Dr. Roach: Couch potato seeks assistance for all-over arthritis pain

Keith Roach
To Your Health
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Dear Dr. Roach: I am a 72-year-old male disabled veteran. I started work out of high school in a factory where I did hard but not brutal work. Then went to Vietnam, where I injured my knee and had to be operated on. Next, I worked for an airline as a baggage handler then became a licensed aircraft mechanic, both of which were hard physical labor.

I have had one knee and one hip replaced, which was brutal and only slightly successful painwise. I now find myself with arthritis in most of my joints. My feet, knees, hips and back keep me from being active at all. I take 90 mg of narcotics per day from the Veterans Affairs doctor, which does not help very much but the pain is very bad when I forget to take them. I have had various shots in my knees and hips with diminishing results, acupuncture, physical therapy, etc., all to no avail.

My pain has turned me into a couch potato. This is very bad for my mental health. I try not to constantly complain to my wife. She helps me the best she can, but no one wants to be with someone who never leaves the couch. I heard about a new drug called tanezumab and that its clinical trials were canceled because it “worked too well.” Any advice?

Dear Anon: Tanezumab is a novel drug and represents a potential new treatment for pain from osteoarthritis. It is a monoclonal antibody against nerve growth factor. There have been 39 trials on tanezumab, including promising trials showing reduction of pain and improvement of activity.

From a drug company perspective, there’s no such thing as a drug working “too well.” The most recent news I saw was that the Food and Drug Administration was planning to make a decision as soon as December 2020. It’s possible a decision will be made while this column is in press.

Other advice I would give is that being a “couch potato” is just not good for osteoarthritis. Regular exercise of any kind helps reduce pain. I do understand you are in terrible pain and on opiates, but any kind of movement will help.

Being in a pool is one activity that virtually all of my patients with severe osteoarthritis can tolerate. You might check on what is available in your area. With so many joints affected, surgery may not be practical, but still ask your doctors at the VA their opinion on whether joint replacement surgery is worth considering.

Dear Dr. Roach: My daughter had chickenpox at age 2-3 years and then had shingles at age 5. She is currently 27 years old. Do you recommend that she have a shingles vaccine?

Anon.

Dear Anon.: It is quite unusual to get shingles so early in life, but there are cases reported as early as 3 years old. The incidence of shingles goes up throughout life, with a significant increase at age 50. For this reason, the new shingles vaccine is recommended to be given at 50. Between 1% and 6% of people will get shingles twice, but three or more times is quite rare.

The new shingles vaccine appears to confer long-lasting immunity, but it is not known whether it would last the 60 or more years of expected life your daughter has. Most importantly, the risk of complications from shingles is much higher in those over age 60. I would recommend she wait to get the vaccine until age 50. It is untested in and not approved for younger ages.

Readers may email questions to ToYourGoodHealth@med.cornell.edu

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