I was just diagnosed a few weeks ago with PsA. I have been fighting the joint pains for years and finally found a doctor that was willing to listen and get me set up with the right specialist. I was put on Methotrexate and refused any pain meds. Most of the pain meds that I have taken in the past make my head feel so bad that I would rather deal with the pain. Trouble is that now the pain is starting to interfere with my work. I work in a profession where being on anytime of narcotic is not allowed.
Does anyone have any suggestions?
Also the Methotrexate leaves me feeling tired all the time and yet I cannot sleep. I have been getting 2-3 hours a night since I have started taking it. Is this something normal that my system just needs time to adjust to the meds first?
Like you I have refused to take pain meds. Until last week, that is. I had a NASTY SI joint flare over Memorial Weekend. Even cut my vaca short. Talk to your doc about Tramadol. Took the edge off and allowed me to continue on. I only take it when needed.
I also refused pain medication, only taking Tylenol Arthritis. Then my most recent flare made me actually shake, I was hurting so badly. Tylenol with codeine takes the edge off. Flexeril made me sleep. I find when I am hurting, I tend to tense up which makes everything worse. I only take the Tylenol with codeine and Flexeril when I really need it. I've started taking the Tylenol Arthritis daily.
Getting your sleep back in sync will help a lot. Most often a course of amitriptyline at bedtime helps a bunch and also resets your pain center getting things going. If you are not getting help with the MTX within a couple months its time for a change. You will have to experiment with an NSAID. It takes several. He may want to jump start you with a course of prednisone is you call him.
I am sure there is a biologic in your future. The sooner the better. Keep your resolve on the narco's it is a wise decision and one that will serve you well. It is a slippery slope that there is no turning back from. Loss of a job will really cause a flare
Under NO CIRCUMSTANCES should you ever take tylenol with MTX unless your Doc tells you. and then ask him at least twice to make sure.you heard him right. Avoid ibuprofen drugs as well (without instruction) You only have one liver and a new one is VERY expensive.
Pain meds will not help the disease and will slow your treatment. We are also learning they ultimately cause more pain and new sources of pain (secondary fibromyalgia, hyperalgesia etc) We all have had an acute pain problem from time to time. I have learned how over the years to take care of it with other means be it TENS PT heat cold stretches etc. many of these episodes are far worse than the old days when it was the pill bottle. The only difference is by treating the disease I get past them better faster and ultimately with less pain.
I am assuming you are an EMT, which certainly is a physically demanding job. I would suggest you get with a PT who is also an athletic trainer and develop a routine specific to your job needs. Stretching through the day and stabilizing joints with muscle (possibly splinting) will help immensely ALSO I don't care how much you are drinking (water) double it while on MTX the "normal 8 glasses" needs to be sixteen, with your job even more. If you are not taking folic acid get some prescribed and remind your doc of your job - you may need more.
Enthesitis is the hallmark of this disease. I have met few EMTs that don't have PsA that have escaped periodic bouts of tendonitis and low back "stuff" I would assume you are wearing a brace, but if not start. But most important is regular stretching. Swimming and hot tubbing is great for your profession too. If you have a hospital connection and can get into their warm water therapy pool for stretching so much the better.
Good luck better days ARE comming
I was told to take the medication I am on and to never take Advil with Methotrexate. The best course of action is to always ask your Dr. for guidance because they should know how you react to certain medications better than anyone. I also started taking Tai Chi classes at a local YMCA. The warm up/stretching exercises are wonderful at relieving pain. :)
Metx makes me tired still, but no problems sleeping. I don't remember if I had that problem in the beginning, but I do know that it takes your body a couple of weeks to adjust to any med. I don't take any narcotic pain med. If fact my Doc is very against any pain med because of the effect on the liver. I am on an noninflammatory. It helps a little. You might ask your Dr about that.
tntlamb said:
Getting your sleep back in sync will help a lot. Most often a course of amitriptyline at bedtime helps a bunch and also resets your pain center getting things going. If you are not getting help with the MTX within a couple months its time for a change. You will have to experiment with an NSAID. It takes several. He may want to jump start you with a course of prednisone is you call him.
I am sure there is a biologic in your future. The sooner the better. Keep your resolve on the narco's it is a wise decision and one that will serve you well. It is a slippery slope that there is no turning back from. Loss of a job will really cause a flare
Under NO CIRCUMSTANCES should you ever take tylenol with MTX unless your Doc tells you. and then ask him at least twice to make sure.you heard him right. Avoid ibuprofen drugs as well (without instruction) You only have one liver and a new one is VERY expensive.
Pain meds will not help the disease and will slow your treatment. We are also learning they ultimately cause more pain and new sources of pain (secondary fibromyalgia, hyperalgesia etc) We all have had an acute pain problem from time to time. I have learned how over the years to take care of it with other means be it TENS PT heat cold stretches etc. many of these episodes are far worse than the old days when it was the pill bottle. The only difference is by treating the disease I get past them better faster and ultimately with less pain.
I am assuming you are an EMT, which certainly is a physically demanding job. I would suggest you get with a PT who is also an athletic trainer and develop a routine specific to your job needs. Stretching through the day and stabilizing joints with muscle (possibly splinting) will help immensely ALSO I don't care how much you are drinking (water) double it while on MTX the "normal 8 glasses" needs to be sixteen, with your job even more. If you are not taking folic acid get some prescribed and remind your doc of your job - you may need more.
Enthesitis is the hallmark of this disease. I have met few EMTs that don't have PsA that have escaped periodic bouts of tendonitis and low back "stuff" I would assume you are wearing a brace, but if not start. But most important is regular stretching. Swimming and hot tubbing is great for your profession too. If you have a hospital connection and can get into their warm water therapy pool for stretching so much the better.
Good luck better days ARE comming
Thanks everyone. I have a lot more answers and questions for my docs now. I am sure once I start sleeping again thing will get better.
Hi I take Amitriptyline at night if I am having a bad time and can’t sleep they work really well for me but I only use them if I m really bad as like anything else if you keep taking them all the time your body gets used to them and they don’t work anymore
I do believe that MTX interferes with my sleep, too. I try to take it early in the evening because I know if I forget, and take it after 7 or 8 p.m., I'll be up all night. I seem to have fewer side effects if I am well hydrated and if I have a high-carb meal that evening. Sorry you are having difficulties. MTX takes some getting used to.