Pain Scale and PT

We already knew that the little smiley-face pain scale was useless.  Someone drew a new one!  It’s definitely worth checking this one out.

That pain scale has nothing to do with what’s going on with PT, but I couldn’t resist passing along the link.  On the PT front, that’s how I’m spending this month.  Why?  When I saw my PCP, he ordered an MRI of my shoulder which showed bursitis, tendinitis (I’ve seen this spelled both with an I and with an O – take your pick), a bursa tear, some rotator cuff tears, and further deterioration of the OA in my AC joint.  Ah, well, that explains why my shoulder hurts.

Dr. PCP referred me for physical therapy.  The guy I’ve seen before was full, but his partner had an opening so I’ve been seeing him instead.  Nice guy, different approach.  I’m scheduled for twice a week over the next month, which will use up half of my allotted PT appointments for the year and results in way too many medical contacts for the first quarter of this year.

  • January:  one doctor’s appointment
  • February:  one scheduled, but the rheumy got sick and cancelled.  Sorry she was sick, but I got a whole month with no appointments of any kind, which I’m thrilled about
  • March:  two doctor’s appointments already, plus another one scheduled for the end of the month, plus PT twice a week all month

PCP asked if I need anything else for the pain.  Not a chance. Which means that the pain makes me in not such a good mood lately.  Feldene and tylenol combine to make things nearly tolerable.  I don’t do so well with the stronger drugs.   My attitude about all this really sucks, and I’m tired of trying to find something to be positive about, so I’ll keep the posting light so as to spare you from my negativity.

Once I’m in a better frame of mind, I’ll post about some of the exercises I’m doing to regain my range of motion.
Thanks for reading.

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22 thoughts on “Pain Scale and PT

  1. I am so sorry you are having so many things going on. I think I am in the same negative place you are. The difference is that you are not going to post a bunch of negative posts while I have been doing so the past few days and am feeling worse and worse about the negativity I have written. I think I am feeling better now and I hope you do soon too. Pain makes everything feel kind of grumpy.

    I know what you mean about hating stronger drugs. I think it is nice that your doctor offered though so you know if it gets to that point you have options even if you wouldn’t use them.

    Doctor appointments are no fun at all. I have so many scheduled for April that I feel sick just thinking about it. Probably the opposite effect an appointment with a doctor should have, right?

    • You’re the only person I know of who has more doctor’s appointments than I do. That’s got to suck majorly. And I haven’t thought your posts were negative; just stating the way things are. Thanks for understanding.

  2. I’ve got my fingers crossed the physiotherapy helps out; it sucks that your shoulder hurts so much.

    As it is for Wren, I hope that for you the coming of spring provides some happy distraction…
    :) L

  3. Nothing like pain and too many dr. appointments to make a person glum. Sounds like you’ve got some rough work ahead on that shoulder, WS. I’m wincing for you. But I also hope the PT helps relieve the pain and gives you increased ROM. Any word on what else they might consider doing to mitigate the problems you’re having with it?

    And oh, yes, pain can make us very grumpy, and with good reason. I understand how you feel about stronger painkillers; they might relieve pain temporarily, but they also make us drowsy and dopey. Further, we form resistance to them and over time, need more and more to do what one tab used to, AND they cause dependence, which is more than unpleasant. Sigh. I wish medical science could come up with a good, useful painkiller that works, but that doesn’t come with all the downsides.

    In the meantime, hang in there. I’m sending as much comfort and calm your way as I can. Be gentle with yourself.

    • Thank you, Wren. I have a couple rice bags that I’ve been using because heat feels really good. Ultrasound helps, as long as they’re careful about where they put the wand and how hard they push. TENS is great, but doesn’t last nearly long enough; I really need to take the plunge and buy my own machine. As for what else might help, the damage isn’t bad enough for surgery – for which I’m extremely grateful (the doctor actually said “yet” which didn’t sound very encouraging, but it’s nice to have a realistic idea of what to expect).

  4. You’ve got the double, or should I say triple, whamy of having RA, helping to work a farm and having all those kids. I’m surprised you haven’t had to have a shoulder replacement already! I’ve had shoulder pain for years and years now, but fortunately still have good range of motion. I think a lot of mine is tendonitis and bursitis too. Never had it imaged though. Mom needs a shoulder replacement but can’t due to poor surgical candidate due to other disability and her sister has already had one. I don’t know what their problem is for sure but guess it’s familial OA. I’m assuming I’ll need a replacement years down the road and will be interested to see what the pathology is even though I’m not looking forward to it. Hope the physical therapy and/or steroid shots may be able to hold off surgery for a long time for you! Some folks swear by those TENS units. Wonder what they cost now.

    • Have you done any PT? I’ve done PT for shoulders & hips in the past, and was able to completely overcome the pain. I’m hoping that it works this time, too. If so, I won’t stop the exercises after a few months; I’ll have to make them part of my regular routine. I’ve read that people with RA can expect joint replacements at some point, but I’m hoping that’s based on old data; new treatments should mean better prognosis. Or maybe that’s wishful thinking.

      There are some tiny TENS machines starting around $35, going up in price depending on manufacturer and features. I saw an ad for a portable one (for people with back pain), that can be hooked up and worn all the time under the clothes. A combined TENS/ultrasound machine like my PT has costs $7K.

      • I don’t know if you just have a very proactive rheumy, or just really great insurance, or if mine just doesn’t think I need any physical therapy yet. :-) One problem I have, that I know a few readers here can probably relate to is that I often seem to get quite a bit better by the time I have an appt with my doc. It does take usually at least 6 weeks to get a regular appt although has been great at getting me in for quickies in an “emergency” situation. It is hard to make time for all the extra visits for PT and such though. I wonder if there some PT stuff online? Lifting heavy things or even just using my arms at shoulder height or above for daily things like doing hair or putting up hangers (even empty ones) seems to make my usual shoulder aching worse. Knock on wood, but I haven’t had a more painful attack of bursitis and/or tendonitis in a few months, but have periodic bad times with those.

  5. I’m sorry you’re hurting so bad. Shoulders seem to be the worst too. I use a rice bag for the heat effects as well. I think the heat helps (or at least relieves some of my crabbiness). Have you thought about a short prednisone taper to use to hold you over until the PT starts helping? Not sure if you can do steroids, but they’ve helped me get over short term hurdles. Take Care.

    • I semi-asked about prednisone at my last rheumy appointment. My rheumatologist is great about doing one med change at a time so that we know what works and what doesn’t. I like that approach. It drives me crazy when someone prescribes three medications and then two weeks later wants to know which one helped. How would I know?! Sorry; mini-rant :) Anyhow, my rheumy didn’t want me to start both enbrel & pred simultaneously. Except for my shoulder, the enbrel has been great.

      • I’d consider steroid shots for the shoulder over oral prednisone. Thought I just read something about those who are on oral steroids while on biologicals have a higher chance of more serious infections. This is yet another reason why I am still debating myself about going on a biological. If I had my old job that might not be as great a consideration. Not that I want my old job back, but you know….Anyway, it’s just really hard for me to get off prednisone even though I know I need to.

        • I agree – somewhat…I was on Prednisone for a while, and it was only after adding a biologic that I was able to taper off the prednisone. It really wasn’t THAT bad to go off the pred once the biologic kicked in. Now I can use pred for a two week taper and it works great. I do agree about considering a cortisone injection. I received one into my shoulder a few years ago, and it helped for several months.

            • Hi Chelsea,
              Yes, I was on prednisone for 9 months before I started the biologic. I was unable to get below 5mg/day without it. Once I started the Humira, I started feeling good so quickly. I started dropping the dose of prednisone by 1mg weekly. I stayed on .5 for a couple of weeks and then was able to stop without any discomfort.

        • Thank you. I’ve been wondering about a little prednisone, but not wanting to go down that road if it isn’t necessary. Having had a few cortisone shots in my shoulders prior to this, I’m a big fan. Unfortunately, last time it didn’t work. I had a depo-medrol injection in this shoulder in January and my shoulder got worse. My PCP said that sometimes it requires a second injection so I’m supposed to talk to my rheumy about it at the next appointment. I wasn’t really clear why he wouldn’t do the shot for me right then, but I suppose that if the rheumy’s looking for something specific she wouldn’t appreciate someone else stepping in and messing up the results with more steroids. Which is too bad, because I like the kenalog that my PCP uses better than the depo-medrol that both my rheumies have used (unless it’s the doctor giving the injection, rather than the specific med that’s made the difference).

  6. I feel for your shoulder situation. I had 2 surgeries on my left shoulder before RA diagnosis. I believe they eventually failed and re-tore because of inflammation. I started Enbrel the same week as you, but ended up being off of it for a month because of infections. During that time both shoulders, sternum, neck started roaring. I now have been back on it plus MTX again for 5 weeks and feel like I could be in “remission” except for both of my shoulders and left knee which I believe is permanent damage.(not sure about the right shoulder). After my last shoulder surgery my ortho. suggested I may need a shoulder replacement. My Rheumy did give me a steroid shot and it knocked some of the pain down for 2 months. Not very long lasting in my case. I do gentle ROM execises so I don’t get too stiff. I have to limit activity or else…

    • Hi Ronda. Good to see you commenting :D
      Your shoulders sound very painful. How often can you get a steroid injection? Since my shoulder isn’t bad enough to warrant surgery, I can’t imagine how much pain a person has to be in to be eligible for a repair or replacement. Joint replacement sounds scary, but I imagine that if it meant pain relief and being able to start using the joint again it would be worth it.

      I read something about recovery from knee replacements being much easier for people who’d done strengthening exercises first. I wonder if that applies to shoulders, too?

      Glad to hear that you’ve been able to resume your meds. Amazing how much they help, huh? :)

  7. I haven’t asked my doctor about another injection, but I imagine 3 or 4 times a year is okay depending on the problem. I’m not even sure what’s wrong with it now. My previous injuries were supraspinatus and bicep tendon tears. I read that you have to be careful with tendons and steroid injections, they can weaken and rupture. The thought of any surgeries scares me after 2 on my shoulder and 2 on left knee and I’m no better off. I guess because I had undiagnosed RA. My muscles around them are now weak. It would be a HUGE benefit to have stronger muscles before any joint replacement. I need to get on the strengthening thing myself. I think I could do isometric exercises. If I were you I would definitely keep with the PT and be careful with your shoulders at home. Respect the shoulder!

    • Darn! I need to quit reading the replies on this post. I just got up to go do something and it set off some tendon along the outside of my shoulder blade dang it! Hopefully it will be short lived. Anyway, yes WS, I’ve heard you can only have 3-4 injections in a joint per year, but yes, you do run the risk of tendon damage with those. Something to discuss perhaps with a surgeon who would be the one doing the repairs anyway. Time to start researching surgeons and developing a relationship with one just in case the inevitable does happen.

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