Stretched nerves...

[starrla]

I have stretched nerves in my left shoulder region, chest and collar bone area on my left side, the pain goes all the way up just past the left ear, jaw sometimes and the back of my head.  I also have a seperated collarbone - shoulder blade.  My left rotator cuff is partially torn-a level 1 tear.  The pain is so intense.  I was taking vicodine.. and lodine.  They made me drowsy, but didn't touch the pain a lot.  So  the doc switched me to Tramadol.... that helped, but not a lot.  Finally I was put on lidoderm patches... up to 3, 12 hours at a time.  It seems to numb the pain a lot.  I am still uncomfortable, but its not intollerable like it is without it.  The physical therapist gave me a tens unit also.  That helps some too.  Anywho... the physical therapist and my family doctor both told me it might be 6 months before I was better.  Has anyone had this type of injury?  How long did it take?  I am having a lot of trouble working.  I worked 4 days, took 6 off, and have worked the last 2 weeks.  I am in extreame pain by the time I get home and am ineffective at work about half the day.  I teach.  

[Tuckamore]

Thanks for the update. It is appreciated.

I am glad you will see a PMP. Hopefully he/she can provide you with better solutions. We'll be thinking of you and watching for for future updates.

Best of luck to you,
Tuck

[starrla]

I went to my family doctor today.  He said to keep taking the Lyrica and the pain patches.  I am off work through the 30th of September.  The family doctor will monitor progress.  I will go to a pain doctor on Monday... Physical therapy is going well.  Thanks

[Tuckamore]

Lyrica contains no aspirin or tylenol.  

However Lodine is a non-steroidal anti-inflammatory drug (NSAID). It is used to reduce swelling and to treat mild to moderate pain. You should discuss what and if you should take any aspirin type products while you are on this patch with your physician or pharmacist.

Tuck

[starrla]

I am using the lodine patch.  Yesterday was a good day.  I hope today will be too, but I finally slept at midnight, woke at 3.  I always try to stay still and fall back asleep.  By 330 I knew that wasn't happening so I just got up.  I couldn't get comfortable.  I am not using the Tramadol, I don't think I will go back on it.  I will talk to my doctor today about a leave, and my meds.  I can't get into the pain management doctor for a week.  Will write again soon!  Thanks to all of you for your help and input.  I am going to ask my doctor about the Voltaren,  My sister told me yesterday not to take to many asprin based or Tylonol based meds for fear of kidney failure later.  Sooooooo I am not sure which ones are and which ones aren't!  Thanks again!

[dustybrown]

Did you say you are using Lodine patches? Or are you taking Lodine by mouth? Again, I think my air headed self missed that. I really think it's important that you take a strong NSAID by mouth. Otherwise the internal swelling will not go down and your pain will persist. You should see if you can get your doctor to prescribe Voltaren (Diclofenac) Extended Release 100MG. I guarantee you will feel so much better. The patches my doctor prescribed for me did not help as much as the actual medication that I took internally.

[dustybrown]

I agree with OtisDaMan, and I think a short leave would do you some good. The dosages of Lodine and Lyrica that you are on are practically not even theraputic. My doctor put me on 1000mg of Lodine. 150mg of Lyrica is typically the starting dose, in fact, when the pharmaceutical company hands out starter packages for new patients, 150mg is the dosage. My pharmacist told me even that is low for Lyrica. Some people are on as high as 400mg! I never was. I didn't go any higher than 200mg.

You do feel a bit groggy and maybe a little drowsy on Lyrica, but that does pass after about a week and you will feel completely normal. Weight gain and laziness is a side effect though, so if it's bothersome, Gabapentin is an alternative as mentioned. Gabapentin is most effective at doses at least at 900mg-1200mgs for the type of pain you are in, but you do have to slowly increase to get your body used to it.  

Again- Tramadol, watch yourself on that stuff. Make sure it's not making you suffer more. If you begin to notice headaches and lots MORE pain, edgy behavior, nervousness and sleeplessness at night, drowsiness during the day- question that stuff. I think that has got to be one of my most despised drugs, but doctors love it because it's non-narcotic, and they can dole out prescriptions of it without any issue.

Although Tramadol is an analgesic, it is similarly structured like an antidepressant as OtisDaMan mention, so that is why you don't want to mix it with another antidepressant. You could suffer from Serotonin Syndrome. Also, Tramadol has been known to cause seizures in some people. I just don't like it, but again this is my opinion and I have known some people to do really well on it and it always surprises me.

Well, not to scare you or anything, but it's been over a year since my surgery and I sleep with an ice pack about 4-5 nights out of the week. Last night was one of them. I am so tired of the shoulder pain myself. I am considering going back to pain management. Perhaps, you should consider going there yourself, or asking your doctor for a referral?

[OtisDaMan]

That is a fairly low dose of lyrica, so if pain persists there is plenty of scope to increase the dose. Probably the most common side effects from it are short term memory vaguaries (eg did I lock the door to the house...), and weight gain - it seems to encourage fat cell growth for some unlucky patients but not others. Pain relief is typically linear in the dose, meaning that doubling the dose should make a proportionate improvement in your pain relief, if it works for you. Gabapentin (aka neurontin) is also possible if lyrica is not agreeable with you.

Tramadol helps some people for pain but it has some undesirable side effects for some; it acts on pain but also acts a bit like an antidepressant in that it affects serotonin function. For that reason it isn't wise to mix tramadol at moderate doses with an SSRI antidepressant - they'll give an additive effect.

I've had rotator cuff trouble after a stay at hospital. It took a fair bit of massage by physiotherapists and about 2 years to completely settle down. The first six months it misbehaved a lot, especially if carrying groceries in that arm.

Hope this helps somewhat.

Regards,

OtisDaMan

[starrla]

The lodine were 100mg.  The lyrica is 60.  I decided to take the lyrica again, and I am going to the family doc Monday to figure out my meds and get a leave of absence.  I think the rest will help me heal quicker.  Thanks!  I am going to head to the couch and sleep.  I can only sleep on the couch.  

[starrla]

Thanks Tuck for your response.  I actually went to the therapist because I am getting depressed, because of the pain and how/why the incident happened.  Anyway, I have decided to talk to my principal (I teach 1st grade) and see if I can take a leave of absence.  I will go in and work Monday, then I will go to my doctor Monday after school and ask him for a medical leave.  

I was given lyrica 60 mgs... but then the orthopedic surgeon said there was no nerve impingment from the MRI's.  My family doctor says the nerves have been stretched thus the heavy pain in my ear, head, shoulder areas.  So I quit taking the lyrica.  I decided after reading a post to start taking it again.  I will see how that helps.  The lodine patches help some and so does the pain.  While at work it is hard for me to concentrate and teach as effectively as I should.  I hate to take a leave of absence as I love teaching and I know the kids will miss me, but it is really probably the best solution.  I am hoping I will heal faster than 7 months if I can take a leave.  I have dissability insurance which will cover most of my check.

[Tuckamore]

Hi Starrla,

Welcome to the Pain Mangement Community. Sorry I am late with my response and sorry to hear about your pain and shoulder issues.

I have had a rotator cuff tear and badly sprained shoulder muscles when I was playing softball about 20 years ago. They never told me what level it was, just that is was severe. Mine took over a year to heal. It was very painful for at least 6-7 months. Sweeping, vacuuming type of motions bothered me for several years. It did heal and now I rarely have pain in the shoulder.

You may want to consider a FMLA if your have worked at your place of employment for one years you are eligible. It ill allow your shoulder time to heal and it may heal faster. I assume you have left to see your physician by now but it is something you may want to discuss with him.

I was given nothing for pain after the initial 2 weeks. I worked full time as a nurse and had some pretty painful days and nights.

NSAID's should help reduce the inflammation and if you have nerve involvement a gabapentin type medication should help ease your pain. Best of luck to you. I hope you will heal quickly and soon have less pain.

Take Care,
Tuck

[starrla]

Laughing!  I know about pain problems making your brain fuzzy!  Don't worry I probably didn't say it right.  I am going to the doctor right now, but when I get back I will get the meds down.  At the moment, I can't remember which ones worked and didn't but maybe after the doctors and a bit of rest I will remember!  Thanks so much !

[dustybrown]

I am such a dope. Please forgive me. My own pain problems make my brain fuzzy sometimes!!! I get it now. Your doctor didn't want you on the Vicodin long term. Sorry. I misread your original note. I am sure if you were interested in trying the anti-seizure meds again he would be willing to try again as well. I think that icky Tramadol will only make you worse.

[dustybrown]

Oh I forgot to ask, what dose of Lyrica were you on? You may do better on proper dose of Lyrica using Lyrica without the Vicodin along with the NSAID and perhaps a benadryl at night to help you sleep. Just a thought.

[dustybrown]

I am not sure about the Lyrica, but when I took Vicodin with Gabapentin I got headaches. It didn't seem to mix well. I know that Lyrica and Gabapentin are sister medications. In fact Gabapentin came out first and Lyrica was developed from Gabapentin from similar technology, so it's possible that maybe they just weren't mixing well for you as well. Not sure though- everyone's bodies are different. The nice thing about Gabepentin though is it comes in a generic, so it's much cheaper.

Both anti-seizure meds are safe to take long term. I am not sure why your doctor didn't want you taking them long term. I am guessing he just didn't want the responsibility of managing your pain long term. That is probably why he is sending you to pain management. By the way, I've had a number of injections in my shoulder- none of them have helped, but again every one is different. You can only have three per year.  

Oh and I am so ignorant...I missed the fact that you ARE taking an NSAID- Lodine. Lodine is one of the more stronger NSAIDs. Some people do very well on. I didn't take to it- it made my ears ring and gave me a stomach ache. I do much better on Voltaren- I take the extended release tablet. What dose of Lodine are you on?

[starrla]

At first they did put me on lyrica.  I think that did help.  I don't know if it made me drowsy or not as I was taking it with vicodine and lodine.  I know the doc said he didn't want me on it too long.  My family doctor did say that he was sending my files to a pain management doctor who would do injections.  My physical therapist said he wasn't big on injections.  I have never had this kind of pain before.  It is very debilitating.  I am frightened I am going to take a lot of time off work.  Working 5 days in a row... by day 2 the pain is intollerable!  

[dustybrown]

Hello starrla,
I have not had such an intense shoulder injury, but I have had a shoulder surgery. I suffered from impingement syndrome and tendonitis and a bone spur. In April of '08 I had a arthroscopic decompression surgery to remove a bone spur, and a ligament. I've been in utter agony since the surgery, but I have learned a few things. First, you need to get yourself on a strong NSAID if you can tolerate it. Can you take Voltaren? Percocets don't even touch the pain I have in my shoulder, but the Voltaren does and it doesn't make you high and it's not a narcotic. It keeps the swelling down. My guess is that you have a lot of swelling?

Also, you might have some nerve pain going on too. You might suggest to your doctor trying a low dose of Gabapentin. This might shock you, but it's a anti-seizure medication doctors use very routinely for pain. It helped me very much. The other alternative is Lyrica, which is like Gabapentin, but it's brand name right now and it's being marketing for Fibromyalgia. It works even better and it's also an anti-seizure med, but it can cause weight gain. That's why I stopped taking it.  

By the way...Tramadol...at least for me...was absolutely worthless. It made me nervous, gave me headaches, made me restless at night and sleepy during the day. I was hurting all of the time on it too. Just a thought. Well I hope I didn't give you too much information at once. I totally feel for you. Good luck.