I've had PsA for the past 5 years or so. It took 6 mths for the docs to figure it out., Anyway, my medication list is as follows (excuse the spellings):
1. Prednisone to determine if its actually arthritis: Made me halucinate so had to stop after 2 days, but the pain went away and Doc decided it was definitely PsA. (Have a family history of it - father)
2. Methotrexate: Was on this about 3 mths to get the pain under control. At first pills, but made me sick, so I did self-injections. They took me off since it will damage the liver (what else is new?)
3. Been on Tramadol and Trazanone for the past, oh, 3-4 years. Trazanone is a sleep help which, they say, isn't addictive, etc. Its fairly mild. I take half the dosage that the doc says to take, because I am the type that can't take too much of anything, LOL. My bod always over reacts...
Now the question: Tramadol which is Ultracet. Pain killer I'm on 24 x 7. Lately I've had to up the dosage for myself. Some days i have to double it, which the doc says is okay. I'm also seeing an increase in numbness in my hands and arms. I like to quilt, sew, hand quilt, and basically function, period--I mean, who can live without their hands??
So the numbness is a growing problem.
Any info on Tramadol? Is it bad long-term? Will I eventually have to try something else? They tried me on a couple of others which was like taking sugar pills--nothing. Can't think of their names, now...
Tramadol is synthetic opiate (called an opiod). It walks talks and acts like an opiate. Multiple states have taken action to treat it as such. There have been others over the years such as stadol and demerol none of which had happy endings.
As with all opiod antagonists/agonists, there is usually a psychological dependence and withdrawl if discontinued. There is also a physiological dependence that with time requires the user to use increasing amounts of the medication for the same relief. This is warning signal that things could get very bad very quickly. Almost always the next move is to actual opiates. It is at this point that the immune system's pain control system starts to surrender. its now been attacked at both ends over a long period of time. The end result is usually more pain that has no relationship to disease.
I don't often express strong opinions about docs but in this instance I will. Any doc that takes a patient off of medication that actually treats the disease and replaces it (or allows) pain medication to be the alternative is of questionable intellignce. If that same do replaces a medication because it may cause liver damage (even though that effect is easily monitored and replaces it with 'Trazodone used off label he is walking a tightrope in a strong wind over the dangerous quack pool and about to go for a dip. Trazadone is metabolized by a liver enzyme called CYP3A4 . Should this enzyme be inhibited in any way say with tramadol or the trazadone it self or something as simple as grapefruit juice your blood pressure can explode or your heart can decide to do its own thing - which is never good. And oh yeah its more liver toxic than the MTX.
Fewer than 1% of any rheumy's patient base these days use long term pain medication. I'm hoping who ever is treating you is NOT a real rheumatologist. If he is you need a new one, if he isn't you need one badly. Nothing is being done to TREAT YOUR DISEASE. The results of that could be crippling (painful if nothing else)
OKay I reread your post. Thats the only reason I'm posting twice in a row. NUMBNESS is not a normal PsA effect. Now I want to be cautious here, so when someone says numbness and tingling thats not always the same thing as numbness and tingling. When tramadol is combined with trazadone there is a time when numbness and tingling in the hands and feet is a very serious condition called Serotonin syndrome. Its rare but its also common enough that the FDA is requiring the labeleing for tramadol to include a warning about it.
I don't know anything about the medications but paresthesia can be a symptom of PsA (and a whole lot of other things). It is abnormal sensations of the skin such as prickling, tingling, itching, burning, numbness. It can be transient or chronic. I have it on both forearms. I also get a 'going to sleep' numbness in my fingers when my elbows are bent at 90 degrees for more than a few minutes eg. typing.
Think it's important that anything like this is raised with a doctor because, as lamb said, it can be a serious condition.
I've told the doc this a few times and he just brushes it off as Carpal. Nothing big, and if I want I can wear a brace at night if it keeps me from sleeping... ??
It is VERY unusual for a Rheumatologist to treat patients who have PsA with pain medications alone. VERY, HIGHLY, STRANGELY UNUSUAL. PsA is a progressive, chronic condition. Progressive in that is gets worse over time. This can cause permanent disability. The only way to slow/ halt this progression is through treatment with DMARDs (like MTX) and/or Biologics (Humira, Remicade, Stellara, et.al). I apologize for speaking so aggressively, but your situation really worries me, as the treatment that you are on is very unconventional and not based on the most current information of what works to control psoriatic arthritis. Please talk to your doctor about this sooner rather than later. If he/ she is unwilling to modify his or her plan of care for you, it is definitely time to find someone who will.
I think Lamb and Grumpy have covered all the bases about Tramadol and its place in PsA treatment. I personally HATED using tramadol, I hated the effect it had on me mentally…it dulled my natural inhibitions much like alcohol does, it didn’t stop my pain but stopped me caring about the pain. I think it is used often to placate patients, and is handed out too easily by some docs. The Gp who prescribed it for me was not my normal gp but one of the 6 in the practice. I’ve not been to see him since as I feel he just wanted me out of the room with an attitude of take this and keep quiet. My rheumatologist has never prescribed pain meds for me.
Weird, it does take my pain away pretty well. The only down side I have with it is it dries me out pretty bad if I take too much of it. Constipation is the result.
I know everyone is different and reacts differently to diff meds. For ex, a lot of folks take Prednisone for long periods but it totally freaks me out; I see pink elephants, Elvis, hear voices, etc. The worse though is feeling like you're falling and never hitting bottom. I didn't sleep the 2 days I was on it. Nasty stuff IMHO.
I guess subtle didn't work. So did you have an increase in liver enzymes that they decided to quit treating your disease? You know the disease that in addition to causing pain in your joints and crippling you also attacks your internal organs including your heart and pancreas also pretty necessary to living. Untreated you have a 50% increased chance of serious heart disease and diabetes an 80% chance of eye disease (uveitis) that causes loss of vision.
Yet he has no problem prescribing a course of treatment that should never exceed 3 months and combines it with black box drug for whom the incidence of sudden death from the combination of sudden death is roughly 23 times greater than that of the incidence of "liver damage" from DMARDs and several thousand and more times frequent than irreversible liver damage. Lets not even talk about what else that combination of meds will do to you.
He is prescribing tramadol in amounts that exceed from a non certified pain management program that in 3 states would be a felony and in at least 27 states lead to disciplinary action from the state board when the Class IV classification becomes effective nationally.
This is singularly the most freaking amazing thing and without a doubt the scariest I have ever read in 4 years on these boards. I understand med free, thats a choice. But to choose an exponentially more dangerous route and WARN us about livers is just wierd. What kind of doctors are advising you????
Read more about PsA PLEASE, it is not a simple disease of "pain"
I'm not ready to push the panic button just yet. I have yet to read anything so horrible about Tramadol, LOL. I like tramadol, frankly. I've had asthma for a long time, and the Tramadol does more for me than the stupid Advair I was forced to pay for., because Tramadol dries out my chest and sinuses which helps me breath better than the silly inhalers they made me use.
Probably the reason I haven't had to be on constant drugs is the simple fact that I've exercised my entire life. I've always been athletic and never smoked, drank; etc. I used to run 10 mile road races, for ex. I've also been a gym person since I was a kid.
Exercise keeps your joints from deteriorating probably just as effectively as all of the drugs people ingest. We've all been told to exercise, but so few do. then they get sick and they have to do drugs because they're so far out of shape it isn't funny. Something to think about. I sit in the doctor's waiting room and everyone in there is so grossly overweight and out of shape that it is sad. And there's no doubt they've been like that their entire life, well before getting arthritis.
The doctor I see smiles when he sees me coming. I'm probably a great relief, LOL. But I am getting older and things are slowin' down. I'm sure I'll be on the drugs all the time eventually. Happens to us all. At least I bought me some time.
He's been there for decades and hasn't killed anyone, so I'm not ready to hit the panic button just yet. :)
Sorry Kim, I know this is going to sound rude but reading your replies I’m thinking that maybe you might be burying your head in the sand. Where will you go when you’ve upped your doses to the max and it no longer works? I’ve seen patients being cut off from their pain meds when their “old faithful” docs can’t prescribe more…its not a pretty sight. Addiction is very easy to get into and a really hard thing to get out of. Please think carefully to what has been said, and after all what’s wrong with getting a second opinion?
I’m not so sure about nobody exercising. I do, four days a week, in fact. I still have PsA, and joint deterioration, which is to be expected with chronic and progressive diseases. We are worried for you. You are in trouble and just don’t know it yet. The fact that you are getting worse, should be setting of alarms all over the place. There are some really smart people on this page; it is so worrying that their words are seeming to fall on dead ears.
i'm getting worse because I haven't been able to exercise at all.
Keep up the exercise, GC! You'd see a huge difference if you ever stop, believe me. And the older we get, the harder it is to get started again. I do plan to probably go back on an antirheumatic. He keeps checking me regularly, BTW, and I suspect he's just waiting for me to say I need something, which I think I'll probably say this time. I hate drugs--they're as bad as the disease IMO.
It may be that my PsA isn't as severe as other peoples. Just a thought. I really don't think I'm in trouble. When I can no longer get out of bed, dress myself, etc --then I'm in trouble. Right now I'm still pretty active. As a matter of fact I just finished mowing an acre of high grass, half of it with a push mower. I'm obviously not dying at the moment.
I'm looking into getting me some special ortho walking shoes, since I can't always hit a trail and end up on the roads. That should help a great deal IMO.
Kim, we really do wish the best for you, which is why we are all urging you to take action,
I have tramadol in my cupboard. It works on my pain, and I’ve chosen to get it out a couple of times over the last year, as a last resort to sleep. Never more than one night in a row. But it’s an addictive pseudo-opiate that screws up your own natural pain system. There is no way known in hell that I would be taking it if I was capable of mowing half an acre of grass with a push mower.
Perhaps you are right - maybe your disease isn’t as bad as many people here - and in that case, you definitely don’t need tramadol 24/7 to control your PsA pain. Heed Louise’s words and do something about it.
I read it isn't addictive. Often I forget to take it, LOL. Been on it for years and if I forget to take it I wouldn't call that addictive.
So what you're saying is, I should not have any pain at all and therefore should not have to take anything but anti-rheumatics?
Is that correct? Just take the liver killers and I shouldn't have to take any pain medication. Is that what all of you are doing?
(I just lump the arthritis meds into "liver killers"; just a term so don't take it personally. They all mess up organs if you're on them too long, according to my doctor.)
The inconsistacies in this thread are overwhelming. First the OP is on the medication 24-7 and its failing. She wants to know what the next step is. Next the OP gas mild disease and often forgets to take the medication. She has found fault with every response. Either the OP is a contrarian or a troll. In either case I am locking the thread. It is going no where.