Non-narcotic treatment for shoulder pain?

[SP1!]

Dr Steve,

Another shoulder/rotator cuff question, I have had two surgeries in 4 year on my shoulder, one a cuff re-attachment/burr clean up and the second was further clean up and labrum repair/clean up. Problem is I am still in pain, advil doesnt touch the chronic pain I have and if I do any physical labor I can barely move my arm and I feel I may have been taking way too many of the advil and I am scared those could hurt me longterm.

I have went back gotten some meloxicam to try to control the swelling and hydrocodone for the pain, the biggest question I have is what are the most common problems that are seen after those surgeries and what other options do I have for long term pain?

I dont want to feel like a drug addict going back for the hydrocodone but those seem to be the only things that get rid of the pain, maybe there are other natural substances that could be used to help joint issues?

Im just sick of the pain and the aches every morning and Im not sure I want to let this doctor cut me back open my shoulder again.

[Dr Steve]

Dr Steve,

Another shoulder/rotator cuff question, I have had two surgeries in 4 year on my shoulder, one a cuff re-attachment/burr clean up and the second was further clean up and labrum repair/clean up. Problem is I am still in pain, advil doesnt touch the chronic pain I have and if I do any physical labor I can barely move my arm and I feel I may have been taking way too many of the advil and I am scared those could hurt me longterm.

I have went back gotten some meloxicam to try to control the swelling and hydrocodone for the pain, the biggest question I have is what are the most common problems that are seen after those surgeries and what other options do I have for long term pain?

I dont want to feel like a drug addict going back for the hydrocodone but those seem to be the only things that get rid of the pain, maybe there are other natural substances that could be used to help joint issues?

Im just sick of the pain and the aches every morning and Im not sure I want to let this doctor cut me back open my shoulder again.

Sorry to have taken so long to get back to you...I was hoping PA John would pick this one up as his specialty is orthopedics.

Any time the shoulder is opened up, inflammation can affect it, with some scarring and other changes that can result in pain. I don't know if further surgery is in your future, but I'd definitely discuss it with your orthopedist (or even get a second opinion...it never hurts just to talk to someone).

There are some things you could try for the pain that don't involve more narcotics or surgery:

1) Glucosamine Sulfate
All kinds of studies have shown that this previously "alternative" treatment is very effective for joint arthritis and pain. If you try it, clear it with your doctor, but DON'T buy the Glucosamine/Chondroitin combination capsules. Chondroitin has never been shown to work, and buying the combo drives the price up 400% or more. Plain ol' glucosamine is dirt cheap, and most people recommend taking 1500mg per day to start.


2) Acupuncture
Seriously. Acupuncture done by someone who actually went to chinese medical school and learned this properly has been shown to be effective for chronic pain. You may have to search around to find someone who didn't just take a 2 week course somewhere, but it may be worth it.


3) physical therapy
physical therapists have all kinds of cool machines and treatments they can use to alleviate pain. if you haven't been in awhile, try one out.


hope this helps. keep us in the loop, willya?


your friend,



steve

[CousinDave]

Avoid the nightshades

[stinkbud]

Acupuncture, physical therapy and nutritional supplementation are all good therapies.

Chiropractic should also be looked into. Chiropractors are traditionally though of as spinal doctors. In reality they are musculoskeletal specialists who treat pain without using medications. I have been working as a chiropractor for nearly ten years and i have had good success in treating shoulder pain over that time.

Get it checked out. Many chiropractors work together with physical therapists and can be very helpful in treating your shoulder.

I have had very good results treating painful and frozen shoulder joints of patients while under general anesthesia. The anesthesia is important because it creates a relaxed state where there is no musclular resistance. Also, adjusting a hot shoulder can be painful as hell. Outside of the pain relievers that are part of the general anesthetic (the center i use administers Fentanyl with the anesthesia, which is a synthetic opioid that is very effective but lasts a very short time), manipulation under anesthesia allows for effective pain relief without narcotic medicine. You can find information about this here (http://www.muatoday.com).

It could be that you are dealing with adhesions in the joint that are part of the natural healing process. It could be something as simple as chronically tight muscles that have gotten worse over the time you have been dealing with your rotator cuff. It could be something else too. You should follow up with your surgeon and get a referral if he/she is comfortable having a chiropractor working with you. Before you get any treatment done, your surgeon should probably order an MRI to get an idea if there is anything that would contraindicate conservative care. Sometimes you just need to get an invasive treatment. Hopefully after two surgeries this isn't the case.

Whatever happens, good luck. Like Dr. Steve said, please keep us posted as how you are doing.

[Dr Steve]

Acupuncture, physical therapy and nutritional supplementation are all good therapies.

Chiropractic should also be looked into. .

agreed, and thanks for mentioning Chiropractic therapy. For certain musculoskeletal conditions, chiropractic has been shown to be effective. I did a search of the medical literature and couldn't find specific evidence for chiropractic therapy in rotator cuff/shoulder injuries, but that doesn't mean it doesn't work.


The thing with all of these is to give them a try; if it works for you, great. If it doesn't, move on to the next thing!


your pal,


steve

[SP1!]

Yeah I have another MRI scheduled next week, all I know is Im not getting cut open again, thats 3-4 months of barely moving my shoulder and gets boring really quick.

I appreciate the response and will ask about alternative treatments.

[drucifer]

I'm not a doctor but amputation seems the best option.

Or suicide.

Thank you,
Dr Ew.

[SP1!]

I'm not a doctor but amputation seems the best option.

Or suicide.

Thank you,
Dr Ew.

Trust me there are days when that would be a better option but considering the fact that your post is entirely trolling in an otherwise serious thread I wont take the advice seriously.

Right now all it seems is that hydrocodone is the only option for pain relief.

[SP1!]

Ok first update, 3rd MRI yesterday(boring) and an arthogram *sp?* which was numbing a bit then injecting a dye into the joint, that really sucked and the numbing wore off way too quickly. I was a little troubled by the doctor(I think he was) doing the arthogram said he saw a tear in the area, again, if I have to go into surgery again I would almost rather cut it off. Lortabs are about the only thing that touches the pain anymore and I am wondering what would be the real harm in using pain killers long term to get rid of the pain?

I am wondering about my surgeon as well, I think he is pretty good and has worked on quite a few athletes and I think he even trained with James Andrews in alabama. Would I be insulting him in getting a second opinion before getting cut open and sitting around for another 5 months?

Also I think I may have injured this when working so I would now get to deal with them for this and I know they wont be thrilled.

[SP1!]

2nd update, good news, its not torn. Still hurts like a bitch though, apparently I have a hole or pin hole partial tear somewhere in my rotator cuff, but the doctor said it should heal up on its own given time to rest, surgery most likely wouldnt help since it would be really hard to find. I dont think I would want to get cut open again anyways.

Thats the main problem, my job entails lifting servers and phone systems up for mounting which way a lot more than the recommended 5lbs, I have to convince my work to try for light duty or time off again for the 3rd time in under 4 years.

[stinkbud]

Great, you won't need surgery. That is amazing news.

Since it is a cuff issue, and not a major tear, you would do well going to either a physical therapist, a physiatrist or a chiropractor. You should definitely be getting ultrasound therapy to the injured muscle. Therapeutic ultrasound is very effective at relieving inflammation and stimulating healing. A PT would be very helpful in rehabbing the cuff and working with exercises. A physiatrist, who is an MD, would be good as far as administering medications (anti-inflammatory steroids and lidocain could be added to ultrasound gel and are very effective as ultrasound waves drive the medicine into the injured tissue, a technique called phonophoresis). Chiropractic can also be helpful as DC's use the same machines as a PT but can work without referral (some states require a primary referral for PT, but since you are under the care of a surgeon that shouldn't be an issue). Any of these methods will contribute greatly to your recovery and will be effective without narcotic pain meds.

Get a recommendation from your surgeon as far as your best course of action.

Also, never be embarrassed to get a second opinion, no matter how good your current doctor is. It is your body and you should make damned sure you know what ALL your options are.

[SP1!]

Great, you won't need surgery. That is amazing news.

Since it is a cuff issue, and not a major tear, you would do well going to either a physical therapist, a physiatrist or a chiropractor. You should definitely be getting ultrasound therapy to the injured muscle. Therapeutic ultrasound is very effective at relieving inflammation and stimulating healing. A PT would be very helpful in rehabbing the cuff and working with exercises. A physiatrist, who is an MD, would be good as far as administering medications (anti-inflammatory steroids and lidocain could be added to ultrasound gel and are very effective as ultrasound waves drive the medicine into the injured tissue, a technique called phonophoresis). Chiropractic can also be helpful as DC's use the same machines as a PT but can work without referral (some states require a primary referral for PT, but since you are under the care of a surgeon that shouldn't be an issue). Any of these methods will contribute greatly to your recovery and will be effective without narcotic pain meds.

Get a recommendation from your surgeon as far as your best course of action.

Also, never be embarrassed to get a second opinion, no matter how good your current doctor is. It is your body and you should make damned sure you know what ALL your options are.

Yeah that would be good but most insurances only cover a few visits before you have to come out of pocket, I really have to check on what my insurance will cover since I have no clue.

I'm glad I wont be needing surgery anymore, I'm tired of not being able to move in the mornings after surgery and people think you are just being lazy when you cant lift anything! I was going to get a second opinion if he had said surgery was needed but I still may get one after I talk to my insurance company.

I guess I am resigned to pain killers now since aleve/advil doesn't even come close to relieving any kind of pain I have.

[Don Stugots]

Acupuncture,

it worked for me.

[SP1!]

it worked for me.

I have no idea where to even think about going for acupuncture down here in atlanta

[stinkbud]

In my experience plenty of plans cover rehabilitation. It may limit you to a physical therapist but they are great options for a healing cuff. If worst comes to worst and the insurance can't cover any good therapy program, you can always check out the Life College clinic in Atlanta. Student chiropractors arent too expensive out of pocket and they appreciate getting patients who need rehab plans.

[Snoogans]

Dr Steve,

Another shoulder/rotator cuff question, I have had two surgeries in 4 year on my shoulder, one a cuff re-attachment/burr clean up and the second was further clean up and labrum repair/clean up. Problem is I am still in pain, advil doesnt touch the chronic pain I have and if I do any physical labor I can barely move my arm and I feel I may have been taking way too many of the advil and I am scared those could hurt me longterm.

I have went back gotten some meloxicam to try to control the swelling and hydrocodone for the pain, the biggest question I have is what are the most common problems that are seen after those surgeries and what other options do I have for long term pain?

I dont want to feel like a drug addict going back for the hydrocodone but those seem to be the only things that get rid of the pain, maybe there are other natural substances that could be used to help joint issues?

Im just sick of the pain and the aches every morning and Im not sure I want to let this doctor cut me back open my shoulder again.

if you are still at the point where vicodins are workin, you need not worry about feelin like a drug addict. Ive been on perc 10's for 2 straight months for some of the shit ive done to myself and comin off them was really not that bad. Ive found when taken for actual pain, they are alot easier to control then just taking them to get fucked up. But you need not worry. I know guys who eat OC 80's like they are fuckin pez

[Dr Steve]

I have no idea where to even think about going for acupuncture down here in atlanta

so glad you don't have to have surgery

and I agree, it's never bad form to ask for a second opinion; most surgeons expect it. It's part of the deal and it's fine. your insurance may indeed not agree, as you said, and it may come out of your pocket (which stinks)...often you can appeal to your insurance company to get them to kick in.

as far as acupuncture, you live in ATLANTA! It's a big city and there'll be a million acupuncturists near you. Now, finding one that's legit may be another thing. My acupuncturist went to a Traditional Chinese Medicine medical school and I have a lot of respect for him. Frankly I don't know enough about acupuncture to tell you how to tell if someone took a 2 week course or whatever. However, word of mouth works for acupuncture as it does for other things. I'd just ask around and see who's around.

Good luck and let me know if there's anything we can do for you!

your pal,


steve