What are the treatment options for burning pain in the hip?

Treatment of Burning Hip Pain

For burning hip pain, begin with oral NSAIDs (such as naproxen 375-500mg twice daily) combined with physical therapy as first-line treatment, while obtaining plain radiographs of the hip and pelvis to guide further management. 1, 2, 3

Initial Diagnostic Approach

• Obtain plain radiographs of the hip and pelvis immediately as the first imaging study before any additional interventions, as this guides all subsequent management decisions and can identify osteoarthritis, fractures, or structural abnormalities 1, 2

• The burning quality of pain may suggest nerve involvement (such as meralgia paresthetica or lumbar radiculopathy), intra-articular pathology, or inflammatory conditions, so careful localization is critical 4, 5

• Determine pain location: anterior (groin) pain suggests intra-articular causes like labral tears or osteoarthritis; lateral pain suggests greater trochanteric pain syndrome; posterior pain may indicate referred lumbar spine pathology or deep gluteal syndrome 4, 6, 5

First-Line Pharmacologic Treatment

• Start oral NSAIDs when not contraindicated - these are strongly recommended for symptomatic hip osteoarthritis with well-established pain-relieving benefits 1, 3

• Naproxen 375-500mg twice daily with food is effective and has been shown comparable to other NSAIDs in controlling hip pain, with less frequent gastrointestinal side effects than aspirin or indomethacin 1, 7

• Add scheduled acetaminophen 1000mg every 6-8 hours as adjunctive therapy, which provides additive analgesia when combined with NSAIDs and has a favorable safety profile 1, 2, 3

• For knee pain specifically (not hip), topical NSAIDs like diclofenac are strongly recommended as first-line treatment with fewer gastrointestinal adverse events, though evidence for hip pain is insufficient due to joint depth 1, 3

Essential Non-Pharmacologic Interventions

• Refer to physical therapy immediately - this is the cornerstone of management and must be implemented as part of comprehensive treatment, with a minimum of 12 supervised sessions showing superior outcomes 1, 3

• PT should focus on hip strengthening, range of motion exercises, and functional task performance for at least 3 months for optimal benefit 1, 2

• Recommend structured self-management programs combining exercise therapy with patient education 1, 3

• For overweight patients, prescribe weight loss programs with structured goals of 4-7kg reduction through weekly supervised sessions 3

• Consider Tai chi as a strongly recommended mind-body intervention that combines meditation with gentle movements for both hip and knee osteoarthritis 3

Second-Line Options When First-Line Treatment Fails

• Add duloxetine 30-60mg daily as alternative or adjunctive therapy when NSAIDs and acetaminophen provide inadequate relief, particularly given its efficacy for osteoarthritis pain 2, 3

• Consider intra-articular corticosteroid injection if radiographs confirm osteoarthritis and oral medications are insufficient - this provides both diagnostic information and therapeutic benefit lasting weeks to months 2, 3

• Hip injections require ultrasound or fluoroscopic guidance for accuracy, unlike knee injections 3

• Avoid injections within 3 months of planned joint replacement surgery 3

• Diagnostic joint injections with anesthetic can confirm intra-articular etiology of pain (such as labral tears) and are safe, useful tools 1

Advanced Imaging Indications

• Order MRI after radiographs if plain films are negative or equivocal and symptoms persist, as MRI is the best test to screen for significant hip pathology including labral tears, cartilage damage, or soft tissue injuries 1

• MR arthrography provides superior delineation of labral tears and articular cartilage compared to standard MRI 1

• Ultrasound has limited utility for hip evaluation due to inability to visualize acetabular or femoral head cartilage adequately, though it can identify effusions and guide injections 1

Critical Pitfalls to Avoid

• Never initiate opioids for hip osteoarthritis pain - they have a poor risk-benefit ratio, may be no better than acetaminophen alone, are inferior to NSAIDs, and cause more side effects and treatment cessation 1, 2

• Do not prescribe glucosamine, chondroitin, or hyaluronic acid for hip pain due to insufficient evidence of benefit 1, 2

• Do not combine NSAIDs with aspirin as this increases excretion of the NSAID and results in higher frequency of adverse events without demonstrated additional benefit 7

• Monitor for NSAID cardiovascular and gastrointestinal risks, particularly in older patients, those on anticoagulants or corticosteroids, and with longer duration of use 1, 7

• Consider adding proton pump inhibitors or switching to COX-2 selective inhibitors in patients at high gastrointestinal bleeding risk, though these strategies are more expensive 1

Surgical Referral Criteria

• Refer for surgical consultation when there is end-stage osteoarthritis with minimal/no joint space on weight-bearing radiographs, or inability to cope with pain after exhausting all appropriate conservative options 3

• For younger patients with focal chondral injuries, labral tears, or femoroacetabular impingement, early referral may improve outcomes as these conditions typically have good surgical results 1