Pain in the hips is keeping reader up at night

Ask Dr. Keith Roach M.D

Pain in the hips is keeping reader up at night

DEAR DR. ROACH: I am a senior, have exercised regularly for years, walking 2 or more miles a day. I am in good health, take no medication but for thyroid, and have no weight problem. Very recently I have developed pain in my hips, mostly in my left hip. The pain is a burning sensation, and it occurs predominately when I sit or rise from a sitting position and when I lie down. I am able to go to sleep at night but am awakened by pain in my hips and throbbing in my legs. I cannot find a position that is comfortable. I get partial relief from acetaminophen or naproxen at night. The pain always makes me eager to get out of bed in the morning. What I don't understand is that I do not have pain in my daily activities, and walking is not at all painful. There is a sore spot that I can detect on the side of my upper leg at the hip area. Am I worsening a condition by continuing to walk? I keep hoping this will go away. — F.H.

ANSWER: This sounds very much like a case of greater trochanteric pain syndrome (formerly called trochanteric bursitis). This happens often in people who walk a lot, like you do, and in people who are overweight or who have a mechanical problem in the knee, hip or back. It seems to be caused by damage to the tendons of the gluteus muscles.

Many general doctors are familiar with and comfortable treating this condition, but the experts are the orthopedic surgeons, sports medicine and rehabilitation medicine doctors. It can be diagnosed by a careful physical exam.

Initial treatment is pain relief and instructions on proper exercise and sitting position. You'll be evaluated for conditions that might be exacerbating the condition, such as leg-length discrepancy. If the initial treatment doesn't work (and it often doesn't), then an injection of steroid into the bursa speeds recovery. With injection, about 60 percent of people with this condition recover within six months. Without treatment, the condition may last one to two years. Cases that last longer than a year should be evaluated for other conditions, especially a gluteus medius tear, which may require surgical repair.

DEAR DR. ROACH: My doctor says that I have high blood levels of vitamins B-6 and B12. I take no vitamins or supplements. The B vitamin levels have been elevated for about two years.

I have tingling in my hands and feet with foot pain. What could be causing this, and how do you bring the levels down? Are there any tests that can help to find the cause? — G.D.

ANSWER: High levels of B vitamins are occasionally seen in people taking large amounts of supplements, but the body is very good at excreting excess amounts.

I found several case studies of people with neuropathy ('neuropathy' just means 'nerve damage,' and there are many causes; a classic symptom of neuropathy is a tingling or burning sensation) related to high levels of B-6, almost all of whom were taking large doses, either by vitamin tablets or supplemented energy drinks. However, some people had high levels despite no supplements, and it is hypothesized that there might be a mutation leading to a problem in B-6 metabolism. The only advice I have is to avoid foods high in B-6 (a list is at http://1.usa.gov/1PxyC3u) and read labels carefully to avoid foods fortified with B-6.

The B-12 level you have is not associated with neuropathy as far as I can find, so I think it's the B-6. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell. edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.