Medications - Glucocorticoids (steroids) and Pain Medications

Glucocorticoids, also called steroids, have strong antiinflammatory effects. Drugs in this class include prednisone and prednisolone. Glucocorticoids may be taken by mouth, injected into a vein, or injected directly into a joint. Glucocorticoids quickly improve symptoms PsA such as pain and stiffness and also decrease joint swelling and tenderness. The improvement is generally temporary

Glucocorticoids are generally used to treat arthritis that severely limits a person's ability to function normally. For such people, glucocorticoid treatment may help control symptoms and preserve function until other slower-acting drugs with greater ability to prevent joint damage begin to work. They may also be used to treat flares of disease, while a person is receiving other treatments. Steroids have many possible side effects and are without doubt the most dangerous class of drugs we us and have the most certain long term and dangerous side effect . The most common effects are weight gain, worsening diabetes, promotion of cataracts in the eyes, thinning of bones (osteopenia and osteoporosis), and an increased risk of infection. Permanent adrenal damage is also fairly common. Thus, when steroids are used, the goal is to use the lowest possible dose for the shortest period of time.

Pain relievers relieve pain, but they have no effect on inflammation. Drugs in this class include acetaminophen, tramadol, and capsaicin cream or ointment. Use of narcotics like codeine, oxycodone, and hydrocodone is generally discouraged because they also have no effect on inflammation. Because of the long-term nature of PsA and the risk of dependence pain medications is high.

Dependence is NOT addiction, but because of the nature of these types of medications they generally require increased levels over time. This increase often leads to increased, difficult, or very little pain management because the bodies normal pain management systems become sluggish or damaged. It can take the pain management system several years to recover if at all once it becomes over taxed. Long term PsA patients will often say that pain meds make their pain worse and lower function..

Often the addition of a tricyclic medication such as amitrptyline , tryptomer, elavil etc. can help the body with natural pain control, sleep or even reduce the amount of medications required for pain control

However, people severe damage or damaged joints that cannot undergo joint replacement surgery may benefit from use of a long-acting narcotic under the supervision of a pain management specialist.

Tramadol

Tramadol is a popular pain medication for PsA patients when normal treatments are unable to keep pain levels under control. Tramadol is an opiate agonists and works by changing the way the body senses pain. Some people mistakenly believe that Tramadol is an NSAID, but it is not. It is available in both fast and timed release versions.

Once thought that as a pure synthetic (Opiod) it would be safer and less habit forming than narcotic pain relievers. However that has been found not to be the case. Other synthetics such as stadol and Demerol have either been take off the market or are rarely used anymore because of both their psychological and dependency risks.

You should never stop taking Tramadol without first consulting your doctor. You may experience withdrawal symptoms if you stopped it suddenly. You doctor will likely decrease your dose of Tramadol gradually.

Drug interactions with Tramadol are fairly common especially with heart medications and anti depressants. Make sure your doctor is aware of all medications (including supplements) as well as your pharmacist.

Side effects are rare although our members complain frequently about constipation. Usually the addition of a stool softener or Miralax takes care of the problem.

There are changing attitudes about this medicine especially at the state and local levels. Its important to know that in some states it is a highly regulated substance and in others less so. Be sure before driving, operating equipment, or using while on the job. You know how your state views the medication.