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Dear dr Roche: I’m 68 and have osteoarthritis all over — neck, spine, hips, knees, shoulders, hands — and all are getting worse. One hip was replaced two years ago, and my shoulder was replaced four months ago. Four years ago, X-rays showed arthritis in my spine and severe stenosis in lower lumbar (L4-L5). I’m at the point now where I can’t walk right, and it is affecting my relatively new hip.

I would like to see a back specialist, but I’m not sure who to see. A back surgeon will try to talk me into surgery and may not provide me with nonsurgical options. A chiropractor may cost me lots of money without solving any problems. Which is the most cost—and time—effective route to take? I’m really in pain.

— S.S

Dear SS: The bad news first: We have no treatments that reverse, stop or even slow down the progression of osteoarthritis.

The good news is that there are some treatments, both surgical and nonsurgical, which may be able to provide you with relief. Before I go into those, let me assure you that there are many back surgeons, both orthopedic surgeons and neurosurgeons, who are very slow to operate and who only do so when other treatments have failed to provide adequate relief or when there is a clear indication for surgery, such as weakness that is progressive due to compression of the spinal cord or a nerve root. I know this because those are the surgeons I like to refer my patients to.

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