As a new member, I would first like to start by thanking everyone for sharing their stories and advice. I have learned more information here than from any of the rheumys I have seen. It's nice to know that there are people who can relate to what I've been going through.
I was diagnosed with PsA fairly recently, but have been dealing with the debilitating symptoms for more than 2 years. I currently am on Enbrel and until recently was taking Meloxicam daily. However, the Meloxicam raised my liver enzymes and I went off it. I've been trying to take ibuprofen but am having stomach issues and probably have quite an ulcer brewing (which is why I started the Meloxicam in the first place).
I am seeing a new rheumy on Friday and was wondering what pain medications have helped everyone. I have a very difficult time sleeping at night due to the constant aching. I've tried taking Tramadol but have a reaction where it makes me itch all over. Any feedback is greatly appreciated.
I'm so glad you asked this question, Sue. I've been wanting to know about pain relief as well. I use tylenol (acetaminophen / paracetamol) 24/7. I take the extra-strength sustained release "arthritis" formula. The bottle says max. 6 a day, but my doc said she'd rather I took no more than five. I always take the maximum dose (2) at bedtime, or the pain keeps me awake. That leaves 3 tablets for daylight hours, which really isn't enough to control things, but I tough it out. Tylenol seems to be the only medication my doctor has offered me.
So my question is like yours: what experiences/wisdom can others offer on the subject of pain relievers?
There is NOT a lot of good news. They have pretty much decided opiods don't do a lot of good (I've always known that, but was nice to have them anyway Enough of 'em you still hurt but care less., but seriously haven't used them years) They suggest of all things based on numerous studies Tylenol (they call it Paracetamol ) If that doesn't work add an antidepressant (TCAs or neuromodulators) which make sense as these are endorphin stimulants. If THAT doesn't work the suggest playing with some other NSAIDS. IF even that doesn't work then its on to MDRD's. Plaquenil should be tried before MTX. The study points to and each step along the way adding back in the Tylenol then other NSAIDS. Tylenol seems to be THE most effective. The study doesn't get into the Biologics. Interestingly 75% of Rheumys (surveyed) said thats how they are doing it.....
Paracetamol combined with ibuprofen worked for me. Meloxicam did nothing for me at all. It’s like I hadn’t taken anything. My GP (the normal doctor, MD in America??) was always puzzled by this. The rheumatologist said it was normal for it to have no impact.
Well, tnt, that's interesting, especially the progression chart. I'm interested in the antidepressant angle. I've been on an antidepressant for years, and now I'm wondering whether I should perhaps be looking at one that does my pain good. Maybe I'll start another thread on that, antidepressants as part of the pain control picture.
I know I preach about NOT using opiads for pain control and anything but. and this why. the disease we have causes pain. but as it progresses the NEXT step is called hyeralgesia. Basically everything hurts more than it really does (which of course makes it really hard to treat.) Not everyone gets it - Thank God. The use of opiads however beyond short term and spaced out well in between gurantees the development of hyperalgesia.
ANYTHING we can do use to help with pain EXCEPT opiads is a better alternative.
When I broke my back lo these many years ago I went years thinking that was the cause of my problems, but at one point I was taking Darvoset like candy (Thank goodness Oxys weren't around) My pain didn't get better it got worse. I was never addicted (the old saw about not getting addicted if you need it isn't necessarily wrong) but I gotta tell you the 4 months I went when I got into a pain management clinic without anything but ice and a TENS unit was a long 4 months and I had a knee surgery in the middle of all that. But I learned new and better ways along with less harmful meds to control the pain. Can anyone say Toradol? (IV even better.)
That being said maybe Seenie can start a new trade supplying all of us south some Two Twenty Twos (the tylenol version) I buy two big bottles every summer when I go up to Waterton
Due to drug allergies, I am unable to take most pain medications. At my worst, I was taking 4 to 6 220mg Naproxen a day. Now, I take one a couple of times a week. I use heat packs, paraffin for my hands, and meditation when there's nowhere to go but straight into it. I find relaxing my mind and body reduces the pain by reducing the stress associated with it.
Thanks, TNT. I had to laugh ... only we Canucks would know what a Two Twenty Two is! By the way, next time you're north of the 49th, pick up a couple of bottles of Robaxacet too. It's an excellent med (tylenol-based) for back pain. It has a muscle relaxant in it.
Seenie
tntlamb said:
Here is a better study to help you on your way Seenie:
I know I preach about NOT using opiads for pain control and anything but. and this why. the disease we have causes pain. but as it progresses the NEXT step is called hyeralgesia. Basically everything hurts more than it really does (which of course makes it really hard to treat.) Not everyone gets it - Thank God. The use of opiads however beyond short term and spaced out well in between gurantees the development of hyperalgesia.
ANYTHING we can do use to help with pain EXCEPT opiads is a better alternative.
When I broke my back lo these many years ago I went years thinking that was the cause of my problems, but at one point I was taking Darvoset like candy (Thank goodness Oxys weren't around) My pain didn't get better it got worse. I was never addicted (the old saw about not getting addicted if you need it isn't necessarily wrong) but I gotta tell you the 4 months I went when I got into a pain management clinic without anything but ice and a TENS unit was a long 4 months and I had a knee surgery in the middle of all that. But I learned new and better ways along with less harmful meds to control the pain. Can anyone say Toradol? (IV even better.)
That being said maybe Seenie can start a new trade supplying all of us south some Two Twenty Twos (the tylenol version) I buy two big bottles every summer when I go up to Waterton
Interesting chart in that link! Cannabinoids ... hmmmmm.....
tntlamb said:
That being said maybe Seenie can start a new trade supplying all of us south some Two Twenty Twos (the tylenol version) I buy two big bottles every summer when I go up to Waterton
FWIW the lotions are good but the new NSAID lotions are better and cheaper. The suckers ridiculous and the brownies better as brownies. I didn't renew my green card.
Seenie said:
Interesting chart in that link! Cannabinoids ... hmmmmm.....
tntlamb said:
That being said maybe Seenie can start a new trade supplying all of us south some Two Twenty Twos (the tylenol version) I buy two big bottles every summer when I go up to Waterton
FWIW the lotions are good but the new NSAID lotions are better and cheaper. The suckers ridiculous and the brownies better as brownies. I didn't renew my green card.
Seenie said:
Interesting chart in that link! Cannabinoids ... hmmmmm.....
tntlamb said:
That being said maybe Seenie can start a new trade supplying all of us south some Two Twenty Twos (the tylenol version) I buy two big bottles every summer when I go up to Waterton
Very interesting information. TNT-I am also concerned about using opiads for pain relief due to the addictive properties. I am trying to exhaust all other alternatives before going down that path. I'm hoping I just haven't found the right combination yet and I will be able to find something to make the pain manageable. We have to have hope, right?:)
In the meantime I guess my ulcer will just get worse. I spoke to my GP in the meantime about it and asked her if there wasn't anything I could take that wouldn't hurt my stomach or liver. She told me no and that everything I could take will hurt one of them. Unbelievable!! I see the new rheumy on Friday-hopefully he can tell me something better.
tntlamb said:
Here is a better study to help you on your way Seenie:
I know I preach about NOT using opiads for pain control and anything but. and this why. the disease we have causes pain. but as it progresses the NEXT step is called hyeralgesia. Basically everything hurts more than it really does (which of course makes it really hard to treat.) Not everyone gets it - Thank God. The use of opiads however beyond short term and spaced out well in between gurantees the development of hyperalgesia.
ANYTHING we can do use to help with pain EXCEPT opiads is a better alternative.
When I broke my back lo these many years ago I went years thinking that was the cause of my problems, but at one point I was taking Darvoset like candy (Thank goodness Oxys weren't around) My pain didn't get better it got worse. I was never addicted (the old saw about not getting addicted if you need it isn't necessarily wrong) but I gotta tell you the 4 months I went when I got into a pain management clinic without anything but ice and a TENS unit was a long 4 months and I had a knee surgery in the middle of all that. But I learned new and better ways along with less harmful meds to control the pain. Can anyone say Toradol? (IV even better.)
That being said maybe Seenie can start a new trade supplying all of us south some Two Twenty Twos (the tylenol version) I buy two big bottles every summer when I go up to Waterton
About the only other thing I can think of that hasn't already been mentioned is Neurontin or Lyrica. These are anti seizure meds, but they do help mediate pain in some people. They are metabolized through the kidneys (not the liver), so folks with kidney problems have to be careful with them.
Tricyclic anti-depressants seem to offer the best control of any of the anti-depressants for arthritis pain:
The tricyclics, unfortunately, seem to have a greater potential for liver toxicity than other anti-depressants.
(Anti-depressants are not a good choice if you also have restless leg syndrome.)
Be very careful with Tylenol if you have elevated liver enzymes. I would only consider it after an okay from my doctor, and even then I would be scared of it in the presence of elevated liver enzymes.
All drugs have to be metabolized, and most go through the liver. When you are taking more than one medication, you have to consider the possibility that both are going through the liver, which can increase chances of adverse reaction.
Other options might be a TENS unit, Lidoderm patches or Voltaren gel. These are good options when pain is localized.
I LOVE Toradol, but it ate one huge hole in my stomach so I had to give up oral Toradol. :-( I still get IMs when things are truly bad. It's a calculated risk to my tummy, but it does work wonders!
Hi Sue....like you, I have an ulcer from use of Celebrex and have been unable to use most of the NSAIDS for that reason. I have had some recent success with the use of Meloxicam along with a stomach "protector" called Pantaprozole that my Rheumatologist prescribed....so far so good anyway, it has been a week and I have had no stomach problems which is highly unusual...usually I have it right away on any type of NSAID. I have been extremely careful to take the meloxicam with food, and the Pantaprazole about an hour before, which is a pain, but it is worth it, if it continues to work. I don't know if it will work for you, or if you have tried it, but it was kind of my last one to try....having tried everything else. Hope that helps.
I take Tramadol. I can't take acetominophen or ibuprofen or many other pain killers. Tramadol isn't perfect and doesn't completely relieve me of pain, but it works better than nothing, so I'm using it. I'm also careful to use it only when I NEED it. I'm in constant pain, and it's nice to have a little relief when I really need it.
