My Primary suggested a PM Clinic. I was hesitate d/t the stigma assoc. with the clinics. I decided to go 7 months later since I can not seem to get off of the Prednisone without excruciating pain and inability to walk. Yesterday was my first day. The doctor wants to give me steroid injections in my SI joints and I agreed to have this done in May.....Has anyone found relief from the SI injections? The epidural steroidal injections worked for a few days and then back to square one. He also wants to inject Synvisc into my knee in which I said "No" but, after researching; have changed my mind. Gave me Butrans pain patch which takes 48 hours or more before feeling effectiveness. Is anyone familiar with that? I really want OFF of the Prednisone since it has caused hyperglycemia. I am wondering what my Rheumy will say about the PM Clinic. I know that if I told him my symptoms while weaning down from the Prednisone that he would put me on a higher dosage. I was diagnosed in Dec. with AS and PsA. Appreciate advice. TY.
I've done Synvisc several times, and it was very helpful. I went through a period of undiagnosable pain in my knees (ie, xrays, both standing and laying, and MRI's showed nothing other than inflammation) and it felt like something was scraping. The Synvisc gave me a buffer that helped reduce that problem for 6 months. After 18 months that pain / feeling went away completely. Very weird.
Anyway, I have also been to a PM clinic. At mine they offered talk therapy, acupuncture, and all the different psychotropic meds and pain meds. It was helpful at the time, because I lived in AZ and the doc couldn't prescribe any pain medication that helped (anything more than 6-10 pain pills for a month or two).
I think it depends on the clinic, and how competent they are, how comfortable you feel with the dr's there. Check with your state to see if there have been any complaints about the clinic too.
Pardon my ignorance but I don't have a clue what Synvisc means. Please enlighten me!
http://orthopedics.about.com/cs/treatment/a/synvisc.htm
bella said:
Pardon my ignorance but I don't have a clue what Synvisc means. Please enlighten me!
Pain Management did give me a few clues on methods for me to use.
I have had the injections into my spine which was for a herniated disc.
The risks associated with Prednisone long term is something you don't want. You do need to make an informative decision by checking it out very carefully. Plenty of info on the net.
Do you use Ice and Heat. One or the other may work better or alternate them. Don't leave ice on your skin for more than a few minutes at a time. Do you have a TENS unit as that might help. Are you on Methotrexate or a Biologic yet as they may help. What about a Non steroidial Anti Inflammatory drug.
I personally find it important to eat very healthy to give my body the best chance to help it work the best it can There are foods that will help with inflammation and ones that you might consider eliminating that might be making things worse. Can't harm and can possibly help. Might be worth trying for a month.
You said in your introduction that you were diagnosed in December so what other meds of you tried? Biologics?
You need to be having a discussion with your Rheumy as to whether or not PM is appropriate at this time.
The number one difficulty with PM is that it becomes nearly impossibly to treat your disease. Its a really hard concept to grasp but the pain is a result of the disease. Absolutley nothing that happens in PM treats the disease. In the case of the spondylitis types of PsA in particular poor control of the disease will lead to pain that no amount of pain management will ever be able to control. It will also lead to severe deformity and crippling. 4 months is not even close to the amount of time it take to get control and a treatment plan in place. Cover the pain and there could be some serious repercussions
Synvisc for PsA and AS????? I haven't obviously got all the information but I can not imagine a worse thing to do. It is a treatment for deteriorating cartlidge from OA. This is far from your problem (unless you have some OA going that you didn't mention) Its an extremly PROFITABLE procedure for the PM doctor. For you you are introducing additional material into a joint are that alreadyhas to much. It will dramatically INCREASE your pain, unless of course you are a marathon runner who has worn the knees out.
How long have you been seeing this guy? He has you on Buprenorphine Treatment???? This is the end of the line stuff Not the start. Or to put another way after nearly every other type of pain med has gotten to the point where they don't work INCLUDING oxy's and Fentanyl. Butran patches are brought out when the others are no longer working Its is an opiate antognist...it is also the main ingredient (Buprenorphine) in Suboxone or Subutex....which are primarily used for help with substance abuse... Yeah some use it for pain control but it is off label. Pop a percocet or some other opiate and you may not wake up. This is some dangerous chit.
You need to have a long serious talk with your reheumy about what he is up to and where he is going. Talk about injections you can only so many. Your PM talk needs to be talking to your other docs to make SURE he isn't going a tangent Synvisc and Butran is very scary.
I'm discounting your pain, we have all been there but what you are doing now very easily could make your pain untreatable and worse in the future. If your docs aren't communicating and you are getting treatment from several sources, you have the possibility of some serious complications.
Boy talk about a typo....
I am NOT discounting your pain.. sheesh.
Butran IS used in the UK more commonly than the US
tntlamb said:
Boy talk about a typo....
I am NOT discounting your pain.. sheesh.
Butran IS used in the UK more commonly than the US
WOW! A lot to think about. I have dealt with arthritic pain for many years. Back pain started in my late 20's. When I fell in 2011 on concrete is when I developed sciatica and numbness in my foot. Since I was seeing an Orthopedist for Osteo of my knees....he sent me over to the Spine spec. in the same practice where I had back surgery X 2 (CSF leak causing the 2nd two days later). Have been in a flare since the surgery 2012 (Apr.) and was not actually diagnosed til Dec. 2013. Initially, thought I had MS and have had every test imaginable. I have multiple autoimmune diseases.....AS, vitiligo, Scalp Psoriasis, PsA, IBD, and Hypothyroidism. When I am on 20 mg. Prednisone; I can function and walk. Any less and I am on crutches. Wondering if the pain is in control if I can get out of the flare and get off of Prednisone. That is my thinking. Humira did not work for me. Methotrexate was just d/c'd due to elevated liver enzymes, however, U/S showed liver is ok. On Enbrel with little benefits. Perhaps not on it long enough. NSAIDS have not worked besides getting my IBD out of control. Tramadol for pain is all that I have been taking since Sept of last year when I was given Percocet so that I could go on vacation. It didn't help much.
The other thing I forgot to say is that my Rheumy sends me to my Primary for all problems other than PsA and AS. My primary is the one who sent me to the PM. I will communicate this with my Rheumy. These are the only 3 doctors.
With all that going on...... Its interesting that you get control with such a (relativley) low dose of predi...one would THINK they could get the inflammation under control.....
Hopefully your docs will communicate with each other a bit better and come up with joint plan. The As is a bugger anbd frequently does lead to pain management.
It is my understanding that it can take some biologics up to six months to work. How long have you been on Enbrel?
I did have the injections in the knee in the Spring of 2012 and I was not dx until August 2012 and it worked for one and not the other. My right knee is all messed up due to a biking accident in 1985 but my left was not OA. And boy did it tell me. It swelled up like a balloon and it hurt! So be sure your knees have OA or it will not work.
I have taken 5 injections of Enbrel so perhaps it just needs more time. I definitely have OA of both knees as I have had
arthroscopic knee surgery on both and told my my surgeon.
Rebel mom said:
It is my understanding that it can take some biologics up to six months to work. How long have you been on Enbrel?
I did have the injections in the knee in the Spring of 2012 and I was not dx until August 2012 and it worked for one and not the other. My right knee is all messed up due to a biking accident in 1985 but my left was not OA. And boy did it tell me. It swelled up like a balloon and it hurt! So be sure your knees have OA or it will not work.
Synvisc is a treatment for OA. I don’t understand why a PsA Patient would be getting that. It is incredibly expensive and the injections are usually a step or two before a knee replacement. I don’t get that at all.
The butrans patch is great for pain control, but this is for people who have failed everything else. I don’t get why anyone would want you to skip everything else and go to that. There are numerous pain management options that don’t include such a strong drug.
My rheum gave me steroid injections in my knees and boy did they help. Easy, inexpensive (relatively speaking) and they helped. Be careful of any pain management group that has their own procedure room, or outpatient surgical center. You will be referred for all sorts of things that you don’t need simply because they may help and the doc can make buku bucks on it. When I went to pain management, I saw the MD one time. When he realized that I didn’t have a problem that he could stick a bunch of needles in, he sent me to the nurse practitioner, never to see the doctor again.
I totally understand the desire to get off of steroids. I came off of them myself due to some allergy like reactions (worst weekend of my life due to rebound pain). I take NSAIDs and opitates, cymbalta, and my psa drugs, completely changed my diet, do relaxation exercises and stretching, I use heat and splinting, and make sure I keep myself up and moving. There are so many ways to manage pain. These are all just band aids until you get the disease under control. I am always aware that this needs to me my priority. I am currently taking MTX and Remicade to accomplish that. It’s been a long road, but I am slowly getting there.
Anyhoo, my point is that a) your docs need to be working to manage the underlying disease better, b) maybe get a second opinion on what the pain management doc is planning.
Good luck to you.
I do have Osteo in both knees. Have had arthroscopic surgery on both knees. The PM doctor told me that the Butrans patch was mild?? I am down to Prednisone 5 mg./day now and can barely get around. Very discouraging. I am making myself get around but, it is so painful. I have had multiple steroid injections in both knees over the years as well as shoulders, and heel. Do not understand why they did not suspect arthritis then.
GrumpyCat said:
Synvisc is a treatment for OA. I don't understand why a PsA Patient would be getting that. It is incredibly expensive and the injections are usually a step or two before a knee replacement. I don't get that at all.
The butrans patch is great for pain control, but this is for people who have failed everything else. I don't get why anyone would want you to skip everything else and go to that. There are numerous pain management options that don't include such a strong drug.
My rheum gave me steroid injections in my knees and boy did they help. Easy, inexpensive (relatively speaking) and they helped. Be careful of any pain management group that has their own procedure room, or outpatient surgical center. You will be referred for all sorts of things that you don't need simply because they may help and the doc can make buku bucks on it. When I went to pain management, I saw the MD one time. When he realized that I didn't have a problem that he could stick a bunch of needles in, he sent me to the nurse practitioner, never to see the doctor again.
I totally understand the desire to get off of steroids. I came off of them myself due to some allergy like reactions (worst weekend of my life due to rebound pain). I take NSAIDs and opitates, cymbalta, and my psa drugs, completely changed my diet, do relaxation exercises and stretching, I use heat and splinting, and make sure I keep myself up and moving. There are so many ways to manage pain. These are all just band aids until you get the disease under control. I am always aware that this needs to me my priority. I am currently taking MTX and Remicade to accomplish that. It's been a long road, but I am slowly getting there.
Anyhoo, my point is that a) your docs need to be working to manage the underlying disease better, b) maybe get a second opinion on what the pain management doc is planning.
Good luck to you.
About the earlier diagnosis? Who the heck knows? I am rapidly losing faith in many doctors for the same reason.
A voltaren patch is mild. Butrans is not. Everything that Lamb says is true, and he has more hard facts than I do. What I know is from working with patients in the ER, so it’s more anecdotal. What I do know is this: it is definitely used like methadone for treatment of opiate addiction, it is not a mild drug at all, it is definitely used for patients with chronic moderate to severe pain. Read some about it on your own from reputable sited like NIH or samhsa.gov. It’s other name is buprenorphine and you will probably get more results using this instead of the brand name. Be careful anytime you are prescribed a drug that you are unfamiliar with. I won’t get an rx filled until I have read more about it. At one point, I just took whatever I was offered because I was miserable. Now, I wait to get a drug rx filled until I have looked into it more and not just for side effect info. I look at the best way to take it, best time of day, what side effects there are and if they can be prevented or counteracted, if it strips any important nutrients from my body, etc… I wouldn’t expect that everyone does that, but at least read about them, ask around, even better, ask your pharmacist. My pharmacist is like a Wikipedia page without all of the errors and he loves to talk drug talk with me. I know that you are in pain now and I know how awful that is, but I stand behind my recommendation to get a second opinion on those patches. Try to get in to see your primary ASAP. Ask for something to help you for right now and get in to see another pm doc. Lidoderm patches are pretty good and are non habit forming. They only work where you put them, and need to be wrapped with an ace wrap because they aren’t very stick. There are topical creams/ gels that are a compounded drugs. They usually have 3-4 drugs in them and you rub them into the painful area. They can do controlled drugs, but don’t have any of the systemic side effects. Also, there are the many nsaids that are out now that can help. Of course, there are also Percocet, Vicodin, and Tylenol #3 and Tylenol #4. Plus, there are all of the non-medicinal remedies I listed before. There are so many more options that what I can list or even have enough knowledge about to give good information. I am sounding very opinionated and I am sorry for that! I have no problem at all with pain management. I think it is a wonderful thing and use it myself. I am not judging anyone. I am simply concerned that your doc went from prednisone to Mach One in a single visit.
If you have OA, then the synvisc can be a wonderful thing. Most of the patients that get them at our center report some really great relief from the OA pain and the benefits of the injection last much longer than the steroids do. Plus, too many steroid injections into the joint capsule cause their own set of problems.
I really do hope the best for you. I know you must really be struggling now, and it really stinks like boys’ gym socks. 
The PM doctor told me that the Butrans patch is a "mild" narcotic. He said that he was putting me on something mild since I had not taken any narcotics since last Sept. when I went on vacation. I will discuss this with my primary doctor. I have had this 10 mcg. patch on for a week and have yet to have pain relief. I am also weaning off of Prednisone so, that may be why since I have been on Prednisone for so long. Thank you for you reply. Gives me something to think about and to talk to my doctor about.
GrumpyCat said:
About the earlier diagnosis? Who the heck knows? I am rapidly losing faith in many doctors for the same reason.
A voltaren patch is mild. Butrans is not. Everything that Lamb says is true, and he has more hard facts than I do. What I know is from working with patients in the ER, so it's more anecdotal. What I do know is this: it is definitely used like methadone for treatment of opiate addiction, it is not a mild drug at all, it is definitely used for patients with chronic moderate to severe pain. Read some about it on your own from reputable sited like NIH or samhsa.gov. It's other name is buprenorphine and you will probably get more results using this instead of the brand name. Be careful anytime you are prescribed a drug that you are unfamiliar with. I won't get an rx filled until I have read more about it. At one point, I just took whatever I was offered because I was miserable. Now, I wait to get a drug rx filled until I have looked into it more and not just for side effect info. I look at the best way to take it, best time of day, what side effects there are and if they can be prevented or counteracted, if it strips any important nutrients from my body, etc.. I wouldn't expect that everyone does that, but at least read about them, ask around, even better, ask your pharmacist. My pharmacist is like a Wikipedia page without all of the errors and he loves to talk drug talk with me. I know that you are in pain now and I know how awful that is, but I stand behind my recommendation to get a second opinion on those patches. Try to get in to see your primary ASAP. Ask for something to help you for right now and get in to see another pm doc. Lidoderm patches are pretty good and are non habit forming. They only work where you put them, and need to be wrapped with an ace wrap because they aren't very stick. There are topical creams/ gels that are a compounded drugs. They usually have 3-4 drugs in them and you rub them into the painful area. They can do controlled drugs, but don't have any of the systemic side effects. Also, there are the many nsaids that are out now that can help. Of course, there are also Percocet, Vicodin, and Tylenol #3 and Tylenol #4. Plus, there are all of the non-medicinal remedies I listed before. There are so many more options that what I can list or even have enough knowledge about to give good information. I am sounding very opinionated and I am sorry for that! I have no problem at all with pain management. I think it is a wonderful thing and use it myself. I am not judging anyone. I am simply concerned that your doc went from prednisone to Mach One in a single visit.
If you have OA, then the synvisc can be a wonderful thing. Most of the patients that get them at our center report some really great relief from the OA pain and the benefits of the injection last much longer than the steroids do. Plus, too many steroid injections into the joint capsule cause their own set of problems.
I really do hope the best for you. I know you must really be struggling now, and it really stinks like boys' gym socks. :-(
Today I received the first of three Synvisc injections in my right knee. Already, I feel good results. Have had Osteo for some time and arthroscopic surgery on both knees. Also had the SI steroid injections and feel some relief in my lower back. Still pain from the actual injections. My hips and legs feel heavy and still difficulty walking but, I have been in excruciating pain and this is wonderful!!!