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 and increase my quality of life rather than wait until 75 and live with pain. It just seems like a big surgery with a lot of post-op healing (six weeks in a brace or four weeks on crutches) and 10 weeks of physical therapy. Is it worth it? — S.W.
ANSWER: The acetabular labrum of the hip is a section of cartilage that helps to keep the hip joint in place and keeps the joint fluid where it belongs. (The shoulder has a labrum too, which can confuse things.) The labrum can be damaged by acute trauma, such as a tackle in American football, but in people in their 50s, it is more likely to be due to repeated small traumas, the kind that often occur with arthritis of the hip. The most common symptom is groin pain with activity.
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, and have tried several times, but it is hard. Is there any over-the-counter product to take its place? I would love to quit. — E.V.
ANSWER: Morphine is a strong opiate, and one of the most effective pain medications we have, in the right circumstances. However, the body can develop tolerance to its effect. With long-term use, many people find that the dose they have been taking loses its pain-relieving effect, and they require higher doses to get the same benefit. In studies of people with chronic pain, after a year of being on opiates like morphine, the pain is usually not any better than it was before they started. Unfortunately, some of the toxicities of opiates, such as constipation, 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 long-term 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.
Unfortunately, few people will get adequate pain relief from moderate to severe pain, the kind morphine is used for, with over-the-counter treatments like acetaminophen (Tylenol) or ibuprofen. Most people need a combination of treatments, including prescription medication, to get good-quality pain relief. A pain management expert is the ideal specialist to help discuss whether alternatives are appropriate.