Surgery requires a lengthy recovery

Dear Dr. Roach: I’m a 55-year-old woman. I recently went to see a surgeon for a torn hip labrum. I learned that labrums do not heal on their own, and injections and physical therapy can only mitigate pain. I’m leaning toward surgery, because it makes more sense to have surgery at 55 rather than wait until 75 and live with pain. It just seems like a big surgery with a lot of post-op healing and 10 weeks of physical therapy. Is it worth it?

S.W.

Answer: In general, I don’t recommend rushing to surgery. A trial of physical therapy is appropriate, as a therapist can help you retrain your muscles to put the hip in a better anatomic position, relieving pressure on the labrum and improving symptoms. There is some evidence that the labrum can heal to a certain extent, although this is controversial.

You are right that the operation does require a lot of recovery time. This makes a trial of PT to avoid surgery even more valuable.

Dear Dr. Roach: I am 91 years old, and have been on morphine sulfate for years. I was a paratrooper for 20 years, so you can probably figure out why I need the morphine. I would like to wean from the morphine. Is there any over-the-counter product to take its place? I would love to quit.

E.V.

Answer: Morphine is one of the most effective pain medications we have, in the right circumstances. However, the body can develop tolerance to its effect. Unfortunately, some of the toxicities of opiates do not develop tolerance, so long-term use of morphine is often problematic.

I say “often” problematic, because there are patients, and I have had some, who do very well with longterm opiates. They have good pain control and little toxicity. If you are one of the lucky few doing well with the morphine, then there may be no reason to go through the process of withdrawal and finding effective pain relief alternatives.

A pain management expert is the ideal specialist to help discuss whether alternatives are appropriate.