Any GP’s in the house? Painkiller question…
Discussion
I have rheumatoid arthritis, was diagnosed 10 years ago. I take Enbrel every week and when things get really bad I have Diclofenac and cocodemol 30/500.
Last few months when I’m having a mild/moderate flare the cocodemols are not longer helping. I was offered Gabapentin a few years ago by my GP but I refused it as one of the side effects can be weight gain which I can’t deal with.
What would be the next step up for me in terms of strength from the cocodemols? I can’t get another GP appointment for 5 weeks atm so just want to research what potentially I could be given.
Last few months when I’m having a mild/moderate flare the cocodemols are not longer helping. I was offered Gabapentin a few years ago by my GP but I refused it as one of the side effects can be weight gain which I can’t deal with.
What would be the next step up for me in terms of strength from the cocodemols? I can’t get another GP appointment for 5 weeks atm so just want to research what potentially I could be given.
Big Rig said:
I have rheumatoid arthritis, was diagnosed 10 years ago. I take Enbrel every week and when things get really bad I have Diclofenac and cocodemol 30/500.
Last few months when I’m having a mild/moderate flare the cocodemols are not longer helping. I was offered Gabapentin a few years ago by my GP but I refused it as one of the side effects can be weight gain which I can’t deal with.
What would be the next step up for me in terms of strength from the cocodemols? I can’t get another GP appointment for 5 weeks atm so just want to research what potentially I could be given.
Stronger (or at least equivalent) to 30/500 cocodamol would be tramadol. It was quite in vogue about 10 years back, thought to be 'cleaner' than codeine with less constipation effect. It's probably more addictive than codeine and was recently (last few years) made a controlled drug. Some people find it very effective, others really struggle with it. More 'weird' side effects (spaced out, crazy dreams etc) with tramadol than codeine IMELast few months when I’m having a mild/moderate flare the cocodemols are not longer helping. I was offered Gabapentin a few years ago by my GP but I refused it as one of the side effects can be weight gain which I can’t deal with.
What would be the next step up for me in terms of strength from the cocodemols? I can’t get another GP appointment for 5 weeks atm so just want to research what potentially I could be given.
Next step up from these mild opiates are strong opiates like morphine or oxycodone.
You could be offered a buprenorphine (type of opiate) patch which you apply every 7 days, slow release 24hr analgesia. They can be effective and mean you wake up in the morning with analgesia already in your system (so in theory pain free).
TBH, opiates aren't great for chronic pain (because addiction, tolerance etc).
Not sure how effective neuropathic pain killers like gabapentin (or pregabalin or amitriptyline) are in rheumatoid arthritis flares tbh. They are good for nerve pain in sciatica etc.
You could discuss the option of celecoxib with your GP instead of the diclofenac. It works in a different way to diclofenac (NSAID) and is supposed to have fewer GI side effects (i.e. bleeding risk). Higher cardiovascular risk however (to the extent that certain versions are banned in the US and EU) so be a bit wary.
In significant flares, you might be better off having a dose of prednisolone (steroid) reducing slowly over a number of weeks (though one of the big side effects from steroids is the weight gain you've mentioned you want to avoid).
I assume you are under the hospital? Often there's a rheumatology nurse specialist you can contact directly who can give advice or liaise with the GP re prescription etc.
I would suggest a trip to the GP to discuss this issue - pain is a complex beast and your GP is one of the best placed people to guide you through this. You may have to try things that don’t suit you before finding the best solution, and be aware as time goes on your body reacts differently to drugs as it becomes accustomed to them.
Explain your pain levels and where you feel it, as well as the side effects that you experience - the more info you give to the GP the better they should be able to prescribe the right drug or combination for you.
Explain your pain levels and where you feel it, as well as the side effects that you experience - the more info you give to the GP the better they should be able to prescribe the right drug or combination for you.
g3org3y said:
Stronger (or at least equivalent) to 30/500 cocodamol would be tramadol. It was quite in vogue about 10 years back, thought to be 'cleaner' than codeine with less constipation effect. It's probably more addictive than codeine and was recently (last few years) made a controlled drug. Some people find it very effective, others really struggle with it. More 'weird' side effects (spaced out, crazy dreams etc) with tramadol than codeine IME
Next step up from these mild opiates are strong opiates like morphine or oxycodone.
You could be offered a buprenorphine (type of opiate) patch which you apply every 7 days, slow release 24hr analgesia. They can be effective and mean you wake up in the morning with analgesia already in your system (so in theory pain free).
TBH, opiates aren't great for chronic pain (because addiction, tolerance etc).
Not sure how effective neuropathic pain killers like gabapentin (or pregabalin or amitriptyline) are in rheumatoid arthritis flares tbh. They are good for nerve pain in sciatica etc.
You could discuss the option of celecoxib with your GP instead of the diclofenac. It works in a different way to diclofenac (NSAID) and is supposed to have fewer GI side effects (i.e. bleeding risk). Higher cardiovascular risk however (to the extent that certain versions are banned in the US and EU) so be a bit wary.
In significant flares, you might be better off having a dose of prednisolone (steroid) reducing slowly over a number of weeks (though one of the big side effects from steroids is the weight gain you've mentioned you want to avoid).
I assume you are under the hospital? Often there's a rheumatology nurse specialist you can contact directly who can give advice or liaise with the GP re prescription etc.
Thank you for taking the time to reply.Next step up from these mild opiates are strong opiates like morphine or oxycodone.
You could be offered a buprenorphine (type of opiate) patch which you apply every 7 days, slow release 24hr analgesia. They can be effective and mean you wake up in the morning with analgesia already in your system (so in theory pain free).
TBH, opiates aren't great for chronic pain (because addiction, tolerance etc).
Not sure how effective neuropathic pain killers like gabapentin (or pregabalin or amitriptyline) are in rheumatoid arthritis flares tbh. They are good for nerve pain in sciatica etc.
You could discuss the option of celecoxib with your GP instead of the diclofenac. It works in a different way to diclofenac (NSAID) and is supposed to have fewer GI side effects (i.e. bleeding risk). Higher cardiovascular risk however (to the extent that certain versions are banned in the US and EU) so be a bit wary.
In significant flares, you might be better off having a dose of prednisolone (steroid) reducing slowly over a number of weeks (though one of the big side effects from steroids is the weight gain you've mentioned you want to avoid).
I assume you are under the hospital? Often there's a rheumatology nurse specialist you can contact directly who can give advice or liaise with the GP re prescription etc.
dobly said:
I would suggest a trip to the GP to discuss this issue - pain is a complex beast and your GP is one of the best placed people to guide you through this. You may have to try things that don’t suit you before finding the best solution, and be aware as time goes on your body reacts differently to drugs as it becomes accustomed to them.
Explain your pain levels and where you feel it, as well as the side effects that you experience - the more info you give to the GP the better they should be able to prescribe the right drug or combination for you.
Explain your pain levels and where you feel it, as well as the side effects that you experience - the more info you give to the GP the better they should be able to prescribe the right drug or combination for you.
Thank you
g3org3y said:
Stronger (or at least equivalent) to 30/500 cocodamol would be tramadol. It was quite in vogue about 10 years back, thought to be 'cleaner' than codeine with less constipation effect. It's probably more addictive than codeine and was recently (last few years) made a controlled drug. Some people find it very effective, others really struggle with it. More 'weird' side effects (spaced out, crazy dreams etc) with tramadol than codeine IME
Next step up from these mild opiates are strong opiates like morphine or oxycodone.
You could be offered a buprenorphine (type of opiate) patch which you apply every 7 days, slow release 24hr analgesia. They can be effective and mean you wake up in the morning with analgesia already in your system (so in theory pain free).
TBH, opiates aren't great for chronic pain (because addiction, tolerance etc).
Not sure how effective neuropathic pain killers like gabapentin (or pregabalin or amitriptyline) are in rheumatoid arthritis flares tbh. They are good for nerve pain in sciatica etc.
You could discuss the option of celecoxib with your GP instead of the diclofenac. It works in a different way to diclofenac (NSAID) and is supposed to have fewer GI side effects (i.e. bleeding risk). Higher cardiovascular risk however (to the extent that certain versions are banned in the US and EU) so be a bit wary.
In significant flares, you might be better off having a dose of prednisolone (steroid) reducing slowly over a number of weeks (though one of the big side effects from steroids is the weight gain you've mentioned you want to avoid).
I assume you are under the hospital? Often there's a rheumatology nurse specialist you can contact directly who can give advice or liaise with the GP re prescription etc.
This is an excellent summary.Next step up from these mild opiates are strong opiates like morphine or oxycodone.
You could be offered a buprenorphine (type of opiate) patch which you apply every 7 days, slow release 24hr analgesia. They can be effective and mean you wake up in the morning with analgesia already in your system (so in theory pain free).
TBH, opiates aren't great for chronic pain (because addiction, tolerance etc).
Not sure how effective neuropathic pain killers like gabapentin (or pregabalin or amitriptyline) are in rheumatoid arthritis flares tbh. They are good for nerve pain in sciatica etc.
You could discuss the option of celecoxib with your GP instead of the diclofenac. It works in a different way to diclofenac (NSAID) and is supposed to have fewer GI side effects (i.e. bleeding risk). Higher cardiovascular risk however (to the extent that certain versions are banned in the US and EU) so be a bit wary.
In significant flares, you might be better off having a dose of prednisolone (steroid) reducing slowly over a number of weeks (though one of the big side effects from steroids is the weight gain you've mentioned you want to avoid).
I assume you are under the hospital? Often there's a rheumatology nurse specialist you can contact directly who can give advice or liaise with the GP re prescription etc.
Talk to your Rheumatology team too, as suggested. There are sometimes new treatments in specialty fields and the hospitals should be on top of this. There are also clinical trial that are occasionally recruiting on new meds.
Big Rig said:
Update. Doc gave me Tramadol and also told me to take paracetamol with them?
Anyway found relief but am feeling very spaced out & getting very strange headaches on & off.
Ive got rheumatoid arthritis along with secondary osteoarthritis and fibromyalgia.Anyway found relief but am feeling very spaced out & getting very strange headaches on & off.
Co-codamol 30/500 are my regular pain killers with tramadol for when things are worse so its pretty similar to yours.
I was given tramadol last year for osteoarthritis. Had some horrible side effects, especially dizzy and feeling very "third party". Went back to amitriptyline.
I had a knee replacement last month. I was given oramorph in the hospital which made me sick, so they swopped it for tramadol. No side effects whatsoever - other than it cured my IBS.
I had a knee replacement last month. I was given oramorph in the hospital which made me sick, so they swopped it for tramadol. No side effects whatsoever - other than it cured my IBS.
xx99xx said:
Tramadol gave me headaches, which is weird for a 'painkiller' to give you a new pain. But personally I liked the spaced out feeling and was worth it.
Tramadol has some analgesic effect by blocking serotonin receptors (and noradrenaline for that matter too). The effect of this block is dilation of blood vessels along with inhibition of spinal cord pain-control pathways. Hence, dilation of blood vessels inside your head and brain can result in headache. Other drugs which use a similar mechanism of action include anti-nausea drugs and they have a 10% rate of headache. There are different subtypes of serotonin receptor but I would assume tramadol and other drugs are probably not sub-type specific enough to avoid the effect entirelyDrugs which stop migraines activate serotonin receptors to reduce vascular swelling which is the basis of their action.
Tramadol! 
Meds and their side-effects, eh? Over 20 yrs ago now I was in agony with a prolapsed disc and nothing was stopping the pain. GP: 'I have just the thing, and he handed me the prescription: 60 Trams.
I managed (according to my wife) just 6 before my she called the docs in a panic.
I'm a 60s teen (sex, drugs and rock 'n roll!) and this was the first and only time I'd been away with the Fairies in my life.
I literally had no f
king idea where I was or what I was doing.
My wife was told to ensure I took no more and a different prescription was issued.
'Luckily' I had not been able to get 'behind the wheel' so to speak or gawd knows what could have happened.
To sum up, my wife recalls me saying that the 'pain was preferable!'
I gave the remaining 56 tablets (yeah, yeah, I know) to my brother-in-law who had recently had his second hip op.
He'd been taking Tramadol and had run out. Side-effect for him was just one, they made him nod off.
As said, 'meds and their side-effects' especially on different people.
Meds and their side-effects, eh? Over 20 yrs ago now I was in agony with a prolapsed disc and nothing was stopping the pain. GP: 'I have just the thing, and he handed me the prescription: 60 Trams.
I managed (according to my wife) just 6 before my she called the docs in a panic.
I'm a 60s teen (sex, drugs and rock 'n roll!) and this was the first and only time I'd been away with the Fairies in my life.
I literally had no f
king idea where I was or what I was doing. My wife was told to ensure I took no more and a different prescription was issued.
'Luckily' I had not been able to get 'behind the wheel' so to speak or gawd knows what could have happened.
To sum up, my wife recalls me saying that the 'pain was preferable!'
I gave the remaining 56 tablets (yeah, yeah, I know) to my brother-in-law who had recently had his second hip op.
He'd been taking Tramadol and had run out. Side-effect for him was just one, they made him nod off.
As said, 'meds and their side-effects' especially on different people.
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