Thanks everyone. And of course Dr. Shelli for her knowledge. I forgot to call the vet. You see, that's why I asked here first. LOL.
So I take it then, Tramadol is not an NSAID. It's probably why my internist suggested it for Miko. And since Dr. Shelli pointed out that NSAIDs aren't good for kidneys, I should probably stay away from all anti-inflammatories as I'm assuming they all take a toll (which I should know since I take way too much ibuprofen/aleve). Hmmm.....
I had heard that glucosamine doesn't do much. When I started it, I figured it couldn't hurt. Of course I'm close to being out (I'm slacking on timing here - which reminds me I have to order something else), but it's costly and the money could go elsewhere if needed.
I forgot, my vet did suggest acupuncture. I wonder how much that would cost. I guess if it helps.....it may be worth it. Granted, the drive there may be stressing on him anyways. I wonder if they do it in-home. Hmmmm.....something to look into.
Neoprene. Well. I guess since Miko got used to his diaper, that may work. I can't sew on a button, so I'd have to enlist my Mom. I started thinking, maybe I can just buy one of those agility jacket thingy's. LOL. More expensive but no work necessary. Darn, nothing for the shoulder area, only a whole body thing.
I'll up Miko's Tramadol and see what happens. Right now, he's taking 12.5mg 2-3x daily as needed (I've been giving it to him mainly at night). I'll give him 25mg and see what that does overnight.

Or when he's having a really rough day. Some days are better.
Again, thanks everyone. I think it helps knowing I have a lot of options, even if they may not all work since Miko has kidney failure and I have to decide, is it worth it to tax his kidneys for XYZ? That part sucks.