At what point do you stop taking NSAIDS because they don't work and what would be next?

I have been diagnosed with PsA and my rhemy has me on methotrexate, gabapentin and then has tried 4 different pain medications which were all NSAIDS. At what point is it time to try something else. I do not respond to NSAIDs and even took OTC naproxen, which helped several years ago but now doesn't. Is my doctor just humoring me or is this really the course of action to take. Confused in Michigan :|

My take Sis, is that your doc is cycling you through the standard treatment protocol. Most DMARDS (methotrexate) take around three months to really get in their stride but if you're not seeing any benefit at that time it's appropriate to be asking "what's next?". NSAID's to my mind are an accompanying therapy not 'the' therapy.

The thing I've learnt is that each doc has his/her own way of doing things so you may be offered another DMARD next, maybe sulfasalzine or leflunomide and after this they may be looking at a biologic, depending on your disease severity.

I reckon we all need to give any treatment a good three months, maybe a bit more if there are any positive signs.

I started on NSAIDs. I had different DMARDs added in or substituted, but the NSAIDs have remained. I have taken different ones through the years and added in a biologic a year and a half ago. But I still take diclofenac for long stretches of time. They work, but not as a solo therapy.

When you start to feel that they are not working You must communicate with your doctor and let them know. Then you will sit down and start to go over all of your choices. It has to be an individual decisions to move one to the next line of drugs The doctor can only suggest but in all it is up to you.

I guess my first question is why he has you on gabapentin? This is usually only used with PsA when there is co-ocurring conditions or underlying nerve damage....... In which case the treatment of your PsA may very well be responding to both the NSAIDS and MTX. NSAIDs only eliminate pain in so far as the pain is caused by inflammation.

The reasons for gabapentin usually respond best to lifestyle changes such as weight loss, exercise splinting surgery etc. and rarely to pain medication

I've cycled through lots of NSAIDs - Naproxen, meloxicam, diclofenac, celebrex. At first the Naproxen worked, the meloxicam not so much, the diclofenac worked ok but then gave me terrible gastric distress, and now celebrex which works-ish (meh - not really but it does seem to help a little with the inflammation) but I think I'm developing similar issues to celebrex as I had with diclofenac (bloating, omg I feel so fat and heavy) so I've decided to take a break from it to see if it helps.

The thing with NSAIDs is that they help with inflammation more than pain - so it might not be terribly noticeable how much they're working until you stop them and it's out of your system. If it's loosing effectiveness then tell your doctor - there are a lot of NSAIDs out there these days.

Your doc may be wanting to keep you on them to help keep inflammation down - which will help prevent damage until you find a systemic drug (DMARD/biologic) that works to keep everything in check. Just taking a regular pain pill, like tramadol or similar drugs, won't do anything to the inflammation but may help with pain.

I was diagnosed 4 years ago and only just got a prescription for something stronger than an NSAID for pain (tramadol). I think this is partly because of my own reticence in asking for it, but also protocol - doctors don't really want to give you anything stronger than they have to, especially if you're looking at medication that can become habit forming such as narcotics.

It's all about balancing your best interest with symptom/pain control. Which can be difficult especially when you're "in the gap" so to speak of looking for an effective treatment.

Out of curiosity - are you on a DMARD or biologic yet?

I am on methotrexate - I am now up to 7 2.5mg tablets. So does my treatment plan sound normal even though I am hurting most days of the week. As I said I take Methotrexate, nabumetone (500mg twice a day), and Gabapentin 400 mg three times a day. I just don’t understand why he isn’t putting me on a different DMARD or biologic. My last blood work showed I still am out of range with most of the inflammation… I have been thinking about trying a new doctor now that I have BC/BS…

Ah sorry, I missed the mtx. I’m sorry it’s taking so long to try a new med. Sometimes treatment progresses slower than we’d like and there’s a lot of hoops to jump through with insurance and biologics, at least (including getting “approval” - if my doctor thinks I need it why can my insurance say I can’t have it?). If ask him at your next visit if the mtx doesn’t seem to be working for you, and if you don’t get a satisfactory answer def might want to change docs.
I hope something changes for you soon, I know how much the waiting part sucks.

you are still at a fairly low dise (for PsA) of MTX. Most folks work up to 25mg and quite a few switch to injectable to get full benefit.... Its best to work up if you can.