Pain body’s way of relaying info
DEAR DR. ROACH: If I recline fully in my recliner and fall asleep, after an hour I am awakened by a pain from my upper legs, buttocks and lower back. If I recline to watch TV or read, I begin feeling this in an hour.
Two Aleve pills remove the pain quickly, but the pain returns if I return to the recliner. If I relocate to a solid chair and sit upright, I get continuing relief. What is causing my discomfort in the recliner?
ANSWER: Your body is trying to tell you something, which is that the recliner is putting your body into a position where your nerves are being pressed on.
The pain is there for a reason — to tell you to change position or, better yet, get up and move around.
DEAR DR. ROACH: I got shingles four months ago. I have bad nerve pain when my clothes touch my skin.
Is there anything to help this? I have had pain pills and creams, but none of them work.
ANSWER: Pain four months after an attack of shingles is called “postherpetic neuralgia,” and it is more common and often more severe in older individuals.
Many people describe it as one of the most painful conditions they have ever experienced. It can be hard to treat, but my experience and most published literature suggests that gabapentin (Neurontin) or pregabalin (Lyrica) are very effective agents; sometimes additional treatments are necessary, especially tricyclic antidepressants, such as amitriptyline. The doses necessary are high, and take time to reach, since the body needs time to become accustomed to the side effects. The cream you tried likely was capsaicin, which is moderately effective for most people but doesn’t work in everybody.
Postherpetic neuralgia usually goes away by itself, but it can take a frustratingly long time — up to three years in older adults. The shingles vaccine is no longer of help to you, but it can prevent this terrible complication.
The rate of PHN is a little over two cases per thousand people per year without the vaccine, and only 0.7 cases per thousand people per year who have been vaccinated.
DEAR DR. ROACH: I am concerned about my 48-year-old son, who is very active and a hard worker.
He has a good marriage and is always happy. He is tall and thin, enjoys food and has a good appetite. He drinks 10 to 12 cans of cola on a daily basis. No coffee, tea or other drink. Maybe he has a beer, but only on rare occasions.
I’ve read articles on cola in pancreatic cancer and also articles on cola in diabetes. What are your thoughts on this?
ANSWER: There is no reliable evidence that drinking sugarsweetened beverages increases risk of pancreatic cancer, but there is some evidence that saturated fat may be a risk factor.
Smoking certainly is, and a diet high in fruits and vegetables probably reduces risk. The connection between new-onset diabetes and pancreatic cancer remains controversial.
On the other hand, the amount of sugar in 12 cans of a sugary soft drink is immense — nearly half a kilo, or a pound of sugar.
This clearly increases the risk of diabetes, despite the fact that he is thin. Further, those calories are “empty”: Soft drinks provide no other nutrients that his body needs.
He would be at less risk for developing chronic disease years from now if he were to reduce his soda intake to no more than one or two a day and instead would enjoy healthier foods, like fresh fruits and vegetables.
DEAR DR. ROACH: My left hip bothered me, and I told my doctor. He did an X-ray, then called me and said I have a hip fracture.
He sent me for an MRI. They read it and also said I had a hip fracture, and sent me to the orthopedic surgeon. The surgeon redid the X-rays and looked at the MRI scan, and told me I do not have a fracture. He measured my legs and found that my left was 3/4 inch shorter than the right. He prescribed an insert into my left shoe, and I had no more pain.
ANSWER: It is certain that some people have differences in the lengths of their legs and that sometimes this leads to symptoms.
A relatively small difference such as yours usually is treated with a shoe or a shoe insert, usually by an orthopedic surgeon, podiatrist or physical therapist. Often, but not always, this results in improvement of the symptoms.
What is surprising about your story is the initial findings of the X-ray and MRI scan. X-ray results certainly can be ambiguous, but the MRI is reported to have 100 per cent sensitivity (that is to say, it shouldn’t miss a case).
One study showed that experienced radiologists have 100 per cent specificity in reading a fracture, meaning there always is a fracture when they say there is, but less-experienced radiologists have “only” a 93 per cent specificity.
It appears to me that your orthopedic surgeon was right and your radiologist wrong, since your symptoms got better.
Most cases of hip fracture are not subtle.
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