Good news! I was just reading a new Sharper Image catalog. There is now a robotic device that washes windows.....lol. Something more for your list......

Our new house is chock full of windows, so Yes! Wow! Checking it out when I'm done here!

Marsharebel - I am currently an F cup with huge dents in my shoulders. I was a C cup by 7th grade, a D by 9th, DD by graduation. Then after each child a little bigger! Losing weight will likely get me down to an E (two sizes down). I prefer my weight at 150 pounds, which puts me right at a DDD or E - still way too much. I've actually had the arthritis in my shoulder since I was 28 (that's when it was dx'd) and it is very likely due to the unfortunate excess of mammary glands!

Yesterday morning I called another pain clinic to ask what kind of treatments they offer. I had actually done a consult with them two years ago at the same time I met my current doctor. I originally went with my PMD because she stressed that she's "integrative" and the other clinic seemed a little too casual about the meds - which I was pretty concerned about at that time! The gal I talked to was encouraging and indicated they would be happy to take me on, so when I go to my next appointment, if my PMD doesn't want to work with me I have a second option to fall back on!

One other thing I did was call Perdue, who makes the OxyContin, and spoke with one of their staff pharmacists. My PMD insists that a 10 mg OxyContin contains MORE than 10 mg of oxycodone, that it is much "more powerful", though she's never been specific on how much she thought was in them. The pharmacist confirmed what I thought, there really is only 10 mg! It's not that I want her to increase my script - for me it's about not having smoke blown at me. I'm not sure what her purpose is in giving me bad information - was it supposed to trigger the "placebo" effect and make me think, "wow! that's a ton of medicine, I won't feel any pain now!!"?

Anyway, I think my list is getting honed down and hope to have a really productive appointment!

In the late 1940s, the steroid cortisone, an anti-inflammatory drug, was first synthesized and hailed as a landmark. It soon became a safe, reliable means to treat the pain and inflammation associated with sports injuries (as well as other conditions). Cortisone shots became one of the preferred treatments for overuse injuries of tendons, like tennis elbow or an aching Achilles, which had been notoriously resistant to treatment. The shots were quite effective, providing rapid relief of pain.

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Then came the earliest clinical trials, including one, published in 1954, that raised incipient doubts about cortisones powers. In that early experiment, more than half the patients who received a cortisone shot for tennis elbow or other tendon pain suffered a relapse of the injury within six months.

But that cautionary experiment and others didnt slow the ascent of cortisone (also known as corticosteroids). It had such a magical, immediate effect against pain. Today cortisone shots remain a standard, much-requested treatment for tennis elbow and other tendon problems.

But a major new review article, published last Friday in The Lancet, should revive and intensify the doubts about cortisones efficacy. The review examined the results of nearly four dozen randomized trials, which enrolled thousands of people with tendon injuries, particularly tennis elbow, but also shoulder and Achilles-tendon pain. The reviewers determined that, for most of those who suffered from tennis elbow, cortisone injections did, as promised, bring fast and significant pain relief, compared with doing nothing or following a regimen of physical therapy. The pain relief could last for weeks.

But when the patients were re-examined at 6 and 12 months, the results were substantially different. Over all, people who received cortisone shots had a much lower rate of full recovery than those who did nothing or who underwent physical therapy. They also had a 63 percent higher risk of relapse than people who adopted the time-honored wait-and-see approach. The evidence for cortisone as a treatment for other aching tendons, like sore shoulders and Achilles-tendon pain, was slight and conflicting, the review found. But in terms of tennis elbow, the shots seemed to actually be counterproductive. As Bill Vicenzino, the chairman of sports physiotherapy at the University of Queensland in Australia and senior author of the review, said in an e-mail response to questions, There is a tendency among tennis-elbow sufferers for the majority (70-90 percent) of those following a wait-and-see policy to get better after six months to a year. But this is not the case for those getting cortisone shots, he wrote; they tend to lag behind significantly at those time frames. In other words, in some way, the cortisone shots impede full recovery, and compared with those adopting a wait-and-see policy, those getting the shots are worse off. Those people receiving multiple injections may be at particularly high risk for continuing damage. In one study that the researchers reviewed, an average of four injections resulted in a 57 percent worse outcome when compared to one injection, Dr. Vicenzino said.

Why cortisone shots should slow the healing of tennis elbow is a good question. An even better one, though, is why they help in the first place. For many years it was widely believed that tendon-overuse injuries were caused by inflammation, said Dr. Karim Khan, a professor at the School of Human Kinetics at the University of British Columbia and the co-author of a commentary in The Lancet accompanying the new review article. The injuries were, as a group, given the name tendinitis, since the suffix -itis means inflammation. Cortisone is an anti-inflammatory medication. Using it against an inflammation injury was logical.

But in the decades since, numerous studies have shown, persuasively, that these overuse injuries do not involve inflammation. When animal or human tissues from these types of injuries are examined, they do not contain the usual biochemical markers of inflammation. Instead, the injury seems to be degenerative. The fibers within the tendons fray. Today the injuries usually are referred to as tendinopathies, or diseased tendons.

Why then does a cortisone shot, an anti-inflammatory, work in the short term in noninflammatory injuries, providing undeniable if ephemeral pain relief? The injections seem to have an effect on the neural receptors involved in creating the pain in the sore tendon, Dr. Khan said. They change the pain biology in the short term. But, he said, cortisone shots do not heal the structural damage underlying the pain. Instead, they actually impede the structural healing.

Still, relief of pain might be a sufficient reason to champion the injections, if the pain were severe, Dr. Khan said. But its not. The pain associated with tendinopathies tends to fall somewhere around a 7 or so on a 10-point scale of pain. Its not insignificant, but its not kidney stones.

So the question of whether cortisone shots still make sense as a treatment for tendinopathies, especially tennis elbow, depends, Dr. Khan said, on how you choose to balance short-term pain relief versus the likelihood of longer-term negative outcomes. In other words, is reducing soreness now worth an increased risk of delayed healing and possible relapse within the year?

Some people, including physicians, may decide that the answer remains yes. There will always be a longing for a magical pill, the quick fix, especially when the other widely accepted and studied alternatives for treating sore tendons are to do nothing or, more onerous to some people, to rigorously exercise the sore joint during physical therapy. But if he were to dispense advice based on his findings and that of his colleagues systematic review, Dr. Vicenzino said, he would suggest that athletes with tennis elbow (and possibly other tendinopathies) think not just once or twice about the wisdom of cortisone shots but three or four times.

Thanks, Fantod! Yesterday in my research I came across several articles that said that steroid shots actually cause breakdown in the tendons over time. I think my doctors so far have all thought this, as every Dr. I've had from my first Dr. in 1999 (when I was just 28) who dx'd my shoulder arthritis to my current PMD has said that I am too young for "typical" arthritis injections.

One reason I've been given is that you can only get so many steroid injections in a lifetime, and the second is that they can cause more damage. I never knew until I started researching recently why those things would be true, but luckily I just took their word for it and never pushed!

You've gotten lots of advice, about specific meds and TMJ things.

We all are perpetually trying to refine our own game plans to manage symptoms better.

2 things I'd like to mention:
First, Individual variation in reaction to meds and other treatments, and variation overtime to a particular treatment. No standardized reactions.

2nd, the one thing you don't mention is 'PACING' your activity. You mention doing less, but pacing is the practice of deliberately alternating brief periods of activity with rest (even just sitting reading) this allows the body to avoid flares.

P.S. Most likely the worsening of your TMJ is that your fibro is in your jaw now as well. Fibro tends to hit our weakest areas most severely.

Best of luck.

Yes, pacing is an important trick that I have yet to master. I find that I most often don't know I've done too much until my pain is out of control, because I am pushing through discomfort to do things.

The TMJD has been around for a long time - for me the fibro is newer. I now know that I used to have TMJD "flares" that would last several months of almost constant pain - I thought they were ear aches! The fibro is newer - I can look back and see the symptoms in the last three years, but just got dx'd at the end of 2012.

Since fibro seems to be caused by the brain mis-firing pain signals (I'm oversimplifying), it seems likely that the TMJD caused the fibro. Too many pain signals sent from the jaw over the years I guess, my pain circuits are fried.

Trix,

Your TMJD may have been a causative factor Only you know what else was in play in your existence as well. (In my case I have a long list of possibilities)

Even w/ TMJD coming first, the fibro can still ramp up the pain.

I hope you try out PACING, adding that sort of moderation can really help, and at minimum shorten recovery time.

I was sort of agreeing with you... since the fibro is basically the brain mis-firing pain signals, it could be the TMJD caused it, and now my real problem is the chronic pain syndrome (fms or whatever) has become primary.

Which really makes me realize that I MUST get a nerve pain med into my regimen, as it is completely lacking!

I have horrible TMJD...I can relate to that pain!!

Read, I think in the aquatherapy article I posted, that the TMJD might be caused (or is it made worse?) by people clenching their jaw. In my case, I put all the stress in my upper back.

That's actually one of my biggest frustrations out here in the real world - everyone hears TMJ and thinks I clench or grind my teeth, which I don't. I wish I had a dollar for every time a split has been suggested. :)

That is, I think, the most common cause though.