Pain in Primary Care

Hip OA: What's the Best First Option?

Charles P. Vega, MD


August 10, 2021

To focus on issues of pain management in primary care, this month I'm presenting a clinical scenario drawn from my own practice. I'll tell you what I plan to do, but I'm most interested in crowdsourcing a response from all of you to collectively determine best practice. So please answer the polling question and contribute your thoughts in the comments, particularly if you disagree with me.

A Painful Hip

You are seeing a 66-year-old woman for a complaint of right hip pain. She has a medical history significant for type 2 diabetes for over 15 years, with albuminuria; chronic kidney disease stage III with an estimated glomerular filtration rate of 47 mL/min; hypertension; obesity; and coronary artery disease with placement of two coronary stents 3 years ago.

The patient's hip has been bothering her for more than 6 months, but she states that "I have just been trying to deal with it." She has used occasional over-the-counter acetaminophen and ibuprofen, both of which have been moderately effective. "But then the pain comes back again," she says. She used to be able to walk for about a half mile, and now she can only walk about a quarter mile due to pain.

The patient's routine medications include metformin 1000 mg twice daily, dulaglutide 0.75 mg weekly, lisinopril 40 mg daily, amlodipine 5 mg daily, atorvastatin 80 mg daily, and aspirin 81 mg daily.

Physical exam reveals that the range of motion of her right hip is reduced by about 10%. She is tender over the hip joint. An x-ray confirms osteoarthritis (OA) of the right hip.


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