Ask Dr. Roach: Daily back or hip pain calls for higher dose of meds or surgery

DEAR DR. ROACH >> I have a degenerating L5-S1 disc as well as osteoarthritis in my left hip, and both are bone on bone. I will eventually need a hip replacement and possibly back surgery, but I’m trying to prolong anything until I get on Medicare in eight months. I stay as active as I can by walking my dog, exercising (weights and biking), and getting back into yoga after a hiatus due to COVID. I also stretch almost daily and play with my grandsons.

But the fact remains that these issues are not going to go away and I’m in pain daily. Walking causes the most pain, but I keep on doing what I can. I toss and turn all night long trying to get in a pain-free position. The only thing that helps take an edge off of my pain when walking are two Tylenol Arthritis caplets and two Ibuprofen, taken together.

I only take this dose once a day and at the most three times a week because I don’t want to take too much of these types of anti-inflammatory/pain-relieving drugs. On the days that I don’t take it, I just deal with the pain and try not to complain. Is it OK to take this dosage, and would it be harmful on my liver to take it daily? Also, am I doing more harm by prolonging these inevitable surgeries?

— M.M.

Dear M.M. >> I can’t answer which problem (your back or your hip) is causing the worst symptoms. In both cases, stretching and keeping active (swimming is a great choice for people who find walking painful) is good advice. For both conditions, the very modest doses of Tylenol and ibuprofen that you are taking are likely to be safe in the long-term. Nothing is completely safe, but I do say that you could keep taking this every day and even go up to twice daily, with very little additional risk and probably more benefit. Being in pain all the time is not good for you, and the amount of Tylenol or ibuprofen needed to harm the liver is much larger than you take.

From there, my advice differs depending on which is the primary problem. I have had many patients undergo hip replacement surgery, and the overwhelming regret I hear is that they wish they had done so earlier. Hip surgery is generally well-tolerated and dramatically improves quality of life. Still, there is always a risk of a poor outcome, but being active beforehand and complying 100% with physical therapy after surgery improves your odds fora good outcome.

Back surgery, on the other hand, is one I have my patients think twice about before undergoing. Back arthritis is not cured, but only palliated by surgery, and as long as people can control the pain and keep up their activity, I advise against surgery.

A very careful evaluation by your surgeon can help identify which problem is most likely to be causing the symptoms. If it’s the hip, I encourage you to discuss surgery; whereas if it’s more the back, the prognosis is not as good with surgery.

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