You are describing multiple issues, so by definition the answer is not going to be found in a single pill, office visit or surgery. I would echo Dr. Soller's comment, "which comment is most symptomatic?"
The evidence for long term significant benefit from chronic opiates medication in improving function or pain is limited at best. Even in the best circumstances, the long term results of chronic opiate medication is limited to about 25% improvement on average. Along with this improvement comes a myriad of potential risks and side effects.
A physiatry (physical medicine and rehab) specialist evaluation would be a good start to an overall multi-disciplinary solution.
Also, I would echo Dr. Koharchick's comments. An evaluation by an experienced clinical psychologist well trained in cognitive behavioral therapy and behavioral medicine based pain management would likely be beneficial. This evaluation can also help stratify the risk of medications such as opiates and help other treating physicians with the risk/reward assessment in choosing the best treatments for your specific situation. Often this type of behavioral medicine treatment can benefit in the range of 25-30% improvement as well a help form realistic goals regarding outcomes and limitations.
Certainly, if you have a chronic shoulder injury, a thorough evaluation by a board certified orthopedic surgeon, preferably sub specialized in upper extremity problems, is in order. A similar evaluation from a similarly qualified knee specialist may also be helpful. You may need one or both joints replaced if they are completely worn out.
An evaluation by a board certified interventional pain management physician would be a good start for the back, neck, and sacrum issues. This field is not only limited to epidural injections but also options to address pain from discs, facet joints, and SI joints. Technology has enabled significant advances in the last few years utilizing radio frequency ablation, ultrasound guided intervention, and spinal cord stimulation. If conservative means are not successful, a thorough evaluation by a neurosurgeon or fellowship trained spine surgeon may be required.
John B. Adams, DO, FIPP, DABIPP, DABFM, CIME
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