumatoid arthritis and take numerous medications. In the last few years it has become harder to sleep each night. I moan, groan, talk, yell, mumble, etc. while I sleep. I usually do not hear myself but everyone else in the house does. Sleep medication does not help me and ear plugs do not help others.

Do you have any ideas what I can do? No one wants to stay with me. I have had sleep studies with no answers. I need help.

DEAR READER: From the separate list you enclosed with your letter, I counted 22 drugs you are presently taking, seven other drug allergies or sensitivities, and a history of medical issues that covered two typewritten pages. And, you were only born in 1945. You’ve had osteomyelitis, fractures, a pulmonary embolism, dislocation, amputations, and respiratory failure to name a few. And, you’ve seen or been operated on by more than a dozen doctors. That’s impressive but exhausting.

Because your medical history is so extensive, I cannot begin to provide an adequate answer in my column. You simply have too many conditions and take too many medications for me to provide you with anything helpful that wouldn’t fill a book. For that reason, I will simply give you some general advice about where to turn for help.

In my opinion, your first step should be to take a copy of your medical history to a rheumatologist at a top notch teaching center. You also require some direction from a dietary point of view. If you modify your meal plans and eat properly, you should be able to eliminate some of your OTC vitamins, the omeprazole, and a few others. If you incorporate extremely mild exercises each day under a physician’s direction, perhaps you can eliminate still others. If you were to visit that facility’s pain clinic, you might be able to reduce or eliminate your methadone. This will not happen over night and you cannot simply discard all the pill bottles at once but I do believe that if one care giver takes the time with you, you can substantially lower your drug requirements. I am always concerned about the potential cross reaction of one drug to another and with you on so many, the possibilities are limitless.

From what I can determine, you have gastroesophageal reflux disease, bursitis, constipation, osteoporosis, a thyroid condition, and more, yet you feel you are keeping everyone up at night only because of your rheumatoid arthritis (RA). So, we will address that issue and see if we can put it in perspective. This chronic, inflammatory disorder commonly affects the lining of the joints in the hands and feet. Cartilage is destroyed, ligaments and tendons weaken and stretch and joints lose their alignment. It is an auto-immune condition, meaning that your immune system has wrongly attacked your body’s tissues. RA is more common in women than in men and often occurs between the ages of 40 and 60. Treatment for RA is geared toward preventing further damage and lowering symptoms of swollen joints, fatigue and more. Complications increase when a person has scarring of lung tissues and blocked arteries.

With the severity of your multiple conditions, I can understand why you have been prescribed prednisone to help reduce the pain and slow the damage to your joints. Unfortunately, steroids are taken at a price. They can cause diabetes, weak bones and cataracts. You are already on a disease-modifying anti-rheumatoid drug but that, too, comes with a side effect of possible liver damage, lung infection and suppression of your bone marrow. While I am not looking to add more drugs to your long list, you might consider asking your rheumatologist if tumor necrosis factor-alpha inhibitors might be appropriate for you. Drugs in this category have been known to help reduce symptoms in general. Sadly, they too come with unwanted potential side effects to include infection and congestive heart failure but those or other RA drugs with fewer unwanted side effects are available.

You need help and direction. A good facility can work with you to reach a goal of less pain and stiffness, stabilization of your symptoms and a good night’s sleep.

Readers who would like related information can order my Health Report “Managing Chronic Pain “ by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.

Around the same time his tooth fell out, he started complaining of pain traveling throughout his body. Sometimes it is in his wrist, which causes swelling, and other times it is in his hips, causing him to shuffle when he walks. Other times, he says he feels it’s in his blood, resulting in an all-over pain. He claims that he will often feel better after physical activity. He takes ibuprofen regularly to control the pain.

We thought it might be Lyme disease, but now I’m wondering if it may have something to do with the “glue.” He started a new job and will be eligible for health insurance in the fall. He would like to put off seeing a doctor until that time, as he does not want a record of a pre-existing condition.

Thank you for any help you can give us. I am very concerned about him.

DEAR READER: Did the dentist give your husband a reason why the tooth fell out? In my experience, healthy adults typically don’t lose teeth without a reason. This can vary from poor oral hygiene to medication side effects.

I am not sure the bonding agent the dentist used is to blame; however, given that the tooth falling out and the onset of pain coincided, they may be linked. My first thought when you described your husband’s symptoms was some form of arthritis.

If there is a possibility of Lyme, I urge your husband to undergo testing. Lyme is not a self-limiting infection; it will worsen over time and without treatment can cause serious, permanent damage. The sooner the diagnosis is made and treatment is begun, the better. There are far too many individuals suffering the long-lasting effects of undiagnosed Lyme simply because they waited to long to see a doctor or, unfortunately, their physicians put off their symptoms, often claiming, “We don’t have Lyme disease here.”

I understand that your husband doesn’t want to have a pre-existing condition listed in his medical records when it comes to obtaining new health insurance. However, he isn’t doing himself any favors by waiting.

DEAR READER: In November 2010, the FDA removed Darvon (propoxyphene) and Darvocet (propoxyphene/acetaminophen) from the market. They also asked generic-drug makers to stop marketing medications that contained propoxyphene. This came after the manufacturer of the drugs completed a new study (at the request of the FDA) that showed propoxyphene put patients at risk of potentially serious and sometimes fatal heart-rhythm abnormalities. Propoxyphene was banned in the United Kingdom in 2005 and in Europe a few years later. It has been a controversial medication for decades.

Known side effects include constipation, dizziness, headache, vomiting, allergic reaction, sedation, coma, hallucinations, cardiac arrest, drug toxicity, convulsions, accidental and intentional overdose, respiratory arrest, suicide, dependence, mental-status changes, cardiac-rhythm abnormalities, heart attack, congestive heart failure and death.

According to its website, www.citizen.org, Public Citizen is a nonprofit organization dedicated to ensuring “that all citizens are represented in the halls of power.” It has taken on and successfully challenged several industries — including pharmaceuticals and automobiles.

In regards to propoxyphene, the organization petitioned the FDA to ban the substance in 1978 and again in 2006. In a press release, Public Citizen says that its February 2006 petition, which followed the U.K. ban announcement, did not even result in an FDA advisory-committee hearing until they sued the agency in 2008, forcing a response to the petition. The hearing wasn’t held until January 2009, in which a 14-to-12 vote favored banning the drug; however, in July 2009, just weeks after the European propoxyphene ban, the FDA denied the petition, instead opting to mandate a black-box warning and ordering a human study to determine whether the drug truly put patients at risk.

It is unclear to me why, if both the United Kingdom and Europe found sufficient evidence to ban propoxyphene, the U.S. FDA did not take steps earlier.

Now to your arthritis pain. In my opinion, narcotic pain relievers typically are not a good option for treating arthritis pain. They carry several side effects, including dependence, and should be used only as a last resort. Based on your brief letter and without knowing what other options you have tried, what other medical conditions you may have and what joints are affected, I can provide only general advice.

I assume because you are taking a narcotic, your arthritis is fairly advanced. If it is affecting your hips or knees, are you a candidate for joint replacement? Have you tried cortisone injection? Replacement-cartilage injections? Do over-the-counter anti-inflammatory drugs, such as ibuprofen or naproxen, work to ease your pain? Have you tried physical therapy, water aerobics or yoga? All of these options may be beneficial to you and may reduce your pain level.

In regards to your “broken bones,” I am unclear what you mean. Are you currently suffering from several broken bones because of an accident or fall? Are these healed injuries? Are they a result of osteoporosis? Which bones are or were broken that are now causing you pain?

If you are suffering from spinal fractures due to osteoporosis, you should increase your calcium and vitamin D intake and consider taking a medication to try to restore some of your bone loss. If the fractures are new and the result of injury, healing will take several weeks and pain should subside during that time. If these are old fractures that are now healed, lingering pain may never completely go away but often isn’t severe and is generally described as an achy feeling, especially during cold, damp weather. If the fractures weren’t set correctly, the bones may have grown abnormally, putting pressure on muscles and nerves.

I suggest that you seek the assistance of a pain clinic or pain specialist, who may be able to offer you other treatment options. He or she can work with you to find the right therapy or therapies that allow you to function well on a daily basis — hopefully without medication or with a drug that doesn’t carry so many side effects.

To provide related information, I am sending you copies of my Health Reports “Understanding Osteoarthritis” and “Consumer Tips on Medicine.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order for each report payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title(s) or print an order form off my website at www.AskDrGottMD.com.

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.

DEAR READER: Cortisone can be injected into joints such as the ankle, knee, shoulder and other areas to relieve pain and inflammation. They have been known to help osteoarthritis, gout, carpal-tunnel syndrome, bursitis, plantar fasciitis and a host of other conditions. About 30 years ago, corticosteroids were given with great regularity. Today, however, a different approach is taken. Some physicians restrict a person to three injections a year, others to three in a lifetime. This has resulted from research indicating that repeated injections can cause damage to tissues over time when given in excess quantities to one area of the body. One consideration is whether or not the injections work. If one or two are unsuccessful for reducing pain, it’s rather unlikely that additional ones will respond any differently.

Side effects include a cortisone flare, in which the injected material crystallizes, causing pain for up to two days that could be greater than what was experienced prior to the injection. Tendons can be weakened, there can be pain at the injection site, and the color of the skin at the site can change. The most common systemic reaction is observed in diabetic patients, who should monitor their readings, because cortisone can cause a rise in blood-sugar levels. Long-term risks of high doses with frequent administration can include weight gain, facial puffiness, cataracts, osteoporosis, hypertension and rare but serious damage to the large joint bones, known as avascular necrosis.

So, in answer to your question, your mother should return to her orthopedic surgeon or the physician who gave her the injections. If that specialist (who is familiar with her medical history) feels strongly that no more should be administered, then I suggest you heed the warning. If, however, your mother is aging, her quality of life is affected, and she cannot find relief from pain through other means, perhaps she will receive a favorable response. The pros and cons can be answered only by the person behind the needle.

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

DEAR READER: The soap-under-the-sheets remedy is very simple. Place an unwrapped bar of soap under the bottom bedsheet nearest to the affected area. Some readers have had success using wrapped soap, as well. It was originally recommended for nighttime leg cramps but has also been found to be beneficial for other nighttime aches and pains in other areas, such as the shoulders, feet, back and neck. The soap may need to be replaced once in a while, say every three to six months, but it still retains its cleaning ability so it does not need to be thrown away. I suggest your wife try it since she has nothing to lose other than her pain.