Thanks for joining us for our March 9 live chat on the common pains that senior citizens experience, including (but not limited to) arthritis, spinal fractures, low back pain and pain after surgery. Dr. Paul Christo, director of the Multidisciplinary Pain Fellowship Training Program at Johns Hopkins University School of Medicine, answered reader questions on problems and treatments.

You can read the transcript from our session below.

Note: Comments made here are for informational purposes only and do not represent or substitute as medical advice. Patients are advised to consult their own physician or pharmacist for advice, diagnosis and treatment.

 Health chat: The aches and pains of aging(03/09/2011) 
11:39
Baltimore Sun Health: 
Hi, Dr. Christo will be with us at noon, but feel free to add your questions now and come back in 20 minutes.
Wednesday March 9, 2011 11:39 Baltimore Sun Health
11:47
Baltimore Sun Health: 
Dr. Christo just informed me that he'll be about 15 minutes late due to an emergency in the operating room. We apologize for the inconvenience.
Wednesday March 9, 2011 11:47 Baltimore Sun Health
12:23
Baltimore Sun Health: 
Thanks for your patience. Dr. Christo has now joined us and we're ready to begin with the first question. Welcome, Dr. Christo.
Wednesday March 9, 2011 12:23 Baltimore Sun Health
12:23
drchristo: 
Hello, sorry for the delay.
Wednesday March 9, 2011 12:23 drchristo
12:23
[Comment From CecilianaCeciliana: ] 
What do you recommend for arthritis back pain?
Wednesday March 9, 2011 12:23 Ceciliana
12:26
drchristo: 
Ceciliana, tylenol at doses no greater than 1000 mg four times a day is typically the first drug of choice. Low dose, anti-inflammatory drugs (motrin, for instance) for the shortest duration of time can be used if tylenol isn't helpful. Other drugs like tramadol and even opioids can be used later. Injections into the spine may also be useful once a physician examines your back and determines a source of pain.
Wednesday March 9, 2011 12:26 drchristo
12:27
[Comment From BetsyBetsy: ] 
For the past few years I try to keep myself active but it seems I keep getting a lot of pain all over my body. Some days I don't seem to get much done. I have hbp, thyroid, arthritis (knees especially), asthma, lower back pain, etc. I am on too much medications. I have discussed this with my dr. and it doesn't seem like there is much I can do about the medication factor. Besides water aerobics and exercising is there something else I can do?
Wednesday March 9, 2011 12:27 Betsy
12:28
Baltimore Sun Health: 
I have some links on pain management for seniors that could be of interest to our readers.
http://www.healthinaging.org/agingintheknow/chapters_ch_trial.asp?ch=19
Wednesday March 9, 2011 12:28 Baltimore Sun Health
12:29
Baltimore Sun Health: 
http://www.theacpa.org/7/Conditions.aspx
Wednesday March 9, 2011 12:29 Baltimore Sun Health
12:29
Baltimore Sun Health: 
http://www.painfoundation.org/learn/pain-conditions/
Wednesday March 9, 2011 12:29 Baltimore Sun Health
12:29
Baltimore Sun Health: 
And some for arthritis, specifically: http://www.nlm.nih.gov/medlineplus/arthritis.html
Wednesday March 9, 2011 12:29 Baltimore Sun Health
12:29
Baltimore Sun Health: 
http://www.cdc.gov/arthritis/
Wednesday March 9, 2011 12:29 Baltimore Sun Health
12:31
drchristo: 
Betsy,

Knee arthritis can be helped with injections of steroid every 3 months or so. Hyaluronic acid (e.g, Synvisc) injections into the knee is an approved treatment and the data suggest benefit. It's usually 3-5 injections total. A device called a TENS unit can be helpful for low back pain. You place small electrodes on your skin and the device provides painless doses of electricity. Behavorial therapy (pain psychology) has also shown to be useful.
Wednesday March 9, 2011 12:31 drchristo
12:31
[Comment From EllenEllen: ] 
I have recently been treated for arthritis using leeches. The results have been fantastic. After one (inexpensive) treatment with a very experienced leeche therapist (with a certification from Russia) I am experiencing incredible relief on my wrists (both have which had become quite painful). I'm having no side effects and have been told to expect the relief to continue for months, perhaps as long as a year. Have you heard of this treatment and what do you think of it?
Wednesday March 9, 2011 12:31 Ellen
12:36
drchristo: 
Ellen,
I'm not familiar with leech therapy for arthritis, although some patients in Europe seem to report relief. I think it's believed that the saliva of the leeches has pain-relieving qualities (anesthetic, analgesic, and histamine-like properties). I'm happy that you're getting relief. I would just caution you or anybody using leeches to make sure that you understand the side effects or any problems with the therapy that are reported.
Wednesday March 9, 2011 12:36 drchristo
12:36
Baltimore Sun Health: 
Here's a link to a recent British news report of a German study of the pain-relieving effects in osteoarthritis patients: http://www.dailymail.co.uk/health/article-72904/Leeches-beat-arthritis.html
Wednesday March 9, 2011 12:36 Baltimore Sun Health
12:38
[Comment From Pain in MDPain in MD: ] 
Dr. Christo - Seems like health insurance protocols make it tougher and tougher to gain timely access to medications in general, but particularly to medication for chronic pain. Can you talk about the impact of delayed treatment on seniors living with conditions like arthritis, osteoporosis, etc. Are the challenges of delayed treatment more acute among those populations?
Wednesday March 9, 2011 12:38 Pain in MD
12:41
drchristo: 
Pain in MD,
I think access to timely pain treatment is important for all ages, especially older adults because the risk of developing persistent pain is higher the longer the pain remains untreated. Insurance protocols, knowledge deficits, transportation challenges, and communcation problems among older adults all contribute to delayed treatment, and should be the focus of improvement in the delivery of pain care to this population.
Wednesday March 9, 2011 12:41 drchristo
12:41
[Comment From JoanJoan: ] 
What other options are there othere than sugery for spinal stenosis?
Wednesday March 9, 2011 12:41 Joan
12:46
drchristo: 
Joan,
First, if the stenosis (narrowing) around the spinal cord or spinal nerves is severe and is causing weakness, sensation problems, or bowel or bladder problems, surgery is probably needed. Make sure you talk to a spine surgeon about your specific symptoms. Otherwise, medications, physical therapy to strengthen the abdominal and back muscles, nerve blocks, and even spinal cord stimulation are useful options. It depends on whether you have back pain only, back and leg pain, or just leg pain. Consult a pain physician for more guidance on what might be most helpful for you.
Wednesday March 9, 2011 12:46 drchristo
12:48
[Comment From Judy CaldwellJudy Caldwell: ] 
I take Gabapentin 1000mg/day for arachnoiditis. I get only a fair amt. of relief. It has been suggested that I get a "port" so that the drugs have a more local effect and not systemic with all the side effects. Would the port help or would it not handle the sx. that I have not just in my legs, but over my entire body? The dr. who suggested the port said that,"Gabapentin can really screw up your head".
Wednesday March 9, 2011 12:48 Judy Caldwell
12:54
drchristo: 
Judy,
You might consider increasing the dose. A typical maximal dose is up to 3600 mg/day. This can be done gradually so that side effects are minimized. I don't know what a "port" means? Gabapentin isn't given intravenously. It's been applied on top of the skin for pain relief. If you mean placing a catheter (small tube) onto a nerve or body part, then we don't have much information on whether it is effective. Local anesthetics are typically delivered through a catheter in the form that you're describing for pain relief, and we have evidence for effectiveness especially following surgery.
Wednesday March 9, 2011 12:54 drchristo
12:55
[Comment From BOB REIDBOB REID: ] 
2009 HAD KIDNEY REPLACED - INFECTION- HEART VALVE REPLACED - INFECTION- TWO HERNIA OPERATIONS - LOST 60 LBS. - THREE STRESS FRACTURES LOWER BACK - CURRENT WEIGHT 160 LBS. AGE 81, - CURRENTLY CAN STAND 15 MINUTES - LIMITED WALKING ABILITY- BELIEVE FRACTURES HAVE HEALED BUT MUSCLES STILL SORE.
Wednesday March 9, 2011 12:55 BOB REID
12:55
[Comment From BOB REIDBOB REID: ] 
ANY RECOMMENDATION ON TYPE OF EXCERSIZE - WEIGHTS - WALKING - AEROBIC?
Wednesday March 9, 2011 12:55 BOB REID
12:58
drchristo: 
Bob,
Aquatherapy can be quite helpful. It can help stabilize and strengthen the muscles, assist with balance, and is well tolerated by older adults. Seek out physical therapy or a physical medicine and rehabilitation doctor to provide an asssessment of your specific needs.
Wednesday March 9, 2011 12:58 drchristo
1:00
[Comment From GuestGuest: ] 
I have an elderly brother who sometimes doesn't want to eat, forgets to eat, etc. This seems to almost render him as a zombie. What usually is the main cause why old people don't eat?
Wednesday March 9, 2011 1:00 Guest
1:00
[Comment From MarieMarie: ] 
I sent a question about eating and I didn't sign my name.
Wednesday March 9, 2011 1:00 Marie
1:03
drchristo: 
Marie,
Pain and the side effects of medications can cause a diminished appetite. In your brother's case, it sounds like he may suffer from dementia (forgetting to eat) and that may be the real cause. Talk to your physician about your brother and get some suggestions about causes and some drug treatments that can be beneficial.
Wednesday March 9, 2011 1:03 drchristo
1:04
[Comment From andyandy: ] 
Excellent question, Pain! Unfortunately, there is a trend away from pain medications in this country due to fear of addiction, which is different from dependence. My question: I had a radio frequency ablation on 3 facet joints in my lower spine a few months back (at Hopkins). It only lasted about a month. What's next, if anything? I have had 2 major flares in as many months and am feeling quite down.
Wednesday March 9, 2011 1:04 andy
1:08
drchristo: 
Andy,
Other sources of low back pain could be explored (disc, muscles, nerve compression) and then treated with specific injections or other medicines. Opioids can lead to addiction (rarely) in treating pain, but other medications like gabapentin (neurontin), tramadol, and antidepressants (elavil, cymbalta) can be helpful and don't have the addiction risk.
Wednesday March 9, 2011 1:08 drchristo
1:08
Baltimore Sun Health: 
That's all the time we have for today. Thanks for your great questions. We'll be back in 2 weeks on another pain topic.
Wednesday March 9, 2011 1:08 Baltimore Sun Health
1:09
drchristo: 
Thank you for your questions.
Wednesday March 9, 2011 1:09 drchristo
1:09