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Pain Relief (Tramadol/Codeine/Diclofenac/Acetaminophen/Diazepam/Gabapentin/etc)

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Rheumatoid Arthritis
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Posted 8/7/2010 7:30 PM (GMT 0)
Just curious, what methods of pain control have you used / do you rely on?

How often do you need to use them?

I take 400-600mg of Tramadol SR (Slow Release) each day, and use diclofenac and 30/500 co-codamol as an adjunct. I ran out of painkillers except diclofenac last night, and can't get any as I am on vacation in Switzerland/France - woke up in AGONY. (due to chronic back pain rather than Arthritis, mainly.) Fortunately, 30/500 is available OTC in France, as is a 10mg Codeine/10mg Ethylmorphine tablet - which will do for a week! (The latter is sold as a cough suppressant, and is accompanied by a suspicious look, but works fine as a pain killer. Codeine is codeine after all!)

I'm considering asking for a gabapentin script from my doctor as I have heard it can ease spinal pain - anyone tried it?

My Rheumy suggested fentanyl patches, and then changed his mind due to the extra hassle/paperwork involved due to it being a controlled substance. I asked if I could have some diazepam/valium so I could sleep in spite of my back pain, as I'm sick of taking so many opiods all the time, but he told me he was too concerned about addiction as I would undoubtedly need it regularly. Hydrocodone/Vicodin/Lortab hasn't been mentioned, and basically I'm having a very hard time breaking the 'tramadol' barrier. I'm currently taking more than the highest allowed dose, but for some reason my Doctor prefers this to prescribing anything more effective :(

James
Posted 8/8/2010 1:22 AM (GMT 0)
I am hypersensitive to codiene so for 14 years went without pain relief of any kind rather then try to figure out something I could take.
So, recently I asked. We decided on 50 mgs of tramadol at bedtime-I can't tolerate it when awake and can't take two doses in 24 hours.
Posted 8/8/2010 1:47 AM (GMT 0)
It might have been a coincidence but after my dr. prescribed 3 tramadol a day to try and get rid of this daily bearable but tiresome pain I have-I began having daily headaches. Sometimes so bad I vomited. Didn't do anything for the daily pain but the head aches sure took my mind off of it. :( What a trade off.....
Posted 8/8/2010 2:27 PM (GMT 0)
Weary - if I take too much tramadol, the next day I have the most piercing headache, feels like an axe wedged in my skull. Ironically, the only thing that will then get red of it..... is tramadol :D

At my worst I was taking 600mg a day, I have a limited supply on me, so I'm now taking 100mg and supplementing with the french codeine/ethylmorphine tabs as necessary. I really would like the fentanyl patch.... pain is BORING.
Posted 8/9/2010 1:17 AM (GMT 0)
I don't get headaches from tramadol and do get good pain relief. I just can't stay awake, think or make decisions.
Posted 8/9/2010 1:17 AM (GMT 0)
I'm lucky in the sense that the MTX works pretty good for me. I have daily pain- but it's bearable. I was trying to be pain free with the use of tramadol but it does nothing. I am resolved to the fact that I have to live with this annoying background pain for the rest of my life. However- I am thankful I am able to carry on fairly normal.
Posted 8/15/2010 8:56 PM (GMT 0)

wearyRAsufferer said...
I am resolved to the fact that I have to live with this annoying background pain for the rest of my life.

I am being repeatedly told this by everyone. I can't stand the fact that being in pain has become the norm, so at any given point that I say I'm not in pain, what I really mean is no additional pain. Tramadol helps reduce the pain to a tolerable (but depressing nonetheless) level. An existence blighted by constant pain is not one I want, I'll risk an opiate dependency over that any day.

I'm currently working developing financial analysis software, but it can be very hard to concentrate on something so complex with this pain ALL THE TIME. Tramadol may slow me down a little, but at least I can function. (plus, I'm good at my job, and can take being slowed.)

ARGH.
Posted 8/15/2010 11:49 PM (GMT 0)
Hello everyone
This is my first post ever! I stumbled across the forum looking for answers to my new pain (between the shoulder blades).
But in regard to pain relief has anyone tried Lyrica? Originally they were only prescribed for epilepsy until it became apparent that they worked well for fibro. My dr gave it to me cos she thought fibromyalgia might be exacerbating my RA.. I've had some good results taking them at night but I save them for and when the pain is really bad. I have had very little success with pain relief try not to take it too regularly but find tramadol useless, codiene helps and mersyndol too but best relief from Lyrica
Cheers ozgirl
Posted 8/16/2010 1:52 AM (GMT 0)
Jay- every day bearable pain is depressing isn't it? My doctor really doesn't get it at all. Then with him flipping out on me because I was drinking on the weekends and I am on MTX....well ***? Life is a real drag these days.
Posted 8/16/2010 2:34 AM (GMT 0)
wearyRAsufferer - I am over them telling me I can't drink... I enjoy it and as far as I can tell,. there is no clear evidence that drinkers on mtx suffer more liver damage than non drinkers on mtx. I have two drinking days a week now not the day before the day of or the day after mtx. The bearable pain does get unbearable at times and you're right dr don't get it... I used to feel like I'd be better off seeing a Vet!
Now changed Rheumy will see how we go. Take care and take heart!
Posted 8/16/2010 1:04 PM (GMT 0)
Bearable pain, over a long enough time frame, isn't.

Trying in vein to get a doctor to see me.

God bless the NHS.
Posted 8/16/2010 5:19 PM (GMT 0)
Jay- you are right bearable pain over a time frame isn't! That's about where I am now. I was in a good place with myself with 2 drinking days too until my last RD visit. He about flipped his lid and told me I need to make a choice- either take MTX and not drink or don't take MTX PERIOD. He said if I came to him in 2 years with a belly bloated of chirosis he would not be able to live with himself for turning his head the other way to my drinking.

I stopped drinking but I am no happy camper. In fact I am MISERABLE. I really don't know what to believe about it and I don't think anyone knows for sure and I'd like to know why not? Surely with all the years people have been taking MTX there are enough of us that drank all along with it.  Maybe no one wants to own up. Maybe no one flipping asks us to do a flipping a study. No- we just have to suffer with this stupid illness and take away any pleasure we get in life on top of it.

AND he cannot get rid of my bearable yet unbearable pain.

FML!!!!!!

Posted 8/16/2010 10:01 PM (GMT 0)
Weary - what an angry little man your rheumotologist seems to be! Moderate alcohol intake is seen as fine by my doctors. It is a very rare occurence for alcohol to cause liver damage due to MTX, and rheumotologists don't really understand the mechanism behind MTX in the liver (nor do I!), a toxicologist would probably tell you they're being extremely over-protective.

I'm genuinely considering re-training and doing a medical degree, just so I can cut through the bull-crap and have some hope of receiving effective treatment.... (here in the UK, you study for medicine degree normally from the age of 18-22. Med school REPLACES college, rather than follows it)

I think we're in very similar positions Weary, may I ask your age/locale, if it isn't too rude?

FML too.
Posted 8/17/2010 1:55 AM (GMT 0)
Jay-

After re-reading my post I sound like an angry little woman as well- LOL! I am angry darn it!

You and I are in very similar positions yet decades apart in age and oceans apart in local. I turn 50 next month and live in the US.

You would do very well in medical school- why not pursue it? You have a very keen intelligence!

A toxicologist would be a good person to ask our questions to...how do we find one?
Posted 8/17/2010 3:12 PM (GMT 0)
We are angry, rightfully so! At least I'm lucky enough to be on Etanercept. Anti-TNF therapy prescriptions are few and far between over here...

Being a medical doctor never really appealed to me, I don't think I have the patience/charm required to do it well, although depending on how much I miss earning money, I may well sign up for med school after I finish my PhD, which I'll hopefully start in 12 months.

I will do some digging, I read a very good post/article somewhere once relating to the misapprehensions of Rheumotologists regarding MTX toxicity. It was a while ago, though.

The USA does seem to have a much stronger prohibitionist attitude than the UK in general, though.
Posted 8/17/2010 5:15 PM (GMT 0)
If you find that article let me know. Or any other info you may come across.

Aren't you disappointed that the Entanercept along with MTX did not give you complete relief? That's why I stopped my injections of Humira.

I felt just slightly better-just my hands did actually and it comes with so many more possible side effects. I wanted to feel pre-RA. I guess that doesn't happen.

I hope I gave the Humira enough time. I was on it 3 months which my doctor said was long enough to know if it was going to work or not. I still had fatigue too. I do not like injecting myself at all. I used the pen and although most times it was just the initial stick that I felt sometimes I guess I hit a nerve ending and I would like to scream out loud. After I did that once everytime I had to push the button I broke out in a sweat and had to talk myself into it.

Instead of being an MD- how about a research medical degree? What are you getting your PhD in?

Posted 8/17/2010 5:35 PM (GMT 0)
I was disappointed, but for quite a while I was doing very well with MTX alone, then once I started Etanercept, i improved once again. I'm very up and down though, but that's the nature of PsA (more so than RA, which swings around less and is a little more predictable in that respect) but given that my symptoms could be explained by Fibromyalgia, I guess I can't blame the meds. (The more I read on it, the more convinced I become that it's exactly what's up!)

Having had numerous steroid shots, Sulfasalizine, MTX, and Etanercept, I've really exhausted all the different types of treatment - and my inflammation etc IS down, as are my inflammation markers, etc. What remains is exhaustion, and unexplainable pain. (And migraines, constipation, muscle twitches, insomnia, cognitive dysfunction.... all of which I previously assumed was part and parcel of arthritis and its treatment...)

i don't know about Humira, but my doctor told me Etanercept should make a difference within a day of the first injection. I'd say I felt a difference after about 2 weeks. Steroid injections used to make me feel like I'd had a full-body transplant or something... those were the days. I used to be apprehensive about injecting myself, but after doing it twice weekly for about 8 months now, I don't even flinch. I chose the syringe of Etanercept over the pen, because it gives me more control in the speed of injection (The pen does it rather quickly, and the pressure really hurts with Etanercept, it must have a low dispersion rate, so I inject it very slowly.) - The first time I injected it, supervised by a nurse, the words that came out of my mouth..... hah. It honestly gets easier though if you ever are in that position again, promise!


Depending on how my next year goes, I'll either study for a PhD in regenerative medicine/tissue engineering or in quantum physics. (Disparate fields, I know, but I've study nanotechnology for 3 years +, which involves both to a high level!) It just depends how good a grade I can get, I'm also trying to hold down 2 jobs, i've had to give one up (due to my back - nightclub security), and the other (which is full time at the moment, designing analysis software) is a daily struggle. I don't think I've made it in for a full 5 days a week in the last 2 months. Fortunately I'm self-employed and just invoice my client weekly, so they don't ask too many questions when they don't see me in my office on site.

Oh, and I need to find someone to pay for my PhD. Any offers? ;)
Posted 8/17/2010 5:42 PM (GMT 0)
oh and ...


Weary - there is no function for private messaging on this forum?! I wanted to show you the following paper:
http://www.medscape.com/viewarticle/528188

Specifically, "Alcohol consumption did not correlate with hepatic injury (mean 5.15 vs 6.6 alcohol units/week consumed by RA and PsA patients, respectively)"

I can't see how good the research was as I'm not a member of the website, and most American sites don't accept British Academics login details. But it is quite plainly starting that there was no correlation whatsoever between MTX and liver injury in MTX treatment. Granted 5-6 units per week isn't very much alcohol by most people's standards, though I guess many people on MTX aren't going to be completely honest about what they drink.
Posted 8/17/2010 5:50 PM (GMT 0)
My goodness- your parents sure must be proud of you!!!!!

I don't know much about PsA. Does it affect your skin too or is that a misconception when you hear the name?

Posted 8/17/2010 6:20 PM (GMT 0)
PsA is very similar to RA. It effects a different set of joints, and is a little more unpredictable. I've heard doctors/nurses refer to it as both more and less severe than RA, but given that my (other, not the one I've mentioned on the board) sister has had a diagnosis of RA for 5 years+, I'd say they can often be indistinguishable.

PsA is normally found in patients with psoriasis (a flaky skin rash). I had very minor psoriasis, which worsened about the time the arthritis symptoms came about. Initially the thought was rheumatoid (like my sisters), until they picked up on the psoriasis. They're now assuming it's PsA - which means my sisters are unlikely to have RA given it is going to be hereditary. I mean, I could have RA and psoriasis - it's possible. (My sisters have never had any psoriasis, and as it happens, i don't have any at the moment, apart from maybe the only 2x2mm square if I accidentally cut myself)

I think what I'm trying to say is, there isn't much in it - for instance, I know PsA often effects the end metacarpo joint in the finger and RA usually does not.


With regards to studying, the biggest thing Arthritis took away from me was a 12 month studentship at Georgia Tech. I was supposed to spend a year there, doing some electronics research, assisting PhDs, alongside studying basically a syllabus of my choice. (While paying only $800 in fees - rather than the many thousands normally charged). Obviously, with arthritis, I couldn't go - I would've had to pay for all treatment myself, I doubt I could even have afforded MTX, let alone the other treatments I've had.... I was accepted for it before I was diagnosed with arthritis, or even displayed any symptoms. 6 months before diagnosis I hiked 350 miles consecutively, and climbed mountains. Now stairs are a challenge! hah.


And all my mother does is go on and on and on and on and on and on about pain medication, and I spend as little time as possible in the same town as my parents for that reason. I swear she exacerbates the condition. People tell me it's because she cares, I'd rather she didn't!
Posted 8/18/2010 2:11 AM (GMT 0)
Do you have "sausage" fingers? It is one of the only things I have heard about with a dx of PsA.

What do you mean you're mom goes on & on about pain meds? Is she saying you are taking them with no need? Or is she distraught over the level of pain you are experiencing?

Is it that you have always excelled so in studies that they take your successes in that area as "just a fact of life?"
Posted 8/18/2010 2:07 PM (GMT 0)
I do not have sausage fingers, although they were quite crooked and slightly disfigured upon diagnosis, they're pretty much normal now. My sisters are however "sausagey".

My mother complains I take too many, and often interrogates me. I have caught her rummaging through my stuff to count what I've taken before, which there is absolutely no need for. It appears to be her primary concern, when it isn't actually a concern at all, I only take what the Doctor prescribes (how could I take more? OTC stuff doesn't help!) Unfortunately my house is too far away from my job, so I am staying with them for the next month or so, which is becoming quite unbearable!

I'm not sure excelled is the right word for me to be honest! My attendance at college last year was about 15% (so if I had 20 hours of Lectures or Labs in a week, I'd go to about 3) - Mainly because if I don't feel very well, there's not much reason for me to bother going into University (no roll call or anything is taken, ever).

I know my American GPA is 3.6-3.9 at the moment, from application to GA Tech, but I have no idea what that means, it's just a number to me!
Posted 8/18/2010 5:51 PM (GMT 0)
I wonder if your sister really has PsA- the sausage fingers are supposed to be the tell tale sign.

I am a worrying type of mom but now that my kids are all adults I have learned to say things I am concerned about once and then know it's not my place to try and control their lives anymore. It was a hard transition. Sometimes I worry in my bed at night but I keep my mouth closed. :)

My daughter graduated summa cum laude with her masters degree but when she speaks and writes- although impressive- you sound worlds above her! Your fields are intense as well. Keep up the good work- I think you have big things ahead of you!
Posted 8/18/2010 8:54 PM (GMT 0)
Laud is latin for to praise, so I'm guessing Summa Cum Laude is a very good thing. Congratulations to her :)

The professor that treats me suggested that it was extremely unlikely that she have Rheumatoid, if I have Psoriatic Arthritis. (My other sister has 'inflammatory' arthritis and psoriasis, but the psoriasis came after she went into remission, so no diagnosis was made.)

Hey, it could be I have Rheumatoid Arthritis and mild psoriasis, fortunately, the treatment is almost identical, and the clinical trial I am on treats PsA as if it were RA, effectively. I just hope come monday when I see a doc, something is actually done, I'd feel a lot better about treatment with a doctors backing (plus, it's cheaper. Every medication costs £7.20 for a months supply in England, providing you have a script)
Posted 8/19/2010 3:15 AM (GMT 0)
Hi Jay, I went back on my pain patches, I'm trying the Norspan patch this time, I just found the tramadol not really helping any more. I have my panadeine forte for BT pain or a small dose of an opiate when I'm really bad. Mostly I just up the dreaded prednisone if I'm flaring. I hate the lot of them.
The trouble with the opiates is you're not suppose to drink at all but they do work knocking out that back ground pain. I feel more energised on them, more able to cope. Last time I tried them I ended up with migraines, so changing patches I hope works for that.
But it might be worth a try for you, the first time I got the patch dose right I couldn't believe how light I felt. Literally like a weight off my back. It was amazing, I had no idea I was in so much pain until it wasn't there!
Ditto the stairs, I live in a house with 2 stair cases, my physio says its really good for me but the amount of times I crab walk down them...
Best wishes, golitho
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