Arthritis Pain-Relief Guidelines | Arthritis Information
More info from the Johns Hopkins Health alerts:
Michele Bellantoni, M.D., Medical Director of Johns Hopkins Bayview Care Center, answers a reader’s question on the safety of narcotic pain medication for chronic arthritis pain.
Q. I prefer ibuprofen over acetaminophen for arthritis pain relief. But now my doctor suggests I take a narcotic pain reliever. Is this safe?
Dr. Bellantoni answers: Although older adults may consider occasional short-term use of nonsteroidal anti-inflammatory drugs (NSAIDs, like aspirin, ibuprofen, and naproxen) and COX-2 inhibitors (Celebrex) for minor aches and pains, the risk of gastrointestinal bleeding, kidney damage, and (with COX-2 inhibitors) heart attack associated with these pain relievers is too great for long-term use. In fact, newly updated guidelines for pain management in older people, published by the American Geriatrics Society (AGS), discourage most people over 75 from taking them.
Many people do find acetaminophen (Tylenol) effective for managing chronic musculoskeletal pain -- and it is considered safe as long as it used as directed. But if it does not help you, your doctor is right: You should consider a narcotic pain reliever such as morphine, oxycodone, hydrocodone, or fentanyl. These drugs do not pose the health risks you face with NSAIDs.
As Michele Bellantoni, M.D., Associate Professor of Medicine, Medical Director of Johns Hopkins Bayview Care Center, and Health After 50 Board Member, points out, “For many older people, the risks of long-term use of NSAIDs and COX-2 inhibitors are more of a concern than the side effects of narcotics. Constipation and drowsiness are the most common of these side effects, and they can usually be managed by working with your doctor to find the optimal dose of medication.”
Sometimes, people who take narcotics abuse them or build up a tolerance, resulting in the need for escalating doses of medication to achieve the same effect. But studies show that abuse is rare among patients with chronic pain, and with newer, long-acting opioids that release controlled amounts of medication into the bloodstream, increasing the dosage usually is not necessary.
So, I've been catching up on today's posts, and other study here and there. Apparently methotrexate and prednisone and commonly prescribed. Again, I got back to the Dr. this week and she hasn't yet prescribed anything to specifically address the RA. I have been taking the 800 mg of Ibuprofen, but it doesn't help much for the pain.
I was wondering if any of you RA patients take any pain medications long term. Is that part of the long term treatment? This article above seems to suggest that it isn't a good idea to treat the pain year after year.
Thanks!
Roland
I take vicodin for PA pain and have been for about 2 yrs now. Unfortunately they are not working like hey used too. They would not put me on the ibuprofen due to stomach issues.
I was told by rheumatologist that I would most likely be on some sort of long term pain relief unless I went into remission
Even though I don't have RA I hope that helped a little. Ramen.. My timed release NSAID was sufficient to take the edge off and make life so much better.. It's stronger and stays with you for the day... better than ibuprofen OTC.
I guess I may be one of the older generation who don't want to take a narcotic... I also didn't take prednisone electing for shots of cortisone when needed in the affected joint.
We all have to weigh the pros and the cons with all medications available and suggested and or prescribed. I take enbrel and methotrexate as opposed to pred and narcotics, because I felt they deal with my disease and help stop it rather than apply a bandaid..I want to feel the pain so that I know if the meds that help stop the disease are doing their job.
Just my humble opinion.. and not a judgment call being made.
You agree meds that help stop the disease. Celebrex medication is a nonsteroidal anti-inflammatory drug that relieves pain. You feel much better after use this medication.
Pain meds are not the same as DMARD's. I have been on quite a few different DMARD's looking for the combination of meds that will help my disease, but haven't found the right ones yet. In the meantime, I have taken NSAID's for years (currently Relafen) and they do not provide pain relief. So for a couple years I took increasing doses of Vicodin, and this last year I switched to Fentanyl patches. They help to control the pain, but they do not eliminate it, therefore I can tell when the DMARD's are starting to work because I have less breakthrough pain....as a matter of fact, I started Actemra a few months ago and it does seem to be helping. My hope it to find the combination of DMARD's that work for me, and then reduce/eliminate the narcotics.
Ramen, the article doesn't suggest (to me anyway) that long term use of narcotics in chronic pain patients isn't a good idea, if anything, they're saying it's better than long term use of NSAID's. The real danger in long-term narcotic use in chronic pain patients isn't abuse, but elimination of the "safety margin"....in other words, let's say I was in a terrible car accident tomorrow with serious injuries, the pain medication they give me won't work as well (because of my tolerance). However the alternative, living with that amount of daily pain, isn't really an option for me, and poses risks of its own. But as Babs said, everyone has to weigh the pros and cons of their individual situation and decide for themselves.
I would like to add...
I felt very fast reduction in pains with the enbrel and MTX combo.. If I were to have continued long term pain... I may have made other choices as far as narcotics... and or prednisone.
Hi all, thanks for the thoughts.
I finally started taking Celebrex a few days ago; insurance shafu held it up. 200 mg, twice a day. I don't notice much difference from the 800mg Ibuprofen, there is still a lot of pain, couldn't sleep much last (again!). The notices that came with the Celebrex says it might take up to 2 weeks to start working, so maybe that is true in my case. So, yeah, it is always pain right now (hands, elbows, feet, knees) unless my mind is busy doing something. That seems to work best. Swelling is the same as it was before starting the Celebrex. Still no DMARDs, waiting for the RA research trial people to call.
Roland
I did experience that it's an accumulative thing with some NSAIDS.
About sleeping.. In flare, I am exhausted and yet often unable to sleep... I had to stop drinking and eating any stimulant... No caffeine... no sugar... no chocolate after 2 pm in the afternoon...then I could sleep better!!
Sweet Dreams!
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