Chronic Hip Pain

What is chronic hip pain?

Hip pain is common, particularly as people grow older. Sometimes, it occurs in an acute manner, such as when someone falls and has a hip fracture. Other times, it comes and goes, such as when people have bursitis. Sometimes, it lasts longer and can become chronic.

The most common cause of chronic hip pain is osteoarthritis. Osteoarthritis is a common form of arthritis. It is a pain condition marked by inflammation of the joints. The inflammation causes pain, swelling, and stiffness.

Osteoarthritis might best be considered the result of general wear and tear. It can occur from injuries, overuse, and age. It results from a loss of cartilage, which ordinarily provides cushioning for the bones in the joints. The loss of cartilage causes inflammation when the hip joint is used. In turn, the inflammation leads to pain, swelling, and stiffness.

Is there a cure for chronic hip pain?

When due to osteoarthritis, hip pain is a chronic condition. Typically, chronic health conditions are also conditions that have no cure and last indefinitely.

Therapies & Procedures for chronic hip pain

In the absence of a cure, patients and their healthcare providers typically pursue therapies with the goals of reducing pain and its impact on the patient's life. In our healthcare system, patients can commonly get many different therapies and procedures for chronic hip pain. Common treatments are anti-inflammatory medications, physical therapy, cortisone injections, hip replacement surgery, and chronic pain rehabilitation programs.

Anti-inflammatory medications

Anti-inflammatory medications are likely the most commonly used medication for chronic hip pain. Anti-inflammatory medications (as well as acetaminophen) have been shown to be mildly effective in reducing the pain of osteoarthritis.1, 2 

Physical therapy

Physical therapy is also commonly used. Physical therapy is proven beneficial in reducing pain for osteoarthritis of the hip.3 

Cortisone injections

Many patients also try cortisone injections for hip pain. Kruse4 reviewed four clinical trials of cortisone injections for osteoarthritic hip pain. Three out of the four trials showed that cortisone injections were able temporarily reduce pain at the two to three month follow-up periods.

Total Hip Replacement Surgery

For a select group of patients with chronic hip pain, total hip replacement is a surgical procedure that can substantially reduce pain. The procedure is also called total hip arthroplasty. It involves removing portions of the hip bones and replacing them with artificial components to form an artificial hip joint.

Conventionally, in healthcare, total hip replacement surgery is thought of as an effective surgery. It is important to note, however, that being effective does not necessarily mean curative. Total hip replacement tends to reduce pain but on average patients tend to continue having pain.5 

In a long-term follow-up study of outcomes more than three years after obtaining a total hip replacement, a third of patients had no reduction in pain or even worse pain. Now, of course, two-thirds of patients who received total hip replacement surgery did improve. However, when compared to a matched group of patients who did not receive total hip replacement, this rate of success did not differ.6 

Rasanen, et al.,7 also found total hip replacement surgeries to be effective on average, but not fully curative.

Chronic pain rehabilitation programs

Chronic pain rehabilitation programs are also a common therapy for patients with chronic hip pain. They are not a cure, but rather help patients to live well despite having chronic pain of a osteoarthritic hip. Chronic pain rehabilitation programs focus on reducing pain, returning to work or other life activities, reducing the use of pain medications, and reducing the need for obtaining healthcare services. It is an intensive, interdisciplinary approach that combines lifestyle changes, coping skills training, and medication management. Research consistently shows that for the goals of reducing pain, returning to work, and reducing the need for pain medications, these programs are highly effective for patients with chronic pain in general.8, 9 (Gatchel & Okifuji, 2006; Turk, 2002).

References

1. Bradley, J. D., Brandt, K. D., Katz, B. P., Kalasinski, L. A., & Ryan, S. I. (1991). Comparison of anti-inflammatory dose of ibuprofen, an analgesic dose of ibuprofen, and acetaminophen in the treatment of patients with osteoarthritis of the knee. New England Journal of Medicine, 325, 87-91.

2. Bjordal, J. M., Ljunggren, A. E., Klovning, A., & Slordal, L. (2004). Non-steroidal anti-inflammatory drugs, including cyclo-oxygenase-2 inhibitors, in osteoarthritic knee pain: Meta-analysis of randomized, placebo-controlled trials. British Medical Journal, 329, 1317-1323.

3. Hernandez-Molina, G., Reichenbach, S., Zhang, B., Lavalley, M., Felson, D. T. (2008). Effect of therapeutic exercise on hip osteoarthritis pain: Results of a meta-analysis. Arthritis Care & Research, 59, 1221-1228.

4. Kruse, D. W. (2008). Intraarticular cortisone injection for osteoarthritis of the hip: Is it effective? Is it safe? Current Review of Musculoskeletal Medicine, 1, 227-233.

5. Fortin, P. R., et al. (1999). Outcomes of total hip and knee replacement: Preoperative functional status predicts outcomes at six months after surgery. Arthritis & Rheumatism, 42, 1722-1728.

6. Nilsdotter, A. K., Petersson, I. F., Roos, E. M., & Lohmander, L. S. Predictors of patient relevant outcome after total hip replacement for osteoarthritis: A prospective study. Annals of Rheumatic Diseases, 62, 923-930.

7. Rasanen, P., Paavolainen, P., Sintonen, H., Koivisto, A. M., Blom, M., Ryynanen, O. P., & Roine, R. P. (2007). Effectiveness of hip or knee replacement surgery in terms of quality-adjusted life years and costs. Acta Orthopaedica, 78, 108-115.

8. Gatchel, R., J., & Okifuji, A. (2006). Evidence-based scientific data documenting the treatment and cost-effectiveness of comprehensive pain programs for chronic non-malignant pain. Journal of Pain, 7, 779-793.

9. Turk, D. C. (2002). Clinical effectiveness and cost-effectiveness of treatments for patients with chronic pain. The Clinical Journal of Pain, 18, 355-365.

 

Date of publication: April 27, 2012

Date of last modification: October 23, 2015

Murray J. McAllister, PsyD, is the executive director of the Institute for Chronic Pain (ICP). The ICP is an educational and public policy think tank. Its mission is to lead the field in making pain management more empirically supported. Additionally, the ICP provides Academic quality information on chronic pain that is approachable to patients and their families. Dr. McAllister is also the clinical director of pain services for Courage Kenny Rehabilitation Institute (CKRI), part of Allina Health, in Minneapolis, MN. Among other services, CKRI provides chronic pain rehabilitation services on a residential and outpatient basis.

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