A question about pain meds

My last infusion did not help me,so for the last four weeks I have had a lot of pain. I have tramadol but I’ll be the first to admit I don’t like taking pain meds. Anyway regardless of the type of pain med should you take them regularly so that the pain doesn’t come back or do you only take them when the pains really bad. I’ve been using the voltaran gel but my SI joint is swollen & very painful. I can’t take the tramadol late at night because it keeps me awake. I’m not sure I’m managing my pain very well. I used to go to a pain management doc in between back surgeries maybe its time to go back. Thoughts anyone?

I'd consult with a pain management specialist, definitely. You might be able to find a pain medication that is a better match for you. I've been through all of them, and found things that work for me with very minimal side effects. I can pick and choose out of what I have to fit the pain I have, the time of day, and level of activity I need to do.

I've done pain medications both ways...consistently, and as needed.

I've found that "as needed" works for me MUCH better because I don't have as many withdrawal issues, and am not as tied to my medication, in case a dr. just up and stops prescribing for me.

I agree with Marietta.

I personally built up a tolerance to tramadol very quickly.

Now I only take the pain meds if I absolutely have to.

No one knows but you, how bad your pain is, but the pain management people hopefully can help.

I'm not a fan of tramadol either. I don't like the way its marketed as being a safe alternative. Just because its a synthetic and an antagonist, doesn't mean it can be every bit as problematic as the opiates and I truly believe it will join its predecessor Stadohl as a good idea gone bad. Some people do well with it but its not different in the end than oxys and a lot harder for most to come off of.

Please be careful of pain management. its a hard path to back off once started. Make sure nothing else is woking. We all have times when we need a little extra help. If its anything but short term, there is a problem that needs addressed. (the answer may be the same but the question needs asked whats wrong???????)

I agree with you about what’s wrong?? Since I was diagnosed very slowly but surely I have gotten more pain in new places. Current right now I have pain in both feet,right foot is smallest 3 toes then up the outer side of foot,it does feel more like tendon than joint. Left foot is on the top of foot & all around the area that I had a cyst removed last year. My right SI joint is bad, I also have bursitis on my right hip. My left hand & wrist have got worse,my right wrist has joined in. My right shoulder is a mess & I have recently started with jaw pain. So despite being on a number of different meds it doesn’t seem to be getting better. I’ve only ever had one set of X-rays done at the beginning,I am however going to see an ortho about my shoulder. Steroids shots into hip,SI & shoulder all help for a while but isn’t that just masking the problem. Something else fairly new is a pinching sort of pain on my right foot and an area on my left knee that keeps going tingly & numb.

If getting shot up helps, its inflammation. They should can find the right combination NSAID, DMARD and Biological. I wnet through 8 NSAIDs before I got the right one. Changed doese 3 times with MTX and Twice with Enbrel. It took over a year and 3 predi bursts but got it.

But please be careful getting shot up. Its pretty easy to rupture a tendon with PsA, getting shot up makes it easier after few times. Don't shy away from podiatrists or orthopedists (just keep your rheumy in the loop. The rheumys sometimes forget we are not only subject to wear and tear as well as injury just like everybody else, but are more likley to have it. We are constantly compensating for something and in turn causing stress/injury on something else. Its a merry go round going to fast. But unless one is completely nuts pain has a cause.

I too am prescribed Tramadol but take it on an "as needed" basis for a lot of the same reasons as mentioned in this thread. For some of the same reasons mentioned by tntlamb, NY has actually gone ahead and made it a controlled substance and is part of the I Stop Law.

I take tramadol as needed, especially considering it seems fairly easy to build up a tolerance to it. When I think about pain, I usually think of it as an indicator that there's something that I need to deal with better - either through medication (such as an increased dose of Remicade because it's active PsA pain), PT/OT, or other means.

I’m having my Remicade dose increased next week. Another question,how does the rheumi know if its PsA related or something entirely different?

PsA is a serious, systemic disease that can affect just about every part of your body. It makes sense to treat the PsA first, if there isn't something REALLY obvious wrong otherwise.

Have you ever heard the saying, when you hear hoofbeats, think horses, not zebras? Dr's are trained to look for the most obvious answer first, before jumping to an exotic solution.

Lindseylou said:

I'm having my Remicade dose increased next week. Another question,how does the rheumi know if its PsA related or something entirely different?