Alternatives to lortab + remicaide failure?

When we decided to start Remicaide for my arthritis my doc said it would take 2-3 months to start working. After my second infusion I noticed barely a difference (could have been no difference). She asked me to wait a few more weeks but still nothing and I've gotten way worse since. I was writhing in pain for 90 minutes this morning before my medicine kicked in before work today. Today she said it won't start working until 6-8 infusions in, up to *46 weeks*! I can't live with this much pain and get through work/school. I made choices based off of incorrect information.

I couldn't find past threads on how long it takes-so how long till you noticed a difference?

I'm on meloxicam, lortab, gabapentin, MTX, lidocaine cream and I ice some joints at night. I took a round of prednisone that helped and asked my doc if I should take another round. I'm just grumpy now but I hate that some people say you can get through this without meds or without opiates. I am miserable even with the meds.

My current clerkship is at a detox and rehab center and many of our patients live with chronic pain, but my preceptor doesn't use any opiates if he doesn't have to. He usually uses 3 meds at once- methocarbamol (muscle relaxer), carbamazepine (mood stabilizer), mirtazapine (antidepressant). I guess the methocarbamol doesn't get patients as high as some others and the mirtazapine is used even when the patient doesn't have depression. I'd be giving up my lortab for 3 drugs, all potentially sedating. He's very respected in the medical community and very successful at what he does. It's very ironic that I sit there in immense pain and on Lortab while helping others get healthy.

I noticed a benefit after my 4th infusion. I hope you get relief soon !

There is perhaps not a worse pain med to use for PsA than loratab. It has a very high incidence of making PsA worse. Its hard to nail down exact number but it is somwhere between 10% and 40%. Who is prescribing it? You need to ask his reasoning. Meloxicam shoild be making a difference, if it isn't I think I woild be moving on. It is one of the milder NSAIDS. Most certainly another run of predi is worth asking for. You might also ask about the newer protocol for Remi. Its now every six weeks with a building front end load. If have had no reaction, it may be helpful. Some docs are resistant to doing it that way because of concerns over allergic reaction.

Narcos effect how all of the common PsA meds work., you may not buy into it, but long term they effect actual disease control and allow permanent long term damage. Your docs cocktail will help. With better inflamation control however you get it, you eill get on top of this.

Hello Jo,

I can't remember how long Remicade took to work, but it wasn't too long, perhaps by the third infusion. That being said, I am on Orencia now and it has taken four or five months to help. I am glad I didn't give up on Orencia as there are only so many medications to try (I have already gone through enbrel, humira and remicade). When Remicade worked it was a miracle, then it stopped working. I got a couple of good years from Remicade and I am thankful for that. I know a woman who has been on Enbrel for 10 years, it has always worked for her and she golfs weekly with almost no pain, we are all different.

As to Lortab, I am doing narcotic free pain treatment. I developed a nasty dependency to Vicodin. Then, on a terrible day, I decided to take a large number of the pills with the hope of not waking up. My pain management has been better since getting off of the narcotics. I use NSAIDS, tramadol (a synthetic opiate with far less abuse potential), daily Cymbalta and Effexor help with both pain and depression, daily low dose prednisone (5mg), and Toradol is my big gun for pain relief.

As I said above, everybody is different. I hope you find some relief. I would try the three medication cocktail. I would never return to the prescription narcotic hell I ended up in.

I had just about given up on Remicade. After the 5 th infusion, I started to see some serious relief. Unfortunately, it lasted 4 weeks and my infusions are set for every 6 weeks! But, this last infusion has really been good. I’m in my fifth week and I’m still holding at a pretty low amount of pain. My knuckles are starting to swell a little, but its so much better than the hell I experienced before my last infusion. I’m really hopeful that this will continue over the next six days. I think Remicade is really starting to work! I had my first infusion in December of last year (the loading doses, anyway).

So my timeline is this: I noticed some change after the fourth infusion (lasted about 2 weeks), after the fifth infusion I had 4 weeks of relief. Now I’m going into my seventh full infusion and I had pretty fantastic results this past five weeks. For me, that means continuous relief from swelling, or inflamed joints and significant pain relief. I still have pain, but I was told not to expect to be pain free, so I’m just happy to be able to function every day!

I could have sworn that Remicade wasn’t going to work for me. It really does take patience. I think that maybe docs aren’t as up front as they should be about Remicade. I also think they aren’t as up front as they should be about pain.

Obviously, if you are concerned, talk to your doc about it. Don’t be surprised if she tells you to be patient. (Easy for them to say!)

Lamb, that's interesting, and I don't recall a lot of people saying they are on it. But since Lortab is a combo of acetaminophen (tylenol, the stuff most of us pop with impunity) and hydromorphone, I assume that it's the hydromorphone that doesn't do us any good. Might explain why, after my surgery, the hydromorphone they gave me made me feel perfectly wretched. Is that the problem med for us?

tntlamb said:

There is perhaps not a worse pain med to use for PsA than loratab. It has a very high incidence of making PsA worse. Its hard to nail down exact number but it is somwhere between 10% and 40%.

Yes, the link is established. It is a rather difficult study to do..... Thus the range. I have heard various explanations. The one that intrigues me most is good ol' Koebner Phenomonen. If you talk to any older nurse who worked in a surgical ward in the old days when everbody stsyed in the hospital post op, A nasty rash on the chest almost like pustular psoriasis was not uncommon. Its just not political pressure that has the rheumys backing off the narcos. I'm not sure tramadol is the answer, but it certainly is a step in the right direction. There are some problems with that drug. I buried a foster kid who used an earlier version (as prescribed) The psyscological implications are huge......

I wish I had answers. Early aggresive treatment is the best.

I think better pain meds are in the pipeline and on their way. I don't think Tramadol is more than a temporary thing, These new drugs are going to be amazing (if they work). Here is one being developed from the venom of a cone snail:

Here is one for autoimmune diseases:

This one is from a sun anemone.

I looked at those, Debbie. Thanks! I’m content with my drugs right now. I wish I didn’t need them, but I haven’t found any non-opiates that give the same relief. I’m glad to know that there are better days and better drugs ahead.