DEAR DR. ROACH: I was diagnosed with multiple sclerosis three years ago, and I seem to have the worst, most aggressive type of the disease. I receive IV steroid treatment and prednisone that relieves my leg pain, but the relief lasts only a month. I have to limit my activities, which has significantly changed my mood and outlook toward life. My MS doctor has prescribed a myriad of drugs for depression, inflammation and pain, most of which I refused because I do not want to live under the vice of a hundred pills a day. The one pain medication I agreed to try was morphine. This allowed me to go about my daily activities almost the way I lived my life before the MS. The problem is my doctor refuses to continue to prescribe painkillers, saying she doesn’t want to further complicate the constipation most people with MS deal with. I am willing to take any medication necessary for constipation, but she won’t budge. Should I deal with the pain, or change doctors? — J.D.

ANSWER: Treatment of non-cancer pain with powerful narcotics like morphine is a big issue right now in the medical community, with some advocating never doing so at all, under any circumstances. I understand your doctor’s concern about constipation, which indeed can be a difficult problem for MS patients even without narcotics. However, I see your point as well that constipation can be treated, and it sounds as though the morphine has done very well for you.

This is the perfect situation for a consultation with a pain specialist. Pain specialists have expertise in managing different kinds of pain as well as complications of their side effects. That leaves your MS doctor to deal with your MS. I would recommend talking to your MS doctor about consultation with a pain-management specialist.

DEAR DR. ROACH: In your opinion, which exercise is better — biking or walking? Specifically, which burns more calories? — W.B.

ANSWER: Any kind of exercise is better than no exercise, and I recommend people do whatever kind of exercise they like and that is comfortable for them. Walking is great because it takes no special equipment, can be done virtually anywhere and doesn’t put excess stress on the joints.

Biking is great, too, because it puts even less stress on the joints, although it may not help the bones stay as strong as does walking or, better yet, jogging. However, biking can be done at any level of intensity, from a low-intensity pedal around the neighborhood, to maximum-intensity bike racing. Changing up your exercises is a great idea too.

If you weigh 130 pounds, walking can burn off 120-350 calories an hour. A slow bike ride might burn 240 calories an hour, but a trained bike racer might burn off 1,000 calories per hour!

TO READERS: Questions about the common problem of uterine fibroids are answered in the booklet of that name. To obtain a copy, write: Dr. Roach — No. 1106, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

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 or mail questions to P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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