A Return To My Concern About Cortisone Injections -- With Pots -- And Bp Spikes -- Advice Please

[lynnie22]

I wrote a post a couple of week ago about this, so sorry if I am repeating myself at all. My orthopedist went away and my cortisone injection has been delayed, which gave me time to read up on potential side effects. I am in terrible pain with a torn rotator cuff in my shoulder -- so I do want relief. It's just that there are warnings about cortisone injections sometimes causing very high blood pressure, one of the problems I have been having periodically these days in any case, probably adrenal related. From 85/50 to 185/115. So have a bit of trepidation about this. The cortisone causing it because of similar issues. So like a potential double whammy.

Those who responded who had had shots had done okay. But after what I read, including s warning from MAYO, I am concerned. Does anyone have suggestions or a better understanding of this, or what else I can do?

Thanks for your help!

[Katybug]

If you have one, what does your cardiologist or POTS neurologist have to say about it?

For pain, you might consider finding a PT that practices myofascial trigger point release and dry needling. This won't take away pain directly but can help referred pain from your muscles tightening up from the injury,thereby reducing the overall pain level. I also had good luck with an osteopath when I dislocated my tailbone many moons ago. He actually gave me an injection of medical sterile hydrogen peroxide in my sacro-coccygeal (sp? ) joint to reduce pain and inflammation. He said it is often used in osteopathy as an alternative to cortisone injections because it has the same benefits without the side effects. We did three injections over time. While it wasn't a permanent fix, it did reduce the acute pain. I honestly don't know much about it as I was 19 at the time and just wanted the pain to go away so I didn't ask a lot of questions.

[lynnie22]

thanks, Katybug. The doctors aren't as concerned about cortizone as I am. My cardiologist doesn't know much abouT POTS, and the POTS doctor is still trying to figure out why I have POTS, what type, and finds it strange that I got it at my age of 64 (61 when first diagnosed). I was reading about all these high blood pressure reactions, and considering my crazy blood pressure, was concerned. I do think the PT I was first going to for this used trigger point release -- but the exercises he had me do tripled the pain. An osteopath is a great idea -- as is more of pain release therapy. Thanks.

[Batik]

Were you the person who wasn't getting any pain meds?

[lynnie22]

I am she.

Actually, my internist FINALLY after two months of this has realized when he saw my bad shoulder is very distorted looking decided to send me to another ortho who specializes in shoulders. Unfortunately, this doc is going on vacation. Still, trying to be squeezed in tomorrow before he leaves, if I can get all my films before. Hopefully will do.

[Batik]

I still can't figure out why no one has tried you on pain medication. That would be the obvious first port of call. Have you asked for any?

[Mydoggielovesme2]

I hope you got in today. It's so painful having a shoulder problem. I was never offered any pain meds either, just the injections. They do help, but side effects are a concern. That's why I'm not having another one. And I am toooooo afraid of surgery because of BP issues. Please let us know how it went.

[Katybug]

I don't know where everyone is located but here in the US, the FDA just changed the ""rating"on certain pain meds that were the ones that regular docs were more willing to prescribe without sending a patient to a pain clinic. So it is harder now (due to liability concerns) to get docs to prescribe anything stronger than high dose ibuprofen. This is a recent change...last month or so.

[lynnie22]

Hi,

Well reporting in. Went to see the shoulder man recommended by my internist -- a surgeon -- and guess what he recommended....of course. But most shoulder specialists are surgeons. He thinks I should have my biceps cut, leaving one bicep. He says the pain is coming from the slight tear in the biceps that are attached to the rotator cuff. It made sense to me, since most of the pain is in my upper arm. As far as pain meds, you must be right, Katybug, cause he was sure hesitant to give me anything. Tylenol or advil, they suggest. He finally gave me a prescription for tramadol, I have no idea what it is. Anyone know? I am in NYC and Batik, I sure have asked for pain meds, even from the original doc. He said he was calling something in, but never did and then went on vacation. Next week I have one more appt with a shoulder sports medicine surgeon -- a client of mine went to him and he suggested no surgery, so hoping. I asked today's doc to give me a new prescription for PT -- have to find a good place to address my shoulder, my neck and the POTS. But as far as pain, no instant cure for sure except the cortisone shot everyone wants to give This doc today did agree that it causes elevation in bp, which might be good on my low BP days, but not on the high ones. Thanks for your concern, doggielovesme. I do think I may end up getting a shot from someone. I'll just take the day off from work so I can counter any side effects I hope.

[Orthohypo]

There are two types of patches that can be applied externally - lidocaine and Flector (NSAID) which avoid the systemic side effects of meds and cortisone. Having had max doses of cortisone and docs other than pain specialists tell me cortisone can make your body do crazy things, I am going to try my best not to do that again for my shoulder pain. (Also had cortisone for herniated disc, so much more than is given for shoulders alone.) There are also compounded pain relief gels and creams that I found out about here in the forum and asked my compounding pharmacy about. After learning about them, I asked my family doc for the Rxs. They are not as convenient as popping a pill, but are fast-acting and help. I can post the info about the ingredients tomorrow. Not sure where you are, but if you want to message me I can give you the name if the pharmacy. They also mail out.

[Mydoggielovesme2]

Tramadol is used to relieve moderate to moderately severe pain. Tramadol extended-release tablets are only used by people who are expected to need medication to relieve pain around-the-clock for a long time. Tramadol is in a class of medications called opiate agonists. It works by changing the way the body senses pain.

[lynnie22]

Hi,

Orthohypo, the compounding gels sound very interesting. If you post, I will get a chance to read the ingredients. I am in NYC. I didn't realize that lidocaine came in patches too -- the doc today did offer a shot of it and/or the cortisone. It sounds like you've been through a lot with pain. Sorry to hear that. I also have severe osteoporosis and am alittle concerned about cortisone injections near my bone, but I know everything has side effects. I am interested in your suggestions.

Thanks, Doggielovesme2, for the info on Tramadone. I change my mind. It sounds pretty strong. I am not eager to be on meds either -- just to be rid of this pain and feel better. Have you been on it or know someone who has?

What do you think of cutting away half your biceps to end the pain? Sounds a bit severe to me.

[Batik]

I'm on tramadol, and it's one of the first-line drugs in the UK. It's basically a synthetic opioid. With the level of pain you're describing, you need stronger pain meds. When I had acute calcific tendinitis in my shoulder, which is extremely painful, I was on the full dose of cocodamol and tramadol on top. Tramadol is unlikely to do you any harm, and if you don't get on with it, you just stop taking it. Cutting a bicep sounds horrendous. I'd suggest talking to a pain organisation, they exist all over the world. They can talk aout surgical vs. Drug treatments, and talk about what's available where you are. I had no idea that pain meds were so difficult in America, sorry for the misunderstanding. How do people with chronic pain manage? I'm a chronic pain sufferer myself, diagnosed vaguely as fibro though EDS is starting to look likely.

To be honest, I'm absolutely horrified that surgery is being proposed before pain medication. If nothing else, a surgeon who is't keen on pain medication is likely to leave you without adequate pain relief after the surgery. That happened to my mother, where the surgeon kept telling her the surgery would fix all her problems. It didn't, she ended up in horrendous pain from the surgery and continued to be in awful pain later as well, and the surgeon just shrugged and said it wasn't his problem. It was eye surgery in that case.

[lynnie22]

Hi Batik,

sorry for the delayed reply. Quite a week. Thank you for your support. Now I know why it's been so hard to get pain meds, and I am also horrified that they are suggesting surgery, or at least this surgeon was. It more horrified me that he suggested that I am too 'old' for rotator cutf surgery even though the tear is supposedly not big, but instead tearing my biceps. It is bad enough that I have torn something, why would I want something else torn? I may indeed get that cortizone shot at this rate, and do PT with a good PT if I can find one. There is little out there in the way of pain support.

[ramakentesh]

ive had cortisone injections for ank spond related sacroilitis - i think it made my POTS feel a little better but it didnt make any worse either way.

[Orthohypo]

I would just say to try to get by with as little cortisone in the injections as possible. I had six in my cervical vertebrae in 18 months plus two (half the amount as the neck) in my shoulder. It made my anxiety really bad. Now that I can tell it's dissipating because the pain levels are going back up, I also notice I have less trouble with anxiety now. I can't stand the anxiety attack weirdness and weakness that knocks me flat. Maybe try it and then see if some of these other things might help. I don't know why the insurance companies in the US will cover that first. This week my new pain specialist is trying facet injections in the vertebrae with a local anesthetic to see if it provides relief. If it helps in two separate sessions, they will try to get nerve ablation approved. This is a drug-free approach which is supposed to last 6-9 months. I hope it works and insurance says yes!

Anyway, the nerve pain gel is ketoprofen/gabapentin/bupivacaine 4%/5%/1%. The muscle relaxer cream is baclofen/magnesium/guaifenisin 2%10%/6%. The message on the phone when I'm on hold says the pharmacist can help with pain issues and to email him. Not sure if I'm allowed to put that info in the post so PM me if you want it.