Lamb I find your last comment interesting. I used to tell my gp the tramidol made me loopy and I could only take it at bed time. It would as you say kill the pain. But it made me zone out too. He kept telling me it shouldn’t when the rhymes put me on sulfasalizine I was able to come off th tramidol almost completely I still take it on really bad days but it doesn’t work like before. The rhumey suggested MTX at our last visit bet she wanted to give the sulfasalizine some more time to work. But I am pretty sure we will either be moving on or adding MTX to my treatment plan
Hi lamb, I’m a bit worried now because I have been on tramadol for about 8 weeks now,the last 4 weeks being 100mg in the morning and 100mg at night. I take this at the same time as the naproxen sodium. I asked the rheumy if I could cut down on the tramadol now but she to continue everything I am doing and then add the Mtx on Tuesdays and folic acid on Thursdays. Then after the Mtx has had time to start to work, after about 2 months to start reducing my tramadol… She said if I try to come off the tramadol too soon b4 the Mtx has kicked in, I might have a rebound flare… It scares me being on this cocktail of meds and I want to back off what I don’t need As much, I don’t want to get addicted 
maybe I already am ? …
tntlamb said:
MTX is a DMARD. By way of explanation that is more illustrative than technically correct It controls inflammation more like birth control pill than anything. The whole inflammatory process goes on, it just never results in inflammation. So on the one hand you get a measure of pain management and on the other it acts like its inflamed. The fatigue is not “real” its “chemical” it can believe it or not be overcome BUT it requires some pretty heavy training. You need to get your heart rate up in the “endorphin rush” state to kill it or push yourself enough, that it gets the idea its not fatigued. ANYONE can do enough low impact repetitive activity to accomplish this (even deep breathing/meditative yoga poses will help) That being said if you take ANY opiates/narcos in any amount even a few times a month you are mostly screwed. The “chemists” working in your body become cluless as what to do. The body becomes perpetually lethargic.
If you are taking an opiate antagonist like tramadol its even worse. The ultimate effect is even though you have “pain control” (you really don’t, your body function has been suppressed enough that you just don’t notice the pain) is you will eventually have more and different pain.
The antagonists also have a psychological effect that is NOT good making them more difficult to come off than heroin if you have been on them any length of time (The used to be a whole bunch of them available - most have been taken off the market) Few modern Rheumys will prescribe any narcos and more than a few will fir a patient who accesses them elsewhere. - The essentially undo most of the treatment the rheumys do) Just stopping them won’t restore normal function. That instant relief comes with a big price. It can take months to get back to normal.
So all of that to say act like you are not fatigued (work out or just work) so your body gets the idea - it will eventually and NO narcos.
No you are not addicted, it sounds like you have a wise doc who knows HOW t
o use the narcos and has a plan. Just remind yourself every day (and spend some time doing so) that your "relief" is coming from the pic picture and not from the narcos.
I agree with Lamb. I had to be on full-dose Tramadol for four months straight last year. I was really scared of addiction, but my doc assured me that she a plan for getting off it. When the time came, it was easy! I had no withdrawal issues at all. I just tapered it down the way the doc said, and then went to “as needed”, and then one day I realized I hadn’t had any for … I forget how many days! And I haven’t had any since.
I really don’t like pain meds, and I avoid them. But you also need to live your life and keep moving. Go with it for now. I’m pretty sure it will all work out OK.
I am confused now. Was I wrong for giving MTX only 4months before going on Embrel?
tntlamb said:
No you are not addicted, it sounds like you have a wise doc who knows HOW t
o use the narcos and has a plan. Just remind yourself every day (and spend some time doing so) that your “relief” is coming from the pic picture and not from the narcos.
Thanks so much seenie, I feel more comfortable with the tramadol now knowing you had been on it for a whole year and were able to taper it down and eventually come off it 
I’m sure I will be fine, thanks again - it’s so hard to know what to expect when I’m not used to taking pain meds on a regular basis - previously I had only taken such strong meds in recovery from surgery…
Seenie said:
I agree with Lamb. I had to be on full-dose Tramadol for four months straight last year. I was really scared of addiction, but my doc assured me that she a plan for getting off it. When the time came, it was easy! I had no withdrawal issues at all. I just tapered it down the way the doc said, and then went to “as needed”, and then one day I realized I hadn’t had any for … I forget how many days! And I haven’t had any since.
I really don’t like pain meds, and I avoid them. But you also need to live your life and keep moving. Go with it for now. I’m pretty sure it will all work out OK.
Thanks so much lamb, that’s very encouraging to hear
tntlamb said:
No you are not addicted, it sounds like you have a wise doc who knows HOW t
o use the narcos and has a plan. Just remind yourself every day (and spend some time doing so) that your “relief” is coming from the pic picture and not from the narcos.
Tara, let us know how your physical therapy appointment goes. Now that I am done having kids, I would like to get my body back in shape but with this diagnosis of PsA and the meds, I don’t really feel like I can do much its very depressing so I have kind of stopped trying. Would be interested to hear what alive the physical therapist has.
Hi Melissa,
My appointment is on Wednesday. I will let you know how it goes. I did some light kettle bell exercises and went swimming for a while but the fatigue is really overwhelming and I’m having more aches then ever…no flares but feeling blah all the time now
Melissa said:
Tara, let us know how your physical therapy appointment goes. Now that I am done having kids, I would like to get my body back in shape but with this diagnosis of PsA and the meds, I don’t really feel like I can do much its very depressing so I have kind of stopped trying. Would be interested to hear what alive the physical therapist has.
Hi Melissa, missed my appointment due to issues with our ferry cancelling sailings :-(. That’s one of the hard parts of Island living…relying on the ferry.
Tara said:
Hi Melissa,
My appointment is on Wednesday. I will let you know how it goes. I did some light kettle bell exercises and went swimming for a while but the fatigue is really overwhelming and I'm having more aches then ever....no flares but feeling blah all the time now :-(
Melissa said:Tara, let us know how your physical therapy appointment goes. Now that I am done having kids, I would like to get my body back in shape but with this diagnosis of PsA and the meds, I don't really feel like I can do much its very depressing so I have kind of stopped trying. Would be interested to hear what alive the physical therapist has.
I’m going to be starting mtx next week. I’m a little worried .but after reading all your posts I’m feeling better about it
Yes, early aggressive treatment is the best for less progression of the disease. Have been on mtx 11 yrs. it still works. Has relieved the big, big swelling, and has made the pain more bearable, more able to live with. I take other meds with mtx. Nausea has waned over the years. I couldn’t tolerate the pill; have to have injection once a week. Still have nausea some, just not as severe. In answer to one other commenter, the fatigue is from the disease, not the meds. The fatigue comes and goes, as does the pain and inflamation. All I can say about the fatigue is just rest, rest, rest. It can be very overwhelming. I don’t think you can fight it. What you will have to fight is the depression. When it comes, get treatment. I still have flare-ups when everything is worse, but am surviving. Hope I wasn’t too negative. Hang in there and good luck.