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.

I’ve since had chiropractic treatments and massage therapy but am unable to continue due to financial difficulties. I saw an orthopedic surgeon but to my dismay, he didn’t refer me for any treatment. Instead, he administered a cortisone shot and asked that I return for a follow-up visit in three months. Follow-up visits were disappointing as he did not even try to refer me for therapy or anything beneficial to my injury.

I took it upon myself to work my knee muscles and provided self-therapy. I’m finally walking a little better, but I still cannot fully bend it. Without having to undergo surgery, is there a sports kinesiologist similar to those who care for professional athletes you can refer me to? Would that be outside my insurance benefits?

DEAR READER: I recommend that you see your primary-care physician and orthopedic specialist to obtain some answers. In a sense of the word, you must know the rules of the game before you can start to play. Perhaps they will both indicate that you have improved as much as you can, that you have arthritis, disc degeneration or other condition(s) that affect many people as they age. If that is the case, there are self-help steps you can take. If not, consider physical therapy, hydrotherapy, yoga, weight loss, pain medication and/or ice/heat for relief. You don’t indicate if you have taken any medication other than the cortisone injections that were somewhat ineffective. Is a trial medication an appropriate first step? Once you receive answers and know your limitations, ask for an appropriate referral, perhaps to a sports-medicine specialist who would be covered under your insurance.

On the home front, your local hospital or health center should have a physical-therapy department with qualified individuals to work with you. A local community center might have yoga instruction and a swimming pool with trained personnel in hydrotherapy. Even if the services are not covered by Medicare or other insurance, these programs should be affordable for seniors.

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.

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.

Now I suffer muscular pain in one leg and even limp when I try to walk any distance. I also have difficulty in climbing stairs. I’m wondering if I can put off the surgery any longer and what the success rate is with the procedure.

DEAR READER: You appear to be the victim of a progressive neurological disorder: pressure on the nerves as they pass through or around the spinal discs, with resulting compression of the nerves leading to chronic pain.

I believe that you have put off repair as best you can but it is surgery alone that will “fix” your back and nerves. My conclusion is based on the limited information in your letter. Your best bet is to be examined and tested by an orthopedic surgeon specializing in discogenic disease. Speak with your primary care physician for his referral.

On the negative side, no surgery can be guaranteed free from side effects. Every person who undergoes surgery responds in a different manner. Some fare extremely well, while others having the identical procedure have a more difficult recuperation period. Age, physical condition, related or unrelated medical problems and a host of other issues all come into play. I cannot begin to guess which category you might fall into. Therefore, I’ll have to pass on projecting the success rate. Quality of life is an important issue and the risks of surgery must be weighed against the pain you are suffering. I recommend selecting a specialist you have confidence and who is highly recommended by your own doctor. This is often the foundation on which to build success.

While you are awaiting your appointment, you might try acupuncture, massage, physical therapy, chiropractic manipulation, and other modalities. Then, should you not be a candidate for a procedure, the specialist can advise which alternative therapy is appropriate.

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 4 ¼” X 9 ½” letter-sized stamped envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.