Friday, 7 October 2016

in pain: the ongoing tale of shoulder impingement

Back at the end of January I did a post about the shoulder impingement I gave myself in September (by pointing at an aeroplane!). Go read it if you want to know lots more, but basically I'd damaged some tendons in my shoulder and it hurt a lot, and wasn't wanting to get better.

At the time I wrote I'd just had a cortisone injection and started getting physiotherapy on the NHS. I was feeling super optimistic.

After I wrote that the local anaesthetic wore off, and the cortisone turned out not to help after all. The optimism took a bit of a battering.

The NHS physio is a lovely woman who gave me exercises to do (after doing nothing for a bit to let the cortisone work) and reviewed my complete lack of progress at regular intervals. To start with my shoulder still hurt like hell several times a day. I had pain radiating down my arm, and my shoulder felt swollen inside all the way around (although I'm told it didn't look swollen).

I spoke to the doctor about managing the pain better. I was absolutely worn down with it, and so I started taking amitryptaline.

This was a big decision for me, and I'm glad that I've got a good doctor who keeps up to date with research and is great at communicating with people to talk through the options sensibly. Last time I had pain problems (you can read all about that deep joy here) I used gabapentin to try to tackle it. I don't know if it made me feel spacey or not, I was already pretty spacey with the pain... but I did feel increasingly distant from my own life. I felt increasingly useless, and started thinking that suicide was probably rather sensible. Thank goodness I said something about this to my husband (and that took a lot to do - I didn't feel like I deserved to be listened to about feelings like that, and I was sure he'd be angry with me, even if I did really feel that he'd see the sense in it). He insisted I go straight to the doctor and tell him how I was feeling. He made me promise I would even though I really didn't want to, and so I did. I was lucky, I got the nice doctor with Doc Martens, and I felt safe to tell him I'd been having some dark thoughts. "How dark?" He wondered. "Really, really dark." I told him. He told me that it was probably because of the gabapentin and I needed to start reducing my dose straight away. I didn't believe that he could be right, but I reduced my dosage and came off, and started to feel hope again. That pain stopped.

I am hopeful that this pain will stop too. But I am really scared of going down the rabbit hole that gabapentin sent me on, so I had a long chat with the doctor. He had seen in my notes that gabapentin 'really went for me' (as he put it), and that's why we decided on a low dose of amitryptaline.

It's working. The pain isn't radiating down my arm any more. That's made me feel so much more capable, even though I have less movement in my shoulder than I did before. The physio has kept me busy with my trusty yellow theraband, and mostly it doesn't feel like she's just keeping me busy.

The movement in my shoulder isn't getting better, in fact recently it's got a little worse. I still can't cuddle very well, or lift stuff, or get dressed. The swollen feeling has improved, but I still can't lie on my back, front, or on that side. It is still blooming annoying. But the pain has decreased, and not just from the painkillers. The moments when it gets really blooming sore have gone right down too, and the physio has added stretches to my strengthening exercises. Those stretches already feel like they're doing something and it's only the second day... they might just be improving my confidence, but that in itself is amazing.

The physio has also referred me to another more senior physio. Apparently this is where they send the cases that don't improve when they should do. In part, I'm taking this as a vindication that it is a REALLY blooming annoying shoulder, but mostly I'm looking forward to moving along the administrative ramps of the NHS. It's a few weeks until that appointment, from which I'm likely to get referred to someone who might (probably) operate to widen the gap the tendons go through as they've probably got thickened by all the damage done, and also to de-calcify the tendons if an X Ray shows that's needed.

Bring it on. I want to move on from this.

Update - October 2016

So, what happened next? Well, the fact is that I didn't write about it because initially it was too boring. Pain just keeps on giving doesn't it? Anyway, after I got referred to the senior physio I got a cortisone injection, and a break from exercises, and then another one. An X ray showed that there was no need for an operation. It took a long time, and I'm still working on it. A long time of boring physio, however, the pain decreased dramatically after this second round of cortisone, and I decided to take myself off the painkillers, possibly foolishly, because it did still hurt, but I felt that factoring them in to my everyday was making me feel like an ill person, and I wanted to feel like a strong person with a problem to overcome.

I've come a long way. I have reclaimed the dresses that tie at the back for my wardrobe, but I'm still spinning my bras around. I have graduated to a red theraband, but I'm still using one. I can wave my arms in the air like I just don't care, but only if I raise them thumb first.

I'm getting there, and so much more positive. And now I'd like a break from pain thanks. 2016 has enough on.