I’m not sure whether this is a new topic or an old one, but it is based on a problem quite new to me.

Six or so months ago, I was diagnosed with PsA and was put after a couple of false starts on a combo of methotrexate, Enbril, and NSAIDS. It was working pretty well: not perfect, but I had been able to resume much of my old life.

Six days ago, I was diagnosed with atrial fibrillation and was put on a pretty potent anticoagulant. The problem is that NSAIDS, which had been my only painkiller and working pretty well in that capacity, are forbidden when on anticoagulants.

I feel the difference without them: the pain is increased pretty markedly, so that I am losing ground on getting active again.

Does anyone else have experience with such a problem?

I can relate. The nsaid i use is naproxen and it makes a huge diiference. I know this because I have had to stop taking it so I could prepare for a procedure due to it being a blood thinner. I take naproxen along with a 24 hour opiod. That allows me to function somewhat so I can attempt to hold my job. So far I am working still. I am hopeful another solution will appear for you. That is a difficult situation. Hang in there.

I can’t really take NSAIDS gor any length of time or my tummy rebels. For some reason I like to form erosions in the lining of my stomach. I have Celebrex and sometimes I can take it. When I can it helps some but not enough.

I’ve recently had two attempts, with different ppi stomach protectors, to take a short course of naproxen.

First time with omeprazole, which made me badly nauseus before I’d even taken the naproxen. I think I “lasted” just over a week before I was feeling so rough after both that I decided to stop.

Next attempt, which ended last Sunday, was with the ppi lansoprazole which I tolerated without any side effects but it was day six of naproxen (and we are talking minimum dose here) that laid me out. Enough’s enough!!

Frustratingly the naproxen was helping quite a bit. I felt like my whole body had been oiled and was operating freely. I was walking really well and the nightime pain which would wake me and the stiffness/pain moving in my sleep which also woke me … gone!

I’ve had Arcoxia in the past as a rescue med and that worked wll but it’s for 14 days only so not a longer term solution.

Looking forward to updating my rheumy on this in a couple of weeks and seeing what her next plan is.

My rheumatologist suggested I give tylenol (generic) a try - 1000 mg 3x/day - though the stuff hasn’t done squat for me in the past, likely because it has nil anti-inflammatory effect. I’m hoping it might give just enough relief that I can ignore what pain is left and carry on. My days of being pain-free are over, apparently, so I’ll have to settle for whatever I can get. We’ll see.

I had to stop nsaids due to highly elevated liver enzymes. After a month I was in intolerable pain and went to a pain clinic. The experience was horrific but a week later, I am a new person. I haven’t been this low on the pain scale since PsA began 2 1/2 years ago. You could look into it. Probably what did the most good was the huge dose of long lasting steroids. All of my joints have improved. I’m not pain free, but I can walk without leaning on the cart while shopping and can stretch way more than I was able to before. The added mobility has further reduced pain. I don’t recommend using pain killers like tylenol except for headache because they can cause liver damage like nsaids. My rhuemy told me I can take tylenol twice a week. Having said that, the procedure at the pain clinic has also reduced my headaches from pretty much constant to far less frequent and much milder.

Yep, a lot of NSAIDs can do that. I was on a high dose years ago for a bad disc in my neck. Developed arrhythmia and docs took me off of them forever after they spent a half day checking my heart.

After a few years I can tolerate a couple a day now and that is about it.\

Be careful,

I have GERD problems and recently saw a pharmacologist as part of a pain program. She advised me not to take Celebrex regularly due to the risk of cardiovascular effects, but has suggested that during a flare I take Celebrex during the day (with ppi), then at night to give my stomach a rest, take low-dose paracetamol-codeine (which is more compatible with rest and sleep than it is with the type of work I do during the day).

This probably works for me because most of the time I’m well-managed with a DMARD (biologic in my case).

I have severe stomach pain if I take more than a couple of doses of NSAIDS. But this morning I fell down when leaving the restaurant where my husband and I had brunch in honor of his birthday. Since my disastrous knee surgeries I cannot get up unassisted, so we had to call the fire department. They were less than a block away, and they quickly got me to my feet again. I was bruised but basically unhurt. But my chronically inflamed edema knee had twisted in the fall, and it was hurting. So when I came home I took four aspirin. I figured I could get away with it because I had a full stomach. So far, so good! I was sorry to create an incident on my husband’s birthday, but I assured him he could still go play Bridge this afternoon. Anyway, I can get away with limited use of NSAIDS, and I save them for emergencies. NancyJ

I am on a blood thinner because of a recent diagnosis of atrial fibrillation. As a result, NSAIDS are completely out the window, with the possible exception of Tylenol, which doesn’t do squat anyway. So unfortunately I need an alternative to NSAIDS, not a way a managing my use of them.

Tylenol is not an NSAID but rather an anelgesic. What does your doc say? Many of the modern “blood thinners” don’t preclude the use of NSAIDS. But there are alternatives including some steroids and antibiotics althought they carry risks of their own.

Meloxicam is a possibility as is celebrex or Non-acetylated salicylate drugs, like choline magnesium salicylate (Trilisate) and salsalate (Disalcid) and eve some of the newer COX 2 NSAIDS

Yes Kutya, we heard you. And as a part of responding with our experiences, Woodworm mentioned a 24 hour opoid, Kmwestmo spoke about a pain clinic and steroid injections, I talked about a pain program, gentle opioids and having a DMARD that manages these things well. Perhaps you could talk to your doc about these options and ask what else is available?

The Nsaids are analgesics AND anti-inflammatories, which tylenol is not. It is also a rather weak analgesic by comparison w/ the NSAIDS per se. I will not take opioids, period. This conversation seems more of a pissing contest than an actual conversation, frankly. I’ll not participate further.

It has always seemed to me that the subject of pain relief is potentially complex.

When contraindications with other meds, severe side effects and downright lack of efficacy come into the picture, that is complex. There are no quick answers, it’s trial & error and a voyage of discovery. Few discussions about pain relief are going to be nice & simple.

When people ask me why I don’t take pain meds these days I usually say it’s because I don’t get much pain really and if I do, it doesn’t last. But also, rightly or wrongly, I shy away from the quest for the ‘right’ drug.

Severe and unrelenting pain - well that is grim but to my mind the answer is relatively straightforward: take anything that fits the bill which your doctor recommends, taking into account all the factors that apply. When I did have severe pain that wasn’t going anywhere, the only answer for me was steroid shots. NSAIDs didn’t work for me at the time.

For intermittent pain, well I continue to avoid painkillers and just complain. I also go into myself on such days - avoiding people, doing things that require focus but little physical effort. That’s not always practicable though. More positively, I am always looking for types of movement that help - it amazes me that 10 minutes tai chi often eases my ‘back & bum’ pain, if only for an hour or so. Resting helps too - I don’t like taking to the sofa at 3pm but if I can get the balance of rest / activity right then the result is pain relief to some degree.


I haven’t been forced not to take NSAIDs but because of the risks involved with them I would like to go off of them. So far I haven’t been able to, though I keep trying.

This week one of my MDs mentioned to me that she uses curcumin/turmeric for pain. She also can’t tolerate the gut issues caused by NSAIDs. I might give that a try.

Hey, just chiming in. If nsaids are not an option here are a few things to consider. Most important—treat the main symptom of the inflammation. This means you need to see a rheumy who can prescibe, biologics or dmards, or some such. Second speak to your rheumy or pcp to deal with symptoms. This includeds pain, fatigue, mobility,brain fog, mental health, and whatever else you will encounter. Talking with your rheumy or pcp about managing pain will require a recommendation to a pain clinic. There are many and/if personal and situational case by case types of things. If you have a doctor and you are feeling like you need another option for nsaids then medical marijuana could be helpful to deal with inflammation. I have read a few papers regarding this. Meloxicam and those types of medications deal with prostaglandins. The upside to this treatment depending where you live is it could also help pain. Mileage may very and it is all situational.

I read that PsA can cause Afibrilation, due to inflammation around the heart. I will try and find the article.
I was first put on Celebrex, did very well with it, but they took me off when I started DMARD’s, I think it was replaced by Plaquenil. If you are having heart problems, they certainly will not give you something strong like Celebrex.
Why are you not being started on Biologics?

Yes, I am on 24 hour opioid and when I am having a procedure I have to stop taking nsaids I notice an uptake in pain which I believe is related to inflammation. I take nsaids along with my opioid currently and both have a place in treating my daily life. There may come a time when I cannot take nsaids any more. I do not look forward to that day and hope that I can take them without issue for a long time.