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Pain mgmt for frozen shoulder
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jocisne1 posted:
After about 2 months of discomfort and a couple of weeks of severe pain, I saw my orthopedic surgeon who diagnosed me with frozen shoulder. When I saw him that day, I was at my wits end and in the worst pain of my life. He gave me a cortisone shot and prescribed PT. He would not give me any pain medication and told me to use Tylenol or Ibuprofen. Many of you who have had frozen shoulder know that neither of these meds help.

He had me wait one week after the shot to start PT. The cortisone helped somewhat. It basically took the edge off and I no longer feel like I want to cut my arm off, but I am still very uncomfortable and can't sleep at night. I started PT yesterday.

I am not scheduled to go back to see him for another 2 1/2 weeks, but I am desperate for some type of pain relief. I simply cannot bear the pain and I am making a lot of mistakes at work because I am so distracted by the pain. I know I have a high pain tolerance because other physicians have told me so. I have recovered from knee surgery and gall bladder surgery without pain medication of any kind. This doctor is very reluctant to prescribe any pain meds, but I think I have a right to some kind of pain relief. I don't know whether to go back to him before the 2 1/2 weeks is up and try to talk with him, or seek another doctor who understands the pain of this condition. This particular doctor specializes in treating professional athletes, and I feel like to him, I am just a middle-aged woman complaining of some superficial condition that I should be able to tolerate until it decides to remedy itself.

Thoughts/opinions appreciated. Thank you!
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_swank_ responded:
Go see another orthopedic surgeon or perhaps even your family doctor. If necessary, get a referral to a pain management doctor. When I was diagnosed with this my ortho doc said he was going to treat it with pain killers for however long it took. He fully understood the amount of pain it caused. If your ortho has already told you he wasn't going to treat your pain there's not a whole lot of reasons to go back and see him. There's not a whole lot else that can be done other than to wait it out.
 
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An_239394 responded:
I use Tramadol with EITHER ibuprofen, naproxen or acetaminophen. I rotate the 3 with the Tramadol from day to day and some days they DO NOT help. I also use Tiger Balm patches and the balm itself. I was surprised how well it worked. I rotate between it and ice packs every other night or so. I use several pillows for support at night as well...but I still only get about 3 - 4 hours, if that, of sleep. I've also used a heating pad for some relief. I had to stop the PT after the 1st trmt because the PT had rotated/massaged it so bad the first time that I could not function at all the next day. My entire collar bone, front chest area and upper back was so sore that I felt like he had cracked every bone in my upper body. Anyways, I found exercises I could do at home and have been doing them some to keep it moving somewhat. The cortisone didn't help me at all and I've read online in several places that some doctors do not recommend cortisone for frozen shoulder! I wished I would have researched it before getting it, but I was wanting pain relief so I did it w/o 100% checking it out. Anyways, I won't do that again. As for the Tramadol, I've read that it is available online without a RX, but that may be wrong? I use a RX from my doctor, so I don't know if that is accurate or not or if it is legal/illegal to do so...so be sure to check into it closely. Remember though that the Tramadol isn't 100% pain free either...good luck.
 
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_swank_ replied to An_239394's response:
I'm not sure why you would use, and even recommend Tramadol when you make a point to say it "DOES NOT" help. I have always found Tramadol to be totally useless and wouldn't accept it if it was given to me. In my experience, strong narcotics are the only thing that will help frozen shoulder other than time.

It it not legal to buy Tramadol on-line. It is a prescription drug so buying it anywhere (in the USA) is illegal without a doctor's prescription.
 
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Peter Abaci, MD responded:
According to the American Academy of Orthopedic Surgeons, frozen shoulders occur in about 2% of the general population. It most commonly occurs between the ages of 40-60 and is more common in women. It is also called adhesive capsulitis because the capsule around the shoulder joint thickens and gets stiff which makes it difficult for the joint to move. Sometimes the cause are unknown, but it can be associated with other medical conditions like diabetes or thyroid disease.

Most cases gradually improve with the help of PT and regularly stretching and exercising it between sessions. Cortisone injections can help improve motion and reduce the pain when needed. When things don't improve with more conservative treatments, then surgery may sometimes be an option.

Frozen shoulders hurt, and doing the rehabilitation work can be painful, especially in the beginning. Most cases respond well to anti-inflammatory medications. In my experience, some patients respond better to one NSAID while others respond better to another. It makes sense to try more than one particular NSAID if the first one tried has not helped. Before changing doctors, it would be worth talking to him about how you are feeling and see if he is interested in trying other options. His first-line recommendations for you were pretty standard even though they haven't helped reduce the pain, yet, in your case.
 
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jocisne1 replied to Peter Abaci, MD's response:
Update: Well, after 3 weeks of PT, I went back to see my dr. today. I explained that while my range of motion has improved slightly, and he confirmed this, I told him that I still have the chronic 24/7 dull ache that never goes away and I can't take it much longer. He said that what I was describing was unusual. What? I thought a dull ache was a classic symptom of FS? I feel as though he does not understand the extreme pain of FS. He is sending me for an MRI to rule out any tears, etc, but said that he cannot help me beyond that. He said that if the MRI comes back as FS, he will refer me to a pain management doctor at that time.

I neglected to mention in my first post that I cannot take NSAID's because I have a tendency to develop ulcers while taking those types of meds. So, those are out. He still won't give me any pain meds because he is afraid of dependency, and I understand that, but I need help with the pain. Don't they make pain medication for a reason? I'm at my wits end still, cannot function in daily life, and quite frankly, suicidal at times because of the chronic pain. I sleep maybe 2-3 hours a night, and do so with my arm packed in ice and propped on pillows because that it the only thing that gives me some relief.
 
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jocisne1 replied to jocisne1's response:
Oh, and I was wondering what I can expect from the pain management doctor? Thanks!
 
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billyf27 replied to jocisne1's response:
I have frozen shoulders with a lot of pain. But the cause is Thoracic Output Syndrome and other nerve damage. You should check the cause of yours. You need to see a pain management doctor.
 
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Peter Abaci, MD replied to jocisne1's response:
Jocisne,

Thanks for the update. First of all, I would like to complement you on working diligently on progressing the range of motion in your shoulder despite the significant pain that you have for the last three weeks. Thanks for the added information about your inability to take NSAIDS.

One way you can approach your doctor about prescribing stronger pain medications is to come up with a plan that you will both find reasonable. For example, ask to start a stronger medication for a specific period of time, like for example three weeks. During that time period, you can do your part by continuing to make significant progress with your shoulder while taking advantage of the new medications. You can then check in with your doctor after three weeks to re-evaluate your progress. After that, come up with plan for the next three weeks or so, and so on and so on. By making this a time limited commitment, he may feel more comfortable prescribing medications that can be potentially addictive down the road.
 
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jocisne1 replied to Peter Abaci, MD's response:
Well, while waiting for prior auth from the insurance company for my MRI ( which I still have not gotten), I saw a pain mgmt doctor today because I am desperate for some relief. He did nothing for me. He gave me a prescription for Pennsaid, which is a topical NSAID. I just looked it up online, and it has only been approved and found effective for OA of the knees. Plus, even though it is not taken internally, I see that there is a risk of ulcers while using this. So, this is out, and I had told him that I cannot take NSAID's. Completely useless.

He said he agrees with the first doctor's Dx, ( and I agree too, I am not questioning that), and that I should get the MRI and decide what to do from there. Well, I am positive that that MRI will show FS, and if it does, my first doctor already has said that he cannot do anything more for me, and was only going to refer me to a pain dr, who I have now already seen.

I can't understand the reluctance of these dr's to help me by giving me some pain medication. I have been compliant in everything that they have asked me to do. I don't have a history of substance abuse or addiction, am on no current meds for any conditions, and sometimes wait out a headache instead of taking Tylenol. I am not drug seeking, but I am looking for help with pain.

At this point, I have given up any hope that anyone will help me. I told my husband that if he finds me trying to cut off my arm, he knows why. And it is not inexpensive for me to see each doctor. I have insurance where I must meet a $3,200 deductible before insurance kicks in. Today I paid $137 for no help. I have paid my other doctor $340 so far. And each time I go to physical therapy, it costs me $78 and I have gone six times already.

I guess I will just wait for my FS to go away on its own. I don't see any other choice at this point. I had so much hope that I would get some type of help today, but now I just feel defeated and depressed. I am so angry at the medical community right now.
 
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annette030 replied to jocisne1's response:
I am sorry you are having such a hard time. Please remember that there are several different kinds of pain management doctor, see an earlier post about a person who did find the right kind for her.

Only one pain management doctor has been of little use to you, try seeing a comprehensive type that uses many different kinds of treatments, including oral meds and opiates.

I wish doctors understood more about the financial end of medicine but they do not.

Take care, Annette
 
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sandys1mom replied to jocisne1's response:
I know exactly how you feel. I injured my right arm at work. Overuse syndrome with an initial dx of carpal tunnel and shoulder impingement. The first surgeon said when he went in my shoulder was a mess. I had a sinking feeling that he screwed up, he did. That was in 2005.

My first PM M.D. abruptly closed his practice. Thank god because he was no help at all. He wanted to put me on a bunch of medicines, I declined, this made him angry and argumentative with me. My current PM M.D. is a GOD SEND. He dx me with Complex Reginal Pain Syndrome. This I acquired from the original surgeon who did my shoulder and two carpal tunnel surgeries. After still being in pain and a second surgery, an MRI Arthrogram revealed a Labral tear.

After being ignored by top M.D's here in Southern Ca., I found an excellent surgeon w/help of my PM M.D. at USC. He solved my problem in 15 minuets. He injected my shoulder with Lidocaine instead of Cortisone. Because of the previous surgeries and Cervical Ganglion Blocks I went through. He dx me with a neuroma.

He went in surgicaly, fixed the impingement from the previous botched two surgeries, fixed the labral tear and removed two neuromas. My physical therpaist had never heard of neuromas causing so much pain. But saw the immediate improvement in my condition.

Then I had the same Ortho figure out why I was having so much pain in my elbow and upper arms that prevented me from driving, holding a book for more than 15 minuets, writing or typing etc... He did the same diagnostic injection with my elbow. This time I had immediate relief of all symptoms except my CRPS.

He just did an Arthroscopy of my elbow and synovectomy. Although I have not tried to drive yet, I am grateful to him. I have two feelings, one of relief and of utter confusion. My initial injury was in March 2003. I had an AME tell the workers compensation that I was 100%. He stated he did not care how much care I received, it did not make his initial dx of me change.

I am fighting this of course. I have people tell me that I should go to law school beause I fired my work comp attornies and took on the system and my care my self.

The one thing my PM M.D. perscribed was a Ketamine compound 10/10/10. This along with Flector and Lidoderm patches has helped me return to the person I use to be prior to the injuries.

Do not give up! Seek treatment at a hospital that is connected with a major university. They are better equipped because they have the latest technology available to them. More importantly they are teaching future doctors.

My doctor went to UCLA, Harvard and is the Assoc. Prof of Orthopedics at the Keck School of Medicine. I lived in San Diego and moved to Orange County. After my injury,I could not go back to work so I went back to school to complete my studies.

The work comp system bankrupted me. But I have emerged a fighter and I do not take NO for an answer. Today I am almost pain free three weeks post-op. My main goal is to be perscription free in the coming months. I don't want any person to have to go through what I went through to get care.
 
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cteee replied to sandys1mom's response:
I have been suffering from the excruciating pain of frozen shoulder for 4 months. I waited to seek medical help because my insurance plan was changing with the new year, and I didn't want to 'pour money down the drain". I am having an Xray and injection MRI this week, then will be seeing an orthapedic surgeon who specializes in shoulders. The PA I saw also works in an orthapedic surgery clinic, and believes that I will probably need to be anesthetized to move the shoulder, then will immediately need to start physical therapy. He said it will be very painful. I don't think I can handle it. Even though I have non-stop burning pain in my shoulder, which spreads in different directions from day to day, can't sleep, and then have the blinding 'event' pain when I move the wrong direction. Has anyone just tolerated this until it goes away on its own? I've read it can just resolve itself in 1-3 years.
 
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billyf27 replied to cteee's response:
You can have an ultrasound which will show tears, swelling, and any nerve injuries. I have had a frozen shoulder for 4 years but its because of numerous problems especially nerve injuries. I also get injections which help a lot.
 
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cteee replied to billyf27's response:
billyf27,
Has your pain diminished at all? I have to admit that I used to think I had a high tolerance for pain (did natural childbirth ...) but now I realize I don't. This shoulder pain is a whole new dimension of pain. I find I can't volunteer for it. I'm about to cancel my 'arthroscopic MRI' because I was informed I need a driver for the appointment, because of the pain and possible complications. I also can't bear the thought of physical therapy. I told my husband I'd rather play Russian Roulette and chance the pain rather than guarantee it with therapy.
Anyone else a weenie like me?


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