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Pain Medications and Ointments/ Cortisone Shots: My Experiences and Side Effects

By Gary F. Zeolla

 

      I have been dealing with a Rotator Cuff Injury since March 14, 2021. Follow the link for details. But here, in short, there was much pain involved, in both my left shoulder and triceps, so much so I had surgery on August 20, 2021. But even after the surgery, I was still experiencing pain in the arm and shoulder. As a result, I had two cortisone shots, one before and one after surgery, and I have used various pain medications and ointments.

      In this article, I want to overview all that I tried, the potential side effects thereof, and why I ended up getting the second cortisone shot five months after surgery. I hope this information is helpful for the reader dealing with chronic pain.

 

Various Pain Medications Tried

 

      I was given a prescription for Meloxicam (Anjeso®, Mobic®, Qmiiz OD®, Vivlodex®) at the emergency room when I went there for my injury in April 2021. Meloxicam is a NSAID (nonsteroidal anti-inflammatory drug). The prescription was good for a full year, and my insurance paid for it. The tablet strength was 15 mg, and the directions said to take it once per day. That was convenient. I took it for several weeks. It helped some, but not much. And, as with all NSAIDs, there are potential side effects with long term use:

 

      Meloxicam can increase your risk of fatal heart attack or stroke, especially if you use it long term or take high doses, or if you have heart disease. Do not use this medicine just before or after heart bypass surgery (coronary artery bypass graft, or CABG).

      Get emergency medical help if you have chest pain, weakness, shortness of breath, slurred speech, or problems with vision or balance.

      Meloxicam may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are using this medicine, especially in older adults (Drugs.com. Meloxicam).

 

      I then tried aspirin (Bayer®). Just a basic 325 mg aspirin, two tablets every four to six hours. Since aspirin is also a NSAID, I stopped taking the Meloxicam when I took the aspirin, as it knew it was not good to double-up on NSAIDs. But the aspirin helped even less than the Meloxicam, which is to say, it did nothing. Aspirin also has potential side effects:

 

     Stroke caused by a burst blood vessel. While daily aspirin can help prevent a clot-related stroke, it may increase the risk of a bleeding stroke (hemorrhagic stroke).

 

     Gastrointestinal bleeding. Daily aspirin use increases the risk of developing a stomach ulcer. If you already have a bleeding ulcer or gastrointestinal bleeding, taking aspirin may cause more bleeding, perhaps to a life-threatening extent.

     Allergic reaction. If you're allergic to aspirin, taking any amount of aspirin can trigger a serious allergic reaction…

     Both aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin IB, Advil, others) and naproxen sodium (Aleve), thin the blood and decrease blood clotting. Regular use of NSAIDs can increase bleeding risks (Mayo Clinic. Daily aspirin).

 

      That last paragraph is why you should not take more than one NSAID at a time. That is why I next tried acetaminophen (Tylenol®), acetaminophen is not a NSAID. I took extra strength, 500 mg caplets, four times a day. Since acetaminophen is not a NSAID, I figured I could take it and the Meloxicam together if needed. But whether alone or with the Meloxicam, the acetaminophen did not help at all. And I already knew long term use could cause liver damage, but acetaminophen has other potential side effects as well:

 

      Side effects of Tylenol (acetaminophen) may include: 

·         Nausea

·         Headache

·         Stomach pain

·         Rash

      Occasionally, the drug can cause serious side effects, including severe skin reactions and allergic reactions. Large doses of Tylenol can initially trigger stomach cramps and nausea before physical conditions quickly deteriorate, leading to liver injury, liver failure and death.

      Use of the drug during pregnancy has also been called into question, but more research is needed…

      Liver damage is the most serious side effect of acetaminophen and it can be fatal. Liver damage can occur when a person exceeds the maximum daily dose of 4,000 milligrams — but it’s also been known to occur in some people at even lower doses (Drug Watch. Tylenol).

 

      I next tried naproxen (Aleve®, 220 mg tablets. It is another NSAID. It is convenient in that you only need to take it twice a day. But I only used it once, as I had an allergic reaction to it. I’m not sure if that was to the drug itself or to the artificial coloring used in it. It could have been the later, as I know I am sensitive to most artificial ingredients. But if I had continued to take it, naproxen can also have long term side effects:

 

      Long-term use of Aleve can make your heart work harder. Aleve makes you retain water, which increases the load on your heart. This extra work can cause pressure on your cardiovascular system and can sometimes lead to a heart attack or stroke (Healthline. Aleve).

 

      Next, I tried ibuprofen (Motrin®, Advil®) It is yet another NSAID. But it was the only drug that helped reduce the pain. That is why I began using ibuprofen regularly back in the spring. The directions say you can take 1-2 tablets every 4-6 hours, but not more than six in a 24-hour period. I was taking about four per day, so I figured that amount would be safe. And it worked in keeping the pain down even somewhat before the surgery and more so afterwards when the pain was not too bad. But after a while, I no longer needed it, as I got deeper into my recovery.

 

Various Pain Ointments Tried

 

      As I as experimenting with the different pain medications, I was also experimenting with different pain ointments. I would mainly use these before and after my rehab exercises and workouts and at bedtime.

      I first used Icy Hot®, since that is the ointment I used back in my college powerlifting days. But it has a rather distinctive smell. In fact, gyms, locker rooms, and contests often smelled like Icy Hot. It didn’t bother me back then, but since I have developed my sensitivities, I feared it would be a problem. It was, but not too bad. I could use it pre- or post-workout, but not at bedtime.

      But unlike back then, the product I got now contained lidocaine. It is a local anesthetic. It is not that strong, not near as strong as say the Novocain you might get at the dentist’s office. But it does numb the area a bit. That is why I primarily used it pre-workout, to numb my shoulder and triceps to get me through a workout. But it does not last very long, an hour or so at best. Therefore, it would not help with sleep. I first used an Icy Hot cream, but it is quite messy. But later I found out it is also available in a roll on. That is much less messy.

      Another roll on with lidocaine is Salonpas®. It does not seem to work quite as well as the Icy Hot, but it also does not smell as much. That enables me to use it at times other than pre-workout. But again, the effect only lasts about an hour or so.

      With even less of a smell is Aspercreme® It in fact has virtually no smell. That is why it has become my ointment of choice at bedtime. It contains the same ingredient (salicylic acid) as aspirin, hence the name. But it also works about as well as aspirin, which is to say, not very much. It also does not last very long, again, about an hour or so. But that is enough for me to get to sleep or to get back to sleep if the pain wakes me up.

      But being a cream, it is also a bit messy. There is a Aspercreme roll on with lidocaine, but it smells, despite the claim that it does not. At least it bothered me so much that I could not use it at all.

      Next, I tried a hemp cream, Zatural Hemp Hot Cream. Hemp is related to cannabis, but it is not the same as the much talked about CBD. This hemp cream seems to best sooth my muscles after a workout, so I only used it post-workout. But it does smell quite a bit, so again, I would never use it at bedtime.

      Later I tired a hemp cream with lidocaine, Maxocaine. It is rather expensive, more expensive than the rest of the products mentioned here. But I figured it would be worth it if it gave me both the pain numbing of the lidocaine products and the soothing qualities of the hemp product. But it did not seem to help any better than the other products. And with the cost, I did not bother to get a second bottle.

      Far more expensive is CBD. It is not available at traditional shopping sites like Amazon or Walmart. But it can be found on many different sites on the Internet. However, it is quite expensive. Most of the CBD products I looked at cost $25-50 for a two-ounce container. That is compared to about $10 for a four-ounce container for most of the preceding products. At that price for the CBD, I knew I could not afford it long term, so I never tried it.

      Lastly, I tried DMSO. This is actually a wood solvent. But going all the way back to my college powerlifting days, it was being touted as a pain liniment. I remember trying it back then. It does not smell like other ointments, but it does give you garlic breath. And it is not in any way FDA approved for human use, so try it at your own risk.

      The bottle I ordered looked exactly like the bottle I used back in college. It is a plastic bottle, but it is specially treated to prevent the solvent from eating through it. I mention that, as the best way to apply DMSO is to pour it into a spray bottle and spray it on. But it needs to be an opaque glass bottle, as DMSO also breaks down in light.

       In any case, DMSO didn’t help back in college, and it didn’t help now. Also, after several uses, it began to make me itchy when I used it, so I stopped using it. But DMSO is rather inexpensive, that is, in its 99% purity form. A 99.999% purity form is also available. But whether it would help or not, I cannot say, as it is quite expensive, so I never tried it.

      Bottom line of all of these ointments is you might get some relief from them. But it is temporary, and some can get quite expensive if you use them long term. But at least the risk of side effects is far less than with oral medications:

 

      The most common side effects are localized at the usage site and include redness, burning, inflammation, and itching. More serious side effects are very rare and most likely related to an allergic reaction to one or more of the ingredients (Drugs.com. Icy Hot).

 

Cortisone Shot Recommendation

 

      By three months after my rotator cuff surgery, I was progressing very well, on schedule, and in a linear fashion. As a result, the pain had lessened to the point that I didn’t need the ibuprofen, but I continued to use one ointment or another pre- and post-workout.

      But then on November 17, I had a setback., I discuss what happened in my rotator cuff story linked to at the beginning of this article. Here, I will just say, I tried to get back on track on my own for a month. But when I was still struggling with ongoing pain, I went back to the surgeon who did the surgery. He didn’t seem to think I had torn open the fixed rotator cuff. He said it was probably due to inflammation and recommended another cortisone shot.

      I had gotten one back in May 2021 before the surgery. It alleviated the pain somewhat for five weeks. But then the pain came back as bad as ever. I was also going to physical therapy at that time. But when it did not help, that is when I realized I needed surgery.

      However, I was leery about getting a second cortisone shot. I had a rather serious reaction to the first shot due to my sensitivities. And I feared a second would be even worse. That was my experience with my two Pfizer Covid shots and my two shingles shots. I was okay with the first, but I had a significant reaction to the second.

      But despite that concern, I scheduled a shot for ten days later. I couldn’t get it at that time, as I was already scheduled to get my Covid booster, and you cannot get both at the same time (Howard J. Luks, MD. Cortisone). But then, over that weekend, the pain seemed to subside significantly, so I figured I could get by without the second cortisone shot. I did, but only going back to taking Ibuprofen regularly.

 

Side Effects of Ibuprofen

 

      However, after about a month, and knowing I had been taking ibuprofen on and off for several months now, I began to worry about the long-term side effects. I did some research on the Internet, and the list of potential side effects was quit disturbing.

 

      The more common side effects of ibuprofen are: 

·          stomach pain

·          Heartburn

·          Nausea

·          Vomiting

·          Gas

·          Constipation

·          diarrhea…

      Ibuprofen changes your body’s production of prostaglandins. This change can lead to an imbalance in your body fluid pressure, which can decrease your kidney function and increase your blood pressure (Healthline. Ibuprofen).

 

      That last point that stuck out at me. My blood pressure had been going up over the past few months, and I couldn’t figure out why. Well, it looked like I just found out. As a result, I stopped taking the ibuprofen. But when I did, my shoulder and arm began to bother me more, especially while working out. And when once again it began to disturb my sleep, I figured I’d better get the second cortisone shot.

      Some more research showed that it was okay to get up to three shots a year. More than that can actually weaken the ligaments. But since it had now been nine months since my first shot, I figured that would not be a problem.

 

      Cortisone shots are very safe to give, and side effects tend to be rare and minor. However, there are a few things you should know before having one….

      Cortisone is a very powerful drug. By injecting the cortisone into a targeted area of inflammation, strong doses of the steroid can be given while limiting possible side effects. Cortisone shots usually work within a few days, and the effects can last up to several weeks….

      Systemic side effects occur because the small amount of cortisone entering your bloodstream affects your whole body, not just the site where the cortisone was given.

      These body-wide effects are rare and usually minor (VeryWell. Using).

 

      If experienced, these tend to have a Severe expression: 

·         an infection

      If experienced, these tend to have a Less Severe expression:

 

·         conditions of excess stomach acid secretion

·         difficulty sleeping

·         high blood sugar (VeryWell. Using).

      There’s concern that repeated cortisone shots might damage the cartilage within a joint. So doctors typically limit the number of cortisone shots into a joint.

      In general, you shouldn’t get cortisone injections more often than every six weeks and usually not more than three or four times a year (Mayo Clinic. Cortisone).

 

Cortisone Shot

 

      With that background, I got my second cortisone shot on Friday, January 14, 2022. I went back to the exam room almost as soon I got to the office. A nurse came in and laid the needle and gauze down that the surgeon would use for the shot and left. I then sat there and waited for about 20 minutes until the surgeon came in.

      I really wish the nurse had not left the needle there, as it was about two inches long, and it was freaking me out thinking about it being stabbed into my shoulder. But the surgeon finally came in. We did not talk much. He just gave me the shot, and that was it. It hurt a bit, but not near as much as I had worried myself into thinking it would. And my shoulder did not hurt at all after the shot. But the surgeon told me to take it easy for a couple of days.

      Afterwards, I went to visit a relative and a friend. On my way home, I passed a new car wash that had just opened, and they were offering free car washes. I figured I’d take advantage of it. But after I drove through the car wash, I found out you could also vacuum your car yourself for free.

      I did that, but I had to use both hands to handle the long tube that attached to the high-powered vacuum, and my shoulder bothered me a bit afterwards. I stopped at restaurant to eat, then went home and took a shower. Then I had a large wash of clothes to put away. I had done the load of wash before I left, but I didn’t have time to finish. But when I did, that aggravated my shoulder a bit more.

      I iced it then and later that day. But it still bothered me some that night, disturbing my sleep. But it felt better by the next day (Saturday), and I rested most all of that day. I did not seem to have any serious reaction to the shot, like I had feared, other than I usually do after going out and stopping at multiple locations due to my MCS.

      But then the next night, I had a flare-up of my “organic tics” in my left shoulder, which kept me awake half of the night. I cannot say for sure if that was a reaction to the shot or not, as I get those tics often, and they can occur anywhere in my body. But it did seem quite coincidental.

      By the next day (Sunday), my shoulder was feeling okay. But I then had four boxes of food and other stuff I had ordered online to put away that morning. I wore a sling as I was doing so, to be as cautious as possible. Afterwards, my shoulder ached a bit, but not much. I worked out later that day, doing an upper body workout, and that went about the same.

      I then had a couple of more nights of my tics flaring up in my shoulder, disturbing my sleep. Thus, if that was related to the shot, I lost three night’s sleep because of it. Meanwhile, now, two weeks later, the pain in my shoulder and arm are about the same as before I got the shot.

      Therefore, it is obvious the second cortisone shot was a mistake. Negative side effect with no benefit. It also means, it is looking like I will be dealing with pain in my shoulder and arm for a long time to come. That means, I now have the same situation in left shoulder that I’ve had in my right shoulder for almost 23 years, ever since my bicycle accident back in 1999, a dull pain that flares up at times. I also experience overall body pain at times from my fibromyalgia. Consequently, it looks like pain will my constant companion for the foreseeable future.

 

Conclusion

 

      Go into any pharmacy in the country, and you are sure to find an aisle devoted to pain medications, and another one devoted to pain ointments. As such, it is obvious pain is a problem for many Americans. Unfortunately, I cannot give any strong advice based on my experience as to how best to deal with it, as I am still doing so. But I hope this article gives the reader some direction as to what to try and the cautions that need to be taken.

 

Notes:

      All product names mentioned in this article are registered trademarks of the respective companies.

      The product links are to Amazon, from which I received a commission if a product is ordered after clicking on one of the links.

 

References:

      Drugs.com. Meloxicam.

      Drugs.com. Icy Hot Pain Relieving Cream Side Effects.

      Drug Watch. Tylenol Side Effects.

      Healthline. Aleve.

      Healthline. Ibuprofen.

      Howard J. Luks, MD. Cortisone Steroid injections and Covid Vaccination: Timing is Everything.

      Mayo Clinic. Daily aspirin therapy.

      Mayo Clinic. Cortisone shots.

      Science Daily. Study Shows Long-term Use Of NSAIDs Causes Severe Intestinal Damage.

      VeryWell. Using Cortisone Shots for Inflammation.

      WebMD. Cortisone intramuscular.

      WebMD. Pain Relief Cream.

Pain Medications and Ointments/ Cortisone Shots: My Experiences and Side Effects. Copyright © 2022 by Gary F. Zeolla.

The above article was posted on this website February 1, 2022.

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