Be cautious. Narcotics very often already have Tylenol in them...so if you add Tylenol to your narcotic you may be taking too much. You can check on your bottle how much Tylenol is in the Norco, and how much in the Tylenol you've been taking. This article explains it perhaps better than I did:
http://www.drugs.com/dosage/acetaminophen.html#Precautions
HoneyBunny said:
Norco, tramadol for break through if its severe. However I often break the norco in half and add Tylenol.
My vicodin has max dose of Tylenol in it.
Just as a basic FYI: be careful if you cut pills in half. Some are delayed release and cutting them in half is not a good thing, it dumps all the medication in you at once so you get an overdosage at the beginning and no follow on effect. The general rule is that if a pill has a score (indented line across the pill) then it can be cut in half on the line. If it doesn't have a score ask a doctor or pharmacist before cutting it in half.
Sustained release is noted as follows on some medications: sustained-release (SR), sustained-action (SA), extended-release (ER, XR, XL), timed-release (TR), controlled-release (CR), modified release (MR), or continuous-release (Contin). You will find the ER,SR,SA,XR..... on the end of the name of the medication. For example, on the label for my potassium it says: POTASSIUM CL 10MEQ ER, this is an exteded release medication and should not be cut in half.
I don't know if this is relevant information to the topic, but it a good thing to know.
Use what works best for you and keeps you sane. The rest is no ones business. 
debbie said:
I am using narcotic free pain relief (which is an entirely different conversation, and my doctor made the decision along with me). For pain I take Tramadol which is a synthetic opoid and Cymbalta daily. I also take Azathioprine and prednisone daily. I am on injectable weekly Orencia as a biologic (it isnāt FDA approved for PsA so I am getting it off label). For flares I inject Toradol 30mg/ml IM and follow with 5 days of Ketorolac pills.
I know the prednisone, Orencia and Azathioprine arenāt pain medications. They do however lessen pain from the disease.
I have a TENS machine as well, sometimes it is a real help with a pain in a specific area. I also wear wrist splints when I sleep at night.
This is working for me well enough, the pain never really goes away completely. I am on SSDI so I have time to take care of myself now, and that is a blessing.
I have seen three Rheumatologists, none of whom prescribe pain medications that are controlled. I really do wish they would just say up front that they donāt prescribe them, but will be happy to give a referral to a wonderful pain management practice. Itās such a simple thing to do, really, but that would mean admitting that something is outside of their scope of practice.
It really IS best to go to a pain specialist.they know so much more than Rheums or GPs do about managing pain. Like Iāve said before, there are some really helpful topicals that help. Lidoderm patches, voltaren gel (an NSAID on the outside with much fewer side effects), compound gels that go on the joints topically, aquatic PT, local injections of medications (again, fewer systemic side effects), yoga for arthritis, biofeedback, acupuncture, plus the standards: Percocet, Vicodin, Tylenol 3 and 4, and the big guns: morphine, Dilaudid, fentanyl. I made a plan with a pain management doc (who was a jerk) and then took it to my angelic, wonderful, super-awesome family doc. She prescribes and follows up on me. I go see the jerk every once in a while to remind myself why heās a jerk. Then I take the revised plan of care back to my stupendously excellent family doc to continue with the plan. I hope that I am able to continue doing this for as long as I can. My doc trusts me and I trust her. She knows Iām not faking or trying to scam drugs, she knows that I feel like a ādrug seekerā anyway because I used to be an ER nurse, she strong enough to tell me when its time to get reevaluated by the jerk, and she doesnāt judge me.
It would be great if there is a drug that your cardio WILL sign off on you to take that will prevent joint damage, because it will just make the pain and dysfunction worse than it already is. Itās a talk you need to have, first with the cardio, āWhat can I take?ā, then with the rheum, āthe cardio says these meds are ok to use with my cardiovascular problems. can we talk about these meds?ā
You need something that will help keep you from feeling like you are simply in varying degrees of pain every day. Pain management can help you with this. Check some of the review sites for a good practice. (I sign up for Angieās List. I got a coupon code, so it ended up being abt. $14/ year. Itās been really worth it so far.) These groups arenāt in the business of judging people, and a really good practice will create a multi-modal plan to manage your pain.
greenlydia said:
Hi Marietta,
Iām 62, was diagnosed with PsA when I was 18, so I have tried just about every treatment out there. The one and only pain treatment Iāve NEVER been offered is ANY type of opioid. I have asked for something to use on an āas neededā basis when the pain becomes unbearable, but all my rheumies have flatly refused! They want to put me back on prednisone or metho or one of the biologics or cortisone injectionsā¦anything but pain killers. I understand that the pain of PsA is basically from the inflammation, and when I ask why canāt they give me a simple anit-inflammatory AND a pain med to take until the anit-inflammatory kicks in, Iām just ignored. I also have CAD (coronary arterial disease) and have 2 cardiac stents. My cardiologist has told me that in his opinion, with my current heart condition, that medications like Remicade and Celebrex, plus a few others, are just not worth the risk. I tend to agree since the pain of PsA will not kill me, but some of these medications my rheumie doctor wants to put me on could. When I said ānoā to Remicade, I have no doubt he wrote that I was ānon-compliantā in my chart. I am angry and frustrated and currently take nothing for my PsA pain, which is, at times, as you all know, beyond bearable. I donāt know where to turn. I will not go back on prednisone, metho or ANY of the biologics, and all these new drugs theyāre coming out with all mention in passing that if you have any kind of cardiac issues, you probably shouldnāt take them. I have literally destroyed my stomach with OTC meds and canāt (or wonāt) take them any longer. Besides, I had to take such massive doses for the most minimal relief, thatās what blew my stomach out.
A few months ago, I was visiting a friend who had just had her second knee replacement. She gave me 5 of her fairly strong Vicodin tablets. I put them away because at that time my pain was ānormalā and I was dealing with. But one day it was really bad and I decided to try one of her pills. It made me pretty tired, but I wasnāt doing anything but laying on the couch anyway, and I will admit it made me feel a bit āloopy,ā but nowhere the point I couldnāt think right or function. What I remember is that for the first time in what seems like forever, I had NO PAIN! ZERO! It was the most wonderful feeling in the world. I wish I hadnāt slept through most of it! LOL But even after I woke up, the pain was virtually non-existant. My ROM was still as bad as ever, my knee was still the size of a small elephants, but I had no pain!
I havenāt taken any more of the pills as I am hoarding them for another really, really bad day.
My question, and Iām sorry itās taken me so long to get to it and thereās been a lot of whining going on in between, is this. If you or anyone here has a doctor that prescribes pain meds for them, could you tell me WHY he/she feels that itās an OK option, but my doctor does not?
This may sound silly but getting some sunshine helps. I went to the beach this past weekend and I felt great. It should not be shocking they use it to treat Psoriasis. The sunshine is very soothing. I also like to stick my feet in the moist sand it feels kinda of like a spa treatment for my feet, which is where a lot if my pain is. The best part you don't need a referral or prescription, and it is free. :)
wow I found that as soon as I was diagnosed I had all kinds of pain pills offered to me, I don't like how they make me feel, often I would get sick taking them so I save them for when I get really bad. I have PsA and fibromyalgia, I find taking Naproxen, two in am and two in pm, works okay for the everyday pain. I don't skip a does because if I do I tend to get stiff and can tell the difference. My Dr. said to not take more then 5 a day, so if the 4 a day that I take don't help then it is time to take a pain pill. I don't know if Naproxen (aleve) is something you have already tried but if you haven't then I would suggest it.
The only thing I have is naproxen. Sometimes I wished I had something for the pain is so bad Iām crying days but she doesnāt want to give me anything stronger. Before going to her my gp did give me steroid shots at the bad times and they worked so good but my rheumy doesnāt want to use that since Iām diabetic. So we are trying naproxen 500 for now! 
Men are offered pain meds a lot more often than women. Studies show this time after time (male and female dr's do this). Men's pain is seen as more legitimate and more severe.
charley said:
wow I found that as soon as I was diagnosed I had all kinds of pain pills offered to me, I don't like how they make me feel, often I would get sick taking them so I save them for when I get really bad. I have PsA and fibromyalgia, I find taking Naproxen, two in am and two in pm, works okay for the everyday pain. I don't skip a does because if I do I tend to get stiff and can tell the difference. My Dr. said to not take more then 5 a day, so if the 4 a day that I take don't help then it is time to take a pain pill. I don't know if Naproxen (aleve) is something you have already tried but if you haven't then I would suggest it.
These kinds of discussions while interesting can be pretty counter productive at times. We do not have each others medical record, we don't know or understand each others full health history and (sometimes our own) believe it or not, there is a fair number of "pain types" that we get that will not respond to narcotic pain meds. In fact they may even aggravate it. (many forms of nerve pain/impingemet aggravated by inflamation for example)
My last knee surgery was a good example. Morphine was doing NOTHING, in fact I was almost to the point of unconsciousness. Fortunatly one of nurses said clearly and loudly For GAWD sake give the man some torodol and get rid of the XXX morphine before he codes. They did and pain was gone in minutes
Don't discount MM if available in your area. You don't just walk into a dispensary with a green card and walk out with a baggy. This stuff isn't like we used to smoke at concerts 30 years ago. There are two major strains and dozens of hybrids and blends for specific purposes. If your doc (or you) doesn't know what I am talking about then don't bother. You could seriously screw things up. BTW I don't use it, there are better and MUCH CHEAPER alternatives. besides that I have no self control around brownies (I can't/wont smoke anything)
Grumpy gave a great how too. You understand why she is considering moving into case management and advocacy. It does vary widely by state region and even practice.
Okie Doke. I just got my refill. If you donāt have insurance and arenāt loaded, this will be untouchable cost-wise, as its over $1000 per fill. My insurance has is as a top tier drug making it $50 per fill. I pay $450/month for COBRA. Iām pretty sure Iām getting the better end of this deal!
This needs to be prescribed by a specialist who really knows what they are doing. There is (of course) a special approval process to get it covered and it comes by post from a compounding pharmacy. There is no specific name for the drug because it is a special ordered blend of drugs. Iām only explaining it so much, because before I worked with pain management patients and orthopedics, I didnāt know anything about these drugs at all.
Transdermal Pain Lotion:
Flurbiprofen 20%
Baclofen 2%
Cyclobenzaprine 2%
Gabapentin 6%
Lidocaine 2.5%
This is not the only combo that is available. There are at least two others that I am familiar with. This one is the starter version as it isnāt as strong as the other two.
If anyone wants any other information, let me know and I will help you out with some links.
Claire
Frances said:
What is the compound cream?
GrumpyCat said:I use Percocet for really ouchie pain and it is by far my favorite of the opiate pain meds. The others make me a little whacky. With this, I also take ibuprofen, flexeril. There have been times when that will not work and I end up in the ER for some iv steroids and Dilaudid. Iām not fond of how either make me feel, but they do nip the pain very quickly.
I also just got a compound cream that is pretty wonderful.
I really wish toradol had no side effects. It is such a great pain reliever. Iām the crazy chick who tells the ER nurse that the Dilaudid doesnāt work as well unless I get toradol too! 
tntlamb said:
These kinds of discussions while interesting can be pretty counter productive at times. We do not have each others medical record, we donāt know or understand each others full health history and (sometimes our own) believe it or not, there is a fair number of āpain typesā that we get that will not respond to narcotic pain meds. In fact they may even aggravate it. (many forms of nerve pain/impingemet aggravated by inflamation for example)
My last knee surgery was a good example. Morphine was doing NOTHING, in fact I was almost to the point of unconsciousness. Fortunatly one of nurses said clearly and loudly For GAWD sake give the man some torodol and get rid of the XXX morphine before he codes. They did and pain was gone in minutes
Donāt discount MM if available in your area. You donāt just walk into a dispensary with a green card and walk out with a baggy. This stuff isnāt like we used to smoke at concerts 30 years ago. There are two major strains and dozens of hybrids and blends for specific purposes. If your doc (or you) doesnāt know what I am talking about then donāt bother. You could seriously screw things up. BTW I donāt use it, there are better and MUCH CHEAPER alternatives. besides that I have no self control around brownies (I canāt/wont smoke anything)
Grumpy gave a great how too. You understand why she is considering moving into case management and advocacy. It does vary widely by state region and even practice.
I have my own injectable toradol at home. I get two injection vials per month, then 5 follow up days of Ketorolac pills (toradol in pill form). It is an IM injection so you have to be petty good at giving youself shots (1.5 inch needle is pretty scary the first time you stick it in your self). But this saves my butt as I am uninsured and an ER trip can be $3k just for pain relief. I am so happy my doc was willing to prescribe it. Toradol injectons, by the way, are so cheap! At Walgreens it is $15 for two vials if you have no insurance and join their prescription savings club ($25 per year). The syringes are $10. The ketorolac pills are $15 for 15 pills. I carefully mark my calendar for the days I have done injections or taken pills so I don't use it too often (I pick up a three month supply for the cost of two months). It is just so helpful for my pain management. I am thankful I have the option.
GrumpyCat said:
I really wish toradol had no side effects. It is such a great pain reliever. I'm the crazy chick who tells the ER nurse that the Dilaudid doesn't work as well unless I get toradol too! :-D
Hi Grumpy,
I gather you are having a very hard time of it and hope you get it sorted out soon.
On another post or two round about its mentioned that you have some intestinal issues - does the toradol cause those to flare?
Iāve been told no NSAIDs because of my gastro issues - and mostly I cope fine because Iām responding very well to Humira, but every now and again Iāll get spine and shoulder troubles that need something. I seem to have a zero pain relief response to paracetamol (always have), and codeine works - but I develop a tolerance very quickly (3 - 7 days), so I am very cautious of using it.
I know you have a lot of knowledge, so would love to hear of your experiences and suggestions.
No Toradol for you! Itās an NSAID and is not indicated for use for more than two weeks or so anyway. Itās also really hard to get a doc to prescribe it because of the high risk for kidney damage and GI bleeding. Other than that, itās a wonderful drug. It works so well for pain control. I wish that it didnāt carry all of the side effects, because I would love to have an NSAID like that to take.
Have you ever thought about a topical NSAID? You apply it directly to the pain site as it is in a lotion or gel form. Typical side effects are much lower when you use it topically.
The patient in me says, āI am so jealous! Gimme some of that Toradol!ā; the nurse in me says, āYikes, thatās a lot of toradol.ā Please be very careful as this drug is a very potent NSAID and has a higher incidence of side effects than any of the other NSAIDs do. There is a reason that I canāt get any doc to prescribe it for me, even though I know and am willing to take those risks. When a doc says, āWouldnt you like some Percocet or Vicodin instead?ā, you know the risks are real. (Also there is data to back it up). Be safe. Make sure you never take it on an empty stomach. Keep an eye out for flank pain, any difficulty or anything unusual with your urinary patterns, bruising, and of course frank blood from GI or urinary tracts. Be safe. Itās an excellent drug, just be careful.
I have my own injectable toradol at home. I get two injection vials per month, then 5 follow up days of Ketorolac pills (toradol in pill form). It is an IM injection so you have to be petty good at giving youself shots (1.5 inch needle is pretty scary the first time you stick it in your self). But this saves my butt as I am uninsured and an ER trip can be $3k just for pain relief. I am so happy my doc was willing to prescribe it. Toradol injectons, by the way, are so cheap! At Walgreens it is $15 for two vials if you have no insurance and join their prescription savings club ($25 per year). The syringes are $10. The ketorolac pills are $15 for 15 pills. I carefully mark my calendar for the days I have done injections or taken pills so I don't use it too often (I pick up a three month supply for the cost of two months). It is just so helpful for my pain management. I am thankful I have the option.
GrumpyCat said:I really wish toradol had no side effects. It is such a great pain reliever. I'm the crazy chick who tells the ER nurse that the Dilaudid doesn't work as well unless I get toradol too! :-D
I get monthly blood tests so my health is monitored that way. I have monthly doc appointments. I also watch how I am physically feeling. My doc has given me her cell phone number so I can get a quick response from her if needed. I got in some real trouble with the narcotics I was being prescribed and depression, a couple of overdoses later I banned myself from them. As things change our medication changes. This is helping now. Who knows what the future holds. This disease is full of suprises, isn't it?
GrumpyCat said:
The patient in me says, "I am so jealous! Gimme some of that Toradol!"; the nurse in me says, "Yikes, that's a lot of toradol." Please be very careful as this drug is a very potent NSAID and has a higher incidence of side effects than any of the other NSAIDs do. There is a reason that I can't get any doc to prescribe it for me, even though I know and am willing to take those risks. When a doc says, "Wouldnt you like some Percocet or Vicodin instead?", you know the risks are real. (Also there is data to back it up). Be safe. Make sure you never take it on an empty stomach. Keep an eye out for flank pain, any difficulty or anything unusual with your urinary patterns, bruising, and of course frank blood from GI or urinary tracts. Be safe. It's an excellent drug, just be careful. :-)
Yay! Iām glad your doc is so good. 
I get monthly blood tests so my health is monitored that way. I have monthly doc appointments. I also watch how I am physically feeling. My doc has given me her cell phone number so I can get a quick response from her if needed. I got in some real trouble with the narcotics I was being prescribed and depression, a couple of overdoses later I banned myself from them. As things change our medication changes. This is helping now. Who knows what the future holds. This disease is full of suprises, isn't it?
GrumpyCat said:The patient in me says, "I am so jealous! Gimme some of that Toradol!"; the nurse in me says, "Yikes, that's a lot of toradol." Please be very careful as this drug is a very potent NSAID and has a higher incidence of side effects than any of the other NSAIDs do. There is a reason that I can't get any doc to prescribe it for me, even though I know and am willing to take those risks. When a doc says, "Wouldnt you like some Percocet or Vicodin instead?", you know the risks are real. (Also there is data to back it up). Be safe. Make sure you never take it on an empty stomach. Keep an eye out for flank pain, any difficulty or anything unusual with your urinary patterns, bruising, and of course frank blood from GI or urinary tracts. Be safe. It's an excellent drug, just be careful. :-)
Thanks very much for the info Grumpy, you are right, no Toradol for me!
You are right that the topical NSAIDs work very well for spine, though I was told no to them as well (as Iāve never heard of toradol, I was half hopeful it would be a totally new class of NSAID without GI risk).
Iām struggling with having to postpone my Humira due to my daughter being exposed to chicken pox. 
Iāll try a massage for my neck and shoulders instead