Pain management help needed for 94-year-old’s sacral fracture
BY KEITH ROACH, M.D.
DEAR DR. ROACH: My 94-year-old mother has a sacral fracture, diagnosed after a fall six weeks ago. A CT scan diagnosed the fracture. She was put on Tylenol 3, and when that didn’t help the pain much, they added Advil. This past week she experienced additional pain and can hardly walk. She said her left leg hurt in the groin area. I took her to the emergency room, and they did another CT scan that showed nothing new. They gave her a shot and a pill for pain, prescribed a muscle relaxant and sent her home.
She has to get up every two hours to go to the bathroom, but she says she can’t walk, that it hurts too much. She sits on the walker, and I wheel her to bathroom. Calls to her doctor have not yielded much except to say that they will have home health call. But I haven’t heard from them. It is so frustrating to see her hurting and be unable to help. Do you have any suggestions? — W.E.
ANSWER: There are many different types of sacral fractures. A few require surgical treatment, but the majority of sacral fractures in older adults are due to osteoporosis and are managed medically.
Principles of treatment include getting the person mobile quickly, and this requires appropriate pain management. It sounds like, in her case, the pain has not been controlled well enough to allow her to be mobile. Treating pain in a 94-year-old is tricky because the risk of side effects is higher in a person as old as your mother.
Physical therapy may be the most important therapy, but again, she has to have the pain under control in order to get benefit from PT. Since her regular doctor doesn’t seem to be helping, a consultation with an expert, such as a pain specialist or a rehabilitation specialist, may be of immense benefit. Treatment of the osteoporosis, which she is extremely likely to have, should be strongly considered.
DEAR DR. ROACH: I am a 78-year-old female in relatively good health. My ophthalmologist says I have the beginnings of dry macular degeneration, and recommends I take AREDS-2 Preservision eye vitamin and mineral supplement by Bausch and Lomb twice a day. It claims to be “the only clinically proven formula.” In addition, he would like me to take 600 mg of omega-3 fish oil supplement daily. Is there any scientific evidence demonstrating that these products are beneficial in any way? — L.J.C.
ANSWER: There is good evidence that the AREDS-2 vitamin formulation does reduce the risk of progression of dry age-related macular degeneration. The benefit is significant, but not large: 11 people needed to be treated for seven years to prevent one person from progressing. The more advanced the AMD is, the more important it is to begin treatment. The data on omega-3 are inconsistent, with one small study showing a benefit and other, larger studies showing no benefit. However, it is unlikely to cause harm. One early study also suggested that high-dose statin drugs, the kind used to treat or prevent blockages in the arteries of the heart, may have benefit. These data are so preliminary that I don’t recommend a statin just for AMD at this time.
Dry AMD can sometimes progress to wet AMD, which is treated with injection of medications called VEGF inhibitors into the eye.