Man..... I've had a MAJOR flare to my left hand the last 3 days. My left wrist and hand tends to be my arthritis "barometer". It's typically never pain free and it's typically the first to flare. This time it's the only thing flaring. Feels like someone is twisting it off the end of my arm.
No sleep the last 2 nights, increased my Prednisone from 2.5mg to 5mg on Sat, 5mg to 10mg on Sun, and now 15 mg this morning. Prednisone seems to calm it to a tolerable level but it doesn't last the full 24 hours. Around 3am I wake to excruciating pain!
So... onto the real topic of this post. I have left a message for the doc and requested some pain meds for when I am at the peak of a flare (e.g. 3am that last 3 nights). The only thing I take for pain right now is 1000mg acetametaphin three times a day.
I want to know what pain meds others are on, and what are the pros and cons of them per your experience.
VICODIN, it's the only thing that helps me through my flares. I hope you find some relief soon. Have you considered ibuprofen or naproxen?
I second that. I had to use Tylenol while I was breastfeeding, and it did no-thing for my pain. The difference between Tylenol and Aleve was AMAZING. Also, darvocet didn't work and gave me anxiety/insomina. I hate it. Percocet worked much better for me, in terms of a narcotic.You should also consider using a splint at night. My favorite night splint is the Pil-O-Splint (google it). It's cushioned and prevents your hand and wrist from getting squished or bent while you sleep. It makes a world of difference, at least for me. You can usually find them at Walmart, Walgreens, etc.
Thanks for all your suggestions.
I'm told I cannot take ibuprofen while on Prednisone, but I'll check out all the others.
The Splint looks good too. I use a wrist splint on this hand more often than not, but have never tried the night time ones that cover the entire hand. I guess it's time to try it.
Doc called back and basically has me "on hold" until tomorrow so that he can consult with one of his Nurse Practiioners that has been treating me through some rescent trying times with my Remicade. So....I guess I'm supposed to pull the ole bullet out and bite on it again tonight as I am positive my hand is going to flare with a vengence again given how it feels right now.
I understand they are contemplating a swith to another med, but they could at least give me some pain relief.
Thanks again!
Interesting - I've never been told to discontinue NSAIDs when taking medrol. Did the rheumatologist tell you not to take them together?
Yes. I was on Ibuprofen, but when they added the Prednisone he switched me to Acetametaphin and ensured I understood the change.I've never been told to stop my NSAID while I was on prednisone either. I've never heard that before.
Hydrocodone (Lortab, Vicodin) helps me through my flares too. Anti-inflammatories aren't enough. I usually have great results with prednisone, but I have to have something until it kicks in. Personally, I find pain from a flare unbearable.
Well with all the questions I had to go check my facts, and I was incorrect. They moved me from Ibuprofen to Acetametaphin when they put me on Methotrexate, not when they put me on Prednisone.
Sorry for the confusion.
[QUOTE=dgeg1212]Well with all the questions I had to go check my facts, and I was incorrect. They moved me from Ibuprofen to Acetametaphin when they put me on Methotrexate, not when they put me on Prednisone.
Sorry for the confusion.
[/QUOTE]
Diane, I took my NSAID with methotrexate too. Could they have taken you off ibuprofen for another reason? Have you been experiencing stomach problems? Bleeding maybe? Also, Acetamenaphin isn't an anti-inflammatory. It is a pain reliever. The only thing they told me NOT to take with my Relafen (NSAID) is with another NSAID, iwhich ncluding Celebrex.
kweenb, I'll have to get clarification from the doc tomorrow. I did confirm they moved me from ibuprofen to acetametaphin when they put me on methotrexate. could just be a quirk my doc prefers.
I'll let you know if I learn differently.
Could be that they expected inflammation to be reduced or eliminated with the addition of methotrexate and prednisone. Definitely clarify tomorrow what you should be doing in the event of a flare!
my post disappeared. We have not found the right combo of drugs to help me yet, so for pain, I am taking vicoden 10/325 and fentanyl patches. I have dilaudid for when the pain gets so bad I have to go to ER, so I don't have to go. All they want to do is push morphine and I have a reaction to it everytime, but everytime they seem to think it won't happen "this time" I don't know what happened to listening to the patient or reading past charts...Diane, make a list of questions you want to ask your dr. and make a copy for him as well, that way you can go down the list together and you won't forget anything. It makes your appt a much more efficient use of your time. My Rheumy loves that I do that. I also give him an updated list of meds from my primary and at the bottom is a list of refills needed.saw the doc today.
First, regarding why I was moved from ibuprofen to acetametaphin when methotrexate was added to my cocktail, is that ibuprofen can increase the toxicity of methotrexate as it does not "clear the liver" as "cleanly".
Second, the doc wouldn't give me a pain med prescription.. Prefers I pop a larger does of corticosteroid to more quickly reduce the inflammation causing the pain. To that end, I was switched from prednisone to medrol (methylprednisolone). Apparently the medrol metabolizes differently (faster and less impact on the liver I believe is what they said).
Anyway...as for today the medrol is working to reduce the inflammation and therefore the pain.
Next step, have to choose new biologic. Obviously I've run the course on Remicade. (See other post regarding Enbrel vs Humira.)
Owie..... I ran into a guy outside the docs office today that was telling me about the fentanyl patch. He could not say enough good about it. He said he had been in major pain for a long time and had run through a multitude of RA and pain meds, but within literally minutes of putting his first fentanyl patch on he was feeling great! Too bad it does not address the inflammation and joint damage though. I think his next step is Rituxin.
Well RD does not often prescibe pain meds. See your regular GP for that. I tryed the fentanol patch and was to scared of it. Maybe because i still had vicoden in my system. I did not leave it on long. Anyway i am just to chicken for it. I take Vicoden one pill 5/500 three times a day and prednisone 10 mg a day. I am currently on Plaqunil generic form. I am allergic to everything else including NSAID"S so that cuts back on my options. That is pain pill wise i am allergic to everything else. RA meds there are still many i have not tried. I am allergic to Arava and MTX. Well I have never tried Percocet so i do not know if i am allergic to that.[QUOTE=dgeg1212]
Owie..... I ran into a guy outside the docs office today that was telling me about the fentanyl patch. He could not say enough good about it. He said he had been in major pain for a long time and had run through a multitude of RA and pain meds, but within literally minutes of putting his first fentanyl patch on he was feeling great! Too bad it does not address the inflammation and joint damage though. I think his next step is Rituxin.
[/QUOTE]
You won't find immediate relief from pain when you first apply the fentanyl patch. It takes a few hours to reach it's peak.
fentanyl patch has bad side affects and should be used with caution. I don't know if I could take a chance with it. I tryed percocet 5 mg and that seems to help some. I am not big into real strong meds I get sick real easy on meds. I tried enbrel for 6 months and was in hostipal 2 x with bad infections so this past week the doctor told me that all meds had to be stopped before he kills me trying to get me better. So all I am on is predisone 20mg a day and percocet 5mg. I put up with alot of pain but thats all the doctor can do for me because I have allgerys to all the meds they have tried. So I have to except this is what it will be. I have ra in all joints and I have plenty of flare ups but it seems I get threw them. joan[QUOTE=angel58]fentanyl patch has bad side affects and should be used with caution. I don't know if I could take a chance with it. [/QUOTE]
What are the bad side effects?
I use the fentanyl patch while taking vicoden 10/325 and have had no adverse effects at all. It doesn't make me loopy, high, or sleepy. It really has helped my pain level. Soon we will be adding embrel to the mix.I use the fentanyl patch as well...along with oxycocet and haven't had any problems with it either.The big whoopdedoo with fentanyl is that is a very strong narcotic, it's dosed in micrograms because it's so potent. Since it's a patch applied to the skin the absorbtion rates can vary depending on where it's applied, how old the patient is etc. The usual way it's prescribed is for the patch to be changed every three days. Take off the patch, wipe the area off and apply another patch to a different area. If the patient doesn't read the directions and leaves other patches on when applying another they can overdose themselves. I had a friend who had a terrible form of cancer, it started in his mouth and had spread to the bones in his face, it was very painful. Because he had a history of drug addiction, the doctor prescribed fentanyl patches and gave them to his mother to apply to him. She was in charge of the patches. She didn't read the directions. He went to take a nap and when she couldn't get him to wake up, she called the medics. He had like 8 patches on him and he was already dead and had been for some time. The medics never told her that he OD'd on the fentanyl. The family still believes the cancer got to his brain before he started radiation. I have patient's that use the patch and love it, then I've had people who have chronic pain come to the ER with the patch on and can't figure out why they can't stop vomiting. One of the side effects of narcotics is nausea and vomiting. Have to weigh the pros and cons of everything. If offered to me, I think I might try it just because all the oral stuff makes my tummy hurt.[QUOTE=wendyr]The big whoopdedoo with fentanyl is that is a very strong narcotic, it's dosed in micrograms because it's so potent. Since it's a patch applied to the skin the absorbtion rates can vary depending on where it's applied, how old the patient is etc. The usual way it's prescribed is for the patch to be changed every three days. Take off the patch, wipe the area off and apply another patch to a different area. If the patient doesn't read the directions and leaves other patches on when applying another they can overdose themselves. I had a friend who had a terrible form of cancer, it started in his mouth and had spread to the bones in his face, it was very painful. Because he had a history of drug addiction, the doctor prescribed fentanyl patches and gave them to his mother to apply to him. She was in charge of the patches. She didn't read the directions. He went to take a nap and when she couldn't get him to wake up, she called the medics. He had like 8 patches on him and he was already dead and had been for some time. The medics never told her that he OD'd on the fentanyl. The family still believes the cancer got to his brain before he started radiation. I have patient's that use the patch and love it, then I've had people who have chronic pain come to the ER with the patch on and can't figure out why they can't stop vomiting. One of the side effects of narcotics is nausea and vomiting. Have to weigh the pros and cons of everything. If offered to me, I think I might try it just because all the oral stuff makes my tummy hurt.[/QUOTE]
So...basically...it's just like anything else...you have to use caution, be responsible and take as prescribed.
Also...for anyone using fentanyl patches...don't use anything like a heating blanket while using the patch, since the heat causes the medication to be absorbed quickly which could create a risk of an overdose.
I have had great sucess with Ultracet. Ultram with tylenol in it. The 24hr Ultram makes me too sleepy, the Ultracet does not. Only bad thing is that it only last 6 hours. It helps me get through the day at work, unable to function without it.
Copyright ArthritisInsight.com