Pain Relief

I had a liver transplant five years ago, and have no complications at the moment.  However, I developed Avascular Necrosis in both shoulders and had also a hip replacement.  Is this common in transplant patients, and was it caused by the steroids?  Also, recently I have serious pain in the front part of both my ankles.  It feels like the tendons.  I can hardly walk.  Is this related?  NSAIDS relieve the pain but are obviously toxic to my liver and kidneys.  what pain relief can I safely take. Please.  They all seem damaging.  Please advise me. thank you.  Vanessa

[Thomas D Schiano, MD]

AVN can definitely occur post-transplantation and is in part related to the steroid use.  NSAID are relatively contraindicated because of their propensity for causing renal problems while taking the immunosuppressive medications.  You should see a rheumatologist.  Acetaminophen can be used up to 2gms a day for analgesia