It's a real pain in the...
April 21, 2016 6:55 PM   Subscribe

Let us suppose that you have injured yourself. Perhaps you've (presumptively) torn your rotator cuff by falling out of bed. Let us further suppose that the area in which you live has a major prescription drug abuse problem, and it takes an act of God to get a prescription for opioid painkillers. Cortisone shot was two weeks ago. Tylenol and Advil point and laugh at your pain, but that's about it. How do you manage your pain? Medication, meditation, woo or not. YANAD. Gimme your best pain hacks.
posted by The Almighty Mommy Goddess to Health & Fitness (27 answers total) 7 users marked this as a favorite
When did you injure yourself? For chronic pain related to tendinopathy, electroacupuncture helped me a lot. (I think the idea is it effectively retunes the calcium channels along sensory neurons' membranes, so they stop telling themselves, and nearby neurons, and the brain to overreact to everything.) No NSAID has ever really helped me with tendon pain in the acute stage (or any stage, really). Only rest makes a difference, for me, at that time (along with bracing or whatever support I can use).

(Have you actually *torn* your rotator cuff? I've had tendinopathy in a supraspinatus, so read some stuff - many advocate early surgery for a larger tear, apparently.)
posted by cotton dress sock at 7:14 PM on April 21, 2016

Try taking a single, regular strength (325 mg) Tylenol every four hours (including in the middle of the night -- set an alarm and keep your water glass and pill next to the bed). It's nowhere near the maximum daily dose in total but once you build up a steady state the analgesic effect is quite a bit more powerful than taking Tylenol "as needed." I learned this trick from a surgeon who uses it as his post-op pain management regimen and manages to keep many patients entirely off of oral opiates.

Icing at intervals helped me when I had rotator cuff tendonitis.

Finally, if you have a physician who in "on board" with your injury enough to give you a cortisone shot, I wouldn't presumptively write off the possibility of getting prescription pain meds. If you can afford it, it's worth going back (or just calling) to say that you're still having significant pain and you would like the doctor to help you find better ways to manage it. A true rotator cuff tear that doesn't improve after a cortisone shot and rest may in fact be a surgical case (if not a "legitimate" reason for a short course of stronger painkillers).
posted by telegraph at 7:21 PM on April 21, 2016 [10 favorites]

The injury occurred two months ago, pain kept getting worse until I wound up in the ER. My orthopedist said it looked like a torn rotator cuff with some nerve involvement from my neck, since the atm is on fire with heavy tingling. Physical therapist came today (I have home health for Reasons), and said since I was in so much pain, with such basic movements, she was going to recommend stronger measures be takenand PT be stopped.
posted by The Almighty Mommy Goddess at 7:25 PM on April 21, 2016 [1 favorite]

When pain killers weren't doing shit all for me, hot baths and cold packs helped enormously. (I also took to having a nightcap so I could sleep, and I do not even like alcohol.)
posted by Michele in California at 7:30 PM on April 21, 2016

You could try taking both Advil and Tylenol, but staggered. So you are taking something every 2 hours (i.e. Tylenol at 8 AM and 12PM and Advil at 10 AM and 2 PM, etc.). This is what was recommended to me after my caesarean. Not the same thing, but painful nonetheless. I hope you find some relief soon!
posted by rozee at 7:32 PM on April 21, 2016 [5 favorites]

I have a herniated C7 disc right now that I'll be having surgery for in (I hope) no more than 6 weeks. But it's been bad since December. Often I have excruciating pain down my right arm and across my shoulder and back, other times it's numbness and throbbing pain, other times it's pins and needles. SO your basic nerve pain. Since it's my right arm, it hurts when I work (I work at a computer) and when I drive (I drive a stick). PT and massage helps, but I can't do that every day. So every day I do 3 ibuprofen every 6 hours. Pain wakes me up right at the 6 hour mark so no alarm is needed. When it spikes otherwise, it's either the heating pad if I can tell the muscles around it are tight or ice packs if it's really just the disc area sending out its evil messages. If it's still awful, I take Tramadol, which I absolutely made my doc give me. My PT says that nerve pain is no joke. I take one when I need it. And at night my doc also gave me Gabapentin, which helps to sleep (calms the nerves down a smidge, makes me drowsy). Go get meds. Seriously.

Tylenol didn't touch this. Flexiril did nothing. But my problem is different from yours, so YMMV.
posted by clone boulevard at 8:06 PM on April 21, 2016

Find your Orthopedic surgeon and get an MRI. Get it fixed, 5-6 weeks is the perfect window between tear and repair, according to the surgeon who fixed my three rotator tendons and bicep all torn off. I took 600 mg ibuprofen every 5-6 hours while awake, then tried sleeping through.

To find a good ortho, call around to PT folks to get a recommendation. That is what I did, and I went on a low calcium diet while torn, and for a couple of months after surgery. This was to keep calcium levels low, to protect torn nervous tissue from calcification and arthritis later. That worked.

But, my old lady friend, fell out of bed and broke her collar bone. Did you get a simple xray?
posted by Oyéah at 8:09 PM on April 21, 2016 [5 favorites]

This sounds crazy but I found it to work with countless running injuries - take turmeric. You can get it in capsule form at your local big box pharmacy or can take a dry teaspoon, mix it in 4oz water and shoot it down.
posted by floweredfish at 8:14 PM on April 21, 2016 [6 favorites]

Tylenol is useless for this kind of pain and is basically poison, so I would avoid it. Pain of this nature is mostly inflammation, so NSAIDS like naprosyn or ibuprofen in combination with ice for short periods is your best bet.
If movement causes pain, avoid moving until those acute episodes subside. see an orthopedist for a definitive diagnosis and get it fixed.
posted by OHenryPacey at 8:31 PM on April 21, 2016 [1 favorite]

Chondroitin as a supplement will support tendon and cartilage healing, and if you're going to try the turmeric thing, heat it with some coconut oil and black pepper. The heat will release the compound, the oil helps with bioavailability and the pepper contains a compound that makes it more effective.

Also nthing going to an orthopedic clinic for an evaluation.
posted by ananci at 8:40 PM on April 21, 2016

Pain of this nature is mostly inflammation

This is arguable, when it comes to overuse injuries (in which degeneration is thought to play an important role), I don't know about tears. And, without an MRI, it's unclear what exactly is happening. I'd get a second opinion - Oyéah's suggestion of asking PTs for recs is brilliant. They see the fallout after surgery. Also ask them which labs give the best reports, for the imaging. Until then, I would just rest it.
posted by cotton dress sock at 8:40 PM on April 21, 2016 [3 favorites]

And it's unclear whether NSAIDs are all that for bone and tendon healing. The regular dosing with Tylenol sounds like it's worth looking at if your system's up for it (& you can be regularly checked), or at least asking a doc about.
posted by cotton dress sock at 8:44 PM on April 21, 2016 [1 favorite]

Seconding turmeric for dealing with inflammation.
posted by HiroProtagonist at 9:00 PM on April 21, 2016 [1 favorite]

500mg naproxen every 12 hours + heat after 48 hours is what I did for a recent back injury. It wasn't all wine and roses, but the anti-inflammatory was much, much more useful to me than the opiate I was initially prescribed. While the opiate did dull the pain, I was also slightly out of it and not careful enough as a result, so I re-injured myself twice while taking them. Annoyed, I tossed them out and stuck with the anti-inflammatory. Not perfect relief, but enough.

You may wish ask your doctor about a TENS unit. I personally dislike the sensation but both of my aunts swear by theirs for interrupting pain cycles. If there's nerve involvement something like Lyrica may be useful. You could ask your doctor about that, too. There are also things like lidocaine patches and pain relief gels.
posted by xyzzy at 9:22 PM on April 21, 2016 [1 favorite]

Nthing tumeric, and also ginger. I usually do it in juice - I juice some granny smith apples, and some lemon, celery, and enough fresh ginger to burn your lips off. It helps when I'm having back spasms. I have some heavy duty pain meds, but I prefer to use ginger along with a heating pad. You can also made a fresh fruit salad and add a ton of fresh ginger. Don't peel it, just wash it, chop it into rough chunks, and throw it in a food processor.
posted by MexicanYenta at 9:27 PM on April 21, 2016 [3 favorites]

Can you get a higher dose of Ibuprofen prescribed? After I gave birth (hello pain!!) I was prescribed a high dose of Ibuprofen that was awesome, awesome, awesome.
posted by Toddles at 10:40 PM on April 21, 2016

Tylenol (acetaminophen) has gone from being every docs darling to the "do not prescribe" list. Ibuprofen is in.
posted by SemiSalt at 4:24 AM on April 22, 2016 [1 favorite]

If docs in your area are not willing to prescribe pain medication (pills), maybe ask for a shot of Toradol (an NSAID) at the doctor's office? That way, they aren't prescribing you 50 Percs or whatever. It's not long-lasting, but it works for many people...
posted by kuanes at 4:36 AM on April 22, 2016

Go back to your Ortho, or a different Ortho and demand intervention.

I had two disks at L7 ad S1 rupture, with pieces of the disk resting on my sciatic nerve for 2 years. The pain was miserable, I wasn't sleeping and moving at all was torture. It was awful. No pain med helped, TENS didn't help, PT didn't help, Chiropractic didn't help. What helped was surgical injections of cortisone.

Now is the time to explore surgery. I am only sorry I didn't do the surgery two weeks into the injury rather than two years. Insist on getting a good pain reliever prior to surgery, and if your current doc is not hearing you, find one who does.
posted by Ruthless Bunny at 4:39 AM on April 22, 2016

I've heard that Bob's Red Mill sells the right kind of poppy seeds for poppy seed tea. Google if you want to know more.
posted by Jacqueline at 5:06 AM on April 22, 2016

Aside from the drug recommendations use ice - a lot. You can get large reusable ice packs with velcro straps specifically for shoulders - I was given one post rotator cuff surgery and told to use it a lot. Mine actually came with two cold pack inserts - would wear it until the pack was no longer frozen then swap. 2 years post surgery I still use it when I overdo it. Amazing how much it will help. I also found being really picky about a lot of pillows positioned just so helped at night.

And yeah - alternate between ibuprofin or naproxen and tylenol. But if you're in that much pain it's not unreasonable to go back for heavier drugs. Ibuprofin and naproxen both can be taken in much heavier doses than the OTC versions but check with your doctor because there are reasons you might be better off with narcotic pain relief - say if your kidneys or liver need to not deal with NSAIDS or tylenol in higher doses respectively. Your PT might be able to contact your doctor if you're concerned about being perceived as drug seeking.
posted by leslies at 5:20 AM on April 22, 2016 [1 favorite]

For inflammation, I find that heat works better for me. You can get those chemical handwarmer bags or fill a sock with rice and microwave it. Also, the tart cherry juice from Trader Joe's seems to help with my inflammatory joint pain (it makes it a little duller and easier to disregard.)

But, seriously, your doctor should give you better drugs or other intervention. You're in a lot of pain and you deserve better!
posted by blnkfrnk at 5:43 AM on April 22, 2016

Hot baths, heating pads, and massage helped me the most. I also found that until the inflammation went down, physical therapy made things much worse.
posted by metasarah at 8:49 AM on April 22, 2016 [1 favorite]

Nthing high doses of ibuprofen.
posted by scrubjay at 8:54 AM on April 22, 2016

Diclofenac is a prescription-strength NSAID and I've found it very effective. It can be hard on the stomach, though, so it is not for long-term use. Your doctor should be happy to prescribe it for you.

Absent that, you can take an NSAID (ibuprofen or naproxen) with acetaminophen since they work in different ways. I prefer the naproxen because the dosing schedule lines up better (naproxen every 12 hours, acetaminophen every 6; ibuprofen is every 4, so you have to take three doses of ibuprofen for every two of acetaminophen). Ankle sprains have been made much more manageable with this regimen.

Also be aware that the OTC dose of any NSAID is much lower than prescription doses. When I had a blocked Eustachian tube, I took ibuprofen for it. I complained to my doctor that the ibuprofen helped only slightly and he said "well, how much are you taking?" I said two pills, and he said "try four." That worked much better, and got the swelling down sufficiently that the food particle that was blocking the tube could slide out, curing me. So, with your doctor's permission, you might try higher doses of NSAIDs. They generally have excellent safety profiles.
posted by kindall at 10:39 AM on April 22, 2016 [1 favorite]

Ice and physical therapy. This sort of thing doesn't get better by itself.
posted by Riverine at 11:38 AM on April 22, 2016

This is going to sound insane - because - as someone with a C-5, C-6 disc herniation - I found the information unbelievable.... However, I am working on a graduate degree and one of my professors works as a clinical psychologist with chronic pain patients (in the same sort of drug problem area as you appear to be)..... several legitimate studies show that talking/telling involved stories uses the same part of your brain that processes certain pain responses. (As soon as I can find an un-paywalled-source I will post it) I truly did not believe him until I went and read the studies myself. I realize that you probably don't feel like it - but getting involved in engaging conversations with supportive friends may help some. I also agree with everyone else on rotating the tylenol/ibuprofen model....
posted by Gyre,Gimble,Wabe, Esq. at 7:27 PM on April 22, 2016 [1 favorite]

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