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Q&A: Hip Joint Pain Treatment Approach and Options–Everything You Need To Know

Which Symptomatic Hip Joint Diseases Causing Hip Joint Pain Require Treatment?

Q&A: Hip Joint Pain Treatment Approach and Options-Everything You Need To Know

What Is The Treatment Approach For Hip Joint Diseases Causing Hip Joint Pain?

Treatments of Hip Joint Diseases Are Divided in 3 Segments As Follows:

  • Diagnosis of Common Symptoms
  • Diagnosis of Cognitive Abnormalities
  • Diagnosis of the Cause of Hip Joint Diseases.

Which Are The Symptoms Associated With Hip Joint Pain That Needs Treatment?

Following Are the Common Symptoms of Hip Pain, Which Should Be Treated With Pain Management

  • Chronic hip pain
  • Muscle spasm
  • Instability
  • Joint stiffness
  • Limping or abnormal gait

Which Cognitive Dysfunctions Caused By Hip Joint Disease Require Treatment?

  • Anxiety
  • Depression
  • Irritability

Describe Causes Of Hip Joint Diseases, Which Requires Specific Treatment?

Causes Of Hip Joint Diseases

  • Inflammatory Disease
  • Infection of Hip Joint
    • Septic (infected) arthritis and bursitis of the hip joint.
  • Traumatic Injury To The Hip Joint
    • Hip Dislocation
    • Hip Fracture
    • Tear of tendon, ligament and hip joint capsules.
    • Labral Tear
  • Ischemic (Lack of Blood Supply) Condition

What Are The Different Treatment Options For Hip Joint Pain?

Treatment of Chronic Hip Pain

  • Anti-inflammatory
  • Opioids
  • Antidepressant analgesics
  • Antiepileptic analgesics
  • Interventional pain management
  • Physical Therapy
  • Surgery

What Are The Different Treatment Options For Hip Joint Pain?

What Are The Different Anti-Inflammatory Medication Used To Treat Hip Joint Pain?

Hip joint pain may be secondary to inflammation of hip joint (arthritis), synovial membrane (synovitis), bursa (bursitis) and tendon (tendinitis). Inflammation of the hip joint are treated with following medications

  • Non-Steroidal Anti-Inflammatory Medications (NSAIDs)
    • Aspirin
    • Tylenol
    • Motrin
    • Naproxen
    • Indomethacin
    • Tolmetin (Tolectin)
    • Sulindac (Clinoril)
    • Diclofenac (Voltaren)
    • Daypro
    • Celebrex (COX 2 inhibitor- less side effects of stomach and intestine)
  • Corticosteroids
    • Oral- Prednisone
    • Injection- Intraarticular (in the joint), tendon, or muscles
  • Disease-Modifying Antirheumatic Drugs (DMARDs).

When Is Anti-Inflammatory Medication Prescribed For Hip Joint Pain?

Anti-inflammatory medications are prescribed following investigation and diagnosis. Anti-inflammatory medication (NSAIDs) may cause stomach pain secondary to gastritis or peptic ulcer of stomach and upper intestine (duodenum). Medications are often prescribed to prevent complication caused by anti-inflammatory medications. Alternatively inflammation is treated with oral or local injection of corticosteroids.

Hip Joint Pain Treatment Using Opioid Therapy, Is it Necessary?

Acute or chronic hip joint pain causing severe restrictions and not responding to NSAIDs is treated with opioids.

  • Acute and chronic hip joint pain not responding to NSAIDs.
  • Acute severe nociceptive pain caused by hip joint dislocation.
  • Post operative nociceptive pain.
  • Acute and chronic nociceptive pain caused by hip joint fracture.
  • Severe neuropathic pain caused by avascular necrosis and labral tear of hip joint.
  • To achieve optimum pain relief prior to physical therapy or daily activities.

When Would One Need Opioid To Treat Chronic Hip Joint Pain?

Indications for Opioid Treatment for Hip Joint Pain Are As Follows

  • Nociceptive Hip Joint Pain– Opioids works very well for nociceptive pain caused by surgery, dislocation and fracture. Chronic neuropathic hip pain may not respond to opioids.

Hip Pain Not Responding to Following Treatments

  • Medication
    • NSAIDs
    • Antiepileptic analgesics
    • Antidepressive analgesics
    • Corticosteroids
  • Physical Therapy
  • Interventional Pain Therapy
  • Surgery

What Is Nociceptive Hip Joint Pain?

Nociceptive hip joint pain is caused by soft tissue inflammation and tissue trauma of the hip joint. Nociceptive pain is acute pain.

Examples Of Nociceptive Hip Joint Pain Are As Follows

  • Initial hip pain following inflammation.
  • Hip pain following dislocation.
  • Hip pain following fracture.
  • Hip pain after surgery.
  • Tissue trauma of the hip joint.

What is Neuropathic Hip Joint Pain?

Neuropathic hip joint pain is caused by peripheral and central sensitization of pain receptors and neurons. Long standing hip joint pain often becomes neuropathic pain. Neuropathic pain is continuous burning pain. Hypersensitive pain receptors trigger pain impulses in response to touch, pressure, or movements. Burning character of neuropathic pain at time is wide spread.

Why Are Opioids Not Effective in Neuropathic Hip Joint Pain?

Hypersensitive peripheral and central pain receptors do not respond to opioids. Opioid requirements to achieve adequate pain relief are extremely high in neuropathic pain. Rapid acceleration of dosage to achieve optimum pain relief may cause increased tolerance and resistance to opioid followed by dependence and addiction.

Why Should One Be Careful To Take Opioids To Treat Hip Joint Pain?

Opioid dependence and addiction is often seen in patients taking long-term opioid treatment. Nociceptive pain lasts for short time and responds well to opioid therapy. Neuropathic pain last for prolonged period and do not respond to opioids. Neuropathic pain and long lasting pain needs higher dosage and rapid acceleration of dosage to achieve optimum pain relief. Close supervision is often necessary if patient is receiving opioid medication for prolong periods. Long-term opioid treatment often causes following side effects-

  • Opioid tolerance.
  • Dependence.
  • Addiction.

List The Most Common Opioids Used In Treating Hip Joint Pain?

  • Hydrocodone– short acting e.g. Vicodine, Loratab, Zydone, and Norco
  • Oxycodone
    • Short acting- Percocet
    • Long acting- Oxycontin
  • Morphine
    • Short acting- MS (morphine sulphate) IR
    • Long acting- MS Contin
  • Dilaudid
    • Short acting- effective for short-term treatment
  • Methadone
    • Long acting- effective for long-term treatment.

Why Some Anti-Depressants And Anti-Epileptics Are Prescribed As Analgesics For Hip Joint Pain?

Chronic pain is either nociceptive or neuropathic pain. Neuropathic pain in most of the cases does not respond to NSAIDs or Opioids. Neuropathic pain caused by hypersensitive pain receptors or neurons often respond to medications such as Cymbalta (antidepressants), Lyrica (antiepileptic) or Neurontin (antiepileptic). Cymbalta (anti-depressant), Lyrica (anti-epileptics), and Neurontin (anti-epileptics), thus also recognized as an analgesics.

List the Anti-Epileptic Medications Used In The Treatment Of Chronic Hip Joint Pain?

  • Lyrica
  • Neurontin
  • Elavil

List The Antidepressants Medication Used In Treatment Of Chronic Neuropathic Hip Joint Pain.

Depression associated with chronic pain is treated with antidepressant analgesics like Cymbalta and Seville. Patient is referred to Psychiatrist for further evaluation and adjustment of effective medication. Following antidepressants are also used to treat depression in chronic pain patients-

  • Cymbalta
  • Seville
  • Elavil
  • Prozac

How Is Muscle Spasm Associated With Hip Joint Pain Treated?

Muscle spasm is treated with following choices of treatments-

  • Muscle Relaxants
  • Sedatives
  • Physical Therapy
  • Interventional Pain Management or Cortisone Injection Treatment

Which Muscle Relaxants Are Effective In Treating Muscle Spasm Associated With Hip Joint Pain?

Following muscle relaxants are prescribed in treating muscles spasm associated with hip joint disease

  • Skelaxin
  • Robaxin
  • Flexeril
  • Baclofen

Is It Safe To Take Muscle Relaxants or Sedatives With Opioids To Treat Hip Joint Pain?

Muscle relaxant often causes sedation in few patients. Combination of opioids and muscle relaxants or sedatives can be fatal because of severe respiratory depression followed by hypoxia (low oxygen in blood). Close supervision by an experienced physician is necessary until therapeutic effective dosage with minimum or no side effects is established.

Why Is Cognitive Symptom Such As Depression Observed In Hip Joint Disease?

Depression is a personality disorder and often seen in chronic pain. Following triggering factors may cause depression in patient’s suffering with chronic pain.

  • Restriction of activities because of pain.
  • Continuous pain not responding to pain medication.
  • Unable to accomplish family obligations.

How Is Anxiety Associated With Hip Joint Disease Treated?

Anxiety is treated with antianxiety medications and psychotherapy. List of antianxiety medications effective in treatment of anxiety disorder are as follows:

  • Xanax
  • Ativan
  • Diazepam
  • Clonazepam

What Is The Goal Of Physical Therapy (PT) To Treat Hip Joint Pain?

Physical therapy is prescribed for following outcome-

  • Treating pain.
  • Treating muscle spasm.
  • Strengthening muscle tone and power.
  • Improving muscle and joint coordination.

What is Interventional Pain Management for Hip Joint Pain?

Interventional therapy for hip pain includes cortisone injection, nerve ablation and placement of spinal cord stimulator or intrathecal catheter to deliver opioid medications in cerebrospinal fluid. Most of the diseases causing hip joint pain are treated with cortisone injection only. Other options are often not needed since surgical treatment has favorable outcome.

Describe The Surgical Treatment Options For Hip Joint Pain?

Surgical treatment is indicated when patient is suffering from irreversible hip joint structural damage. Surgery is performed to reduce pain and restore the joint function. Following surgical treatments are often performed in hip joint diseases causing hip pain.

  • Hip joint arthroscopy.
  • Partial hip joint replacement.
  • Instrumentation- rod placement, screw and plate placement.
  • Total joint replacement.
  • Tendon repair.
  • Hip resurfacing.

What is Hip Joint Arthroscopy?

Hip joint arthroscopy is very safe procedure. Procedure is performed under local anesthesia or sedation depending on patient’s pain tolerance and apprehension. Sedations are very safe with intense monitoring and efficient short acting medications. Indications for procedure are as follows-

  • Diagnosis: Arthritis, fracture of joint capsule or cartilage.
  • Therapeutic: Removal of fragments of capsule or cartilages within the joint, which is the cause of intense pain with joint movements.

Watch 3D Video of Hip Joint Diagnostic Arthroscopy For Hip Pain

How Safe Is Hip Joint Surgery?

Partial or total hip joint replacement and instrumentation for fracture of neck of femur are the most advanced researched equipment inserted in human body. Several thousands of hip joint replacement surgeries and repair of fractured neck of femur are performed every year over last 15 years. The technique of surgery and quality of equipment are improvised every year. Complications such as infections and malfunction of the artificial joint are very rarely seen in recent years.

Guidelines for surgical procedure, anesthesia and recovery are very well documented and has shown extremely satisfactory outcome. Patients are discharged same day if pain tolerance is satisfactory or kept in hospital or outpatient observation room for 23 hours until pain is control by dosage adjustment of pain medication.

What Is Tendon Reconstruction Surgery for Hip Joint Pain?

Ruptured tendon is one of the causes of severe hip joint pain. Ruptured tendon may heal with time causing severe scarring of tendon and continuous pain with hip joint movement. Pain is often difficult to treat with medications and conservative treatment. The diagnosis of ruptured tendon involves MRI studies and ultrasound examinations of tendon. Surgery involves exposure of the end of tendon, which is ruptured and attachment to the part of the bones of hip joint. Since there are not many major blood vessels and vital organs, complications are very rare.

What Is Hip Resurfacing Surgery?

Hip resurfacing surgery is an advanced technique that replaces the total hip joint replacement surgery. The surface of the head of the femur and acetabulum is replaced and covered with cobalt metal cap. Advantage of surgery is part of the head and neck of femur left intact and disadvantage is weak neck of the femur may fracture over the following few years. Most of the surgeons will choose patients for this surgery after careful evaluation.


Also Read:

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:July 3, 2019

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