Doc: Therapy needed for pubic bones inflammation

Keith Roach
To Your Health

Dear Dr. Roach: For a year now, I have had such terrible pain in my pubic area and down my inner thighs. An X-ray (for another problem) showed that I have osteitis pubis. I have read about it online and found that there is no real treatment for it. My doctor prescribed hydrocodone with acetaminophen for me for a trip I recently took, and I couldn’t see that it really helped. Tylenol has helped some, in that it helped me relax. Sometimes when it really flares up, I have trouble walking because of the pain, and I feel that people may think I am drunk. I am 84 years old. Can you tell me and others what you know about it, please?

M.B.

Dear M.B.: The pubic bones are fused together in the front by connective tissue, called the “pubic symphysis.” When this area gets inflamed, it is called “osteitis pubis.” It is most common in athletes; however, arthritis of the hip is a known risk factor, and I read one case report of a 78-year-old woman who had this condition, apparently as a result of a urinary tract infection.

Although pain medication may be necessary, the primary treatment, after ice and rest, is physical therapy. Injection of an anti-inflammatory is recommended in some cases, and powerful anti-inflammatory medicines are used for people who still don’t respond. Opiates, such as the hydrocodone you were prescribed, are not good as long-term treatment for pain; the body has a mechanism for regulating the pain receptors blocked by opiates, and most people do not get a good response that lasts very long. I’ve never seen surgery required, but there are reports of people getting better after surgery when all other treatments fail.

A sports-medicine doctor, orthopedic surgeon or rheumatologist is likely to have the most experience with this uncommon condition, and I’d recommend that you consider a referral.

Dear Dr. Roach: I recently had a parathyroidectomy to cure my hyperparathyroidism, so I was interested in one of your recent columns. The writer mentioned that he or she had normal calcium levels, but didn’t state the levels or his or her age. Normal calcium levels are lower as you get older, but labs may give a range that is not adjusted for age, and may list high levels as “normal” for older patients. In my case, the lab labeled my levels as “normal” even though they were 10.7 and I am in my 50s. (An adult my age should have calcium levels below 10.) This delayed my treatment. I wanted to be sure you were aware of this problem with labs so you could inform other doctors and patients. Hopefully, others won’t have to suffer the way I did.

K.E.

Dear K.E.: Blood calcium level does change throughout life; however, it’s really only in the teenage years and the 20s that calcium levels normally get above 10. For people 30 and older, a blood calcium level above 10 should raise suspicion of elevated parathyroid hormone. A blood level evaluation of the hormone answers the question nearly always, but the ordering provider needs to consider the diagnosis in order to check the lab results.

Many people with elevated calcium due to hyperparathyroidism have no symptoms and might not need treatment. It sounds like you had symptoms, the most common of which include abdominal pain, kidney stones and depression. Subtle symptoms such as fatigue, weakness, poor appetite or just frequently missing work may be unrecognized or just assumed to be due to age.

I appreciate your writing.

Email questions to ToYourGoodHealth@med.cornell.edu.