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Pain relief
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Pain relief

I was diagnosed with psoriatic arthritis when I was 18 years old. I'm 62 now. Over the years I have been on probably everything out there, starting with gold treatments back in the early 70's. Because there wasn't much available back then, I ate aspirin like candy which helped at that time, but blew out my stomach. Then came ibuprophene and it's clones and I began taking them. I can't anymore. NSAID and DMARDS and cortisone injections and prednisone and metho injections and Remicade and Enbrel and Humira...........I've probably left something out, but you get the picture. The Enbrel worked quite well, but after 2 years I began getting some weird lab reports and while it was never conslusively connected to the Enbrel, I became wary of the biologics because I felt they just really didn't know enough about the long term effects, so I told my rheumo I was done. My arthritis is now in every joint of my body with the exception of my elbows for some reason, but the bottom line is that I live in constant, very bad pain. My rheumo wants me to try Celebrex, but my cardiologist says no............too many cardiac risks AND GI bleed warnings. So much testing required during treatment. The anxiety while taking it would, in my opinion, far outweigh any benefits. I asked my rheumo to let me try opioids. I DO understand that these types of drugs are controversial in the treatment of arthritic pain, and are never the first line treatment choice, but I think I've given the other stuff a fair trial. I've also done a fair amount of research on what some of the top doctors in this field have said about using opioids...........doctors from the Mayo Clinic, Johns Hopkins, The Cleveland Clinic, and articles in the New England Journal of Medicine. I haven't garned my opinions from the National Inquirier! All of these reports have made a point of bringing to light the debate surrounding this issue, but they have also said it's a viable alternative in the "correct" patients, side effects and long term affects are less daunting and far better well known, the worst possibility is the addiction issue, but even that was shot down by most. Long term studied had been done on this factor and it was proven, quite overwhelmingly, that while "dependence" WAS a factor, addiction was low on the list. At age 62, my hippie days are long past, I do not abuse any of my medications (and I take some that could be) and I do not have to take them on a regular daily basis. As like most of us, I have days that are bearable and then I have days that are pure agony. It's THOSE days I would like to take something to stop the pain. If I become dependant, well, that's just the price we have to pay sometimes. I have no desire to become some junkie laying about in my front yard. I want to live the best life I can, free of as much pain as possible. I have my first grandchild on the way and I don't plan on being a drooling fool in the rocking chair. I understand the gravity of how these meds can be abused. And who knows, maybe I would hate them. Maybe I would not like how they made me feel, maybe they would not help.......I would simply like to try them and see. I tried everthing my doctor asked me to, I don't understand why he is so firmly against them. I am also aware that there is some concern in this country that doctors are being a bit too free with the pain med scripts, so I understand they are probably under a certain amount of scrutiny. But this is a legitimate use of these drugs, backed up by some very big names in the medical community and I thinking I need to take my request to another doctor, which I really don't want to. I've been with my rheumo for years now...........but his staunch and negative atitude is making me angry.
Sorry for the length of this post, I really just meant to ask if there was anyone here who DID use opioids for pain management and how it was working for them.
Right now, I am taking nothing and life is pretty grim........not  much fun.
Any advice, suggestions, thoughts are welcome.
Thanking you in advance           
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1193998_tn?1265121197
Hi there,

It sounds to me like you need to find another doctor or a pain management clinic who will work with you on finding the best pain relief options, including careful use of opioids. It seems to me you've exhausted all other options and your research is solid. If it were me, I would "fire" the doctor who refuses to treat you as a partner in your own treatment.
4 Comments Post a Comment
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Avatar_dr_f_tn
Hi,
How are you? Aside from psoriatic arthritis, are there other comorbid conditions present?  Indeed, each doctor differs in their management belief. Also, the use of opioids as a treatment for non-malignant chronic pain remains a subject of considerable debate. Seeking another doctor's or rheuma's  management opinion may be done. Any treatment with the potential to improve chronic pain symptoms should be prescribed and the results carefully studied. At the end of the day, decision still comes from you. You can also try other options such as complementary and alternative medicine's biofeedback and acupuncture for pain relief. Hope this helps. Take care and do keep us posted.
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370181_tn?1408130715
Thank you for your response
.
You mentioned the debate regarding the use of opioids in "non-malignant" chronic pain. This term became very familiar while doing my research.

It ended up making me very angry. In NO WAY am I assuming my chronic pain can be compared to the chronic pain of a terminal cancer patients, but for that ambiguous "THEM" out there to assume MY pain doesn't destroy the quality of my life is incredibly naive.

I would wish this disease on no one, but if, for only ONE day, my rehumo  had to live with this pain, I am absolutely positive his opinion would change 180 degrees.

I have have been diagnosed with severe hyperlipademia, I have CAD and two cardiac stents, with a third looming on the horizon. I have controlled high blood pressure, GERD, a history of GI bleeds, migraines and PTSD (dealt with from 15+ YEARS of psychiatric care) and panic disorder.
I take these meds daily:
Alprazolam 4mg qd
Atenolol 50mg qd
Amlodipine 5mg qd
Niaspan 2000mg qd
Atorvastatin 40mg qd
Maxalt PRN
Nitro PRN
81mg aspirin qd
Zantac PRN (nightly)
Zoloft 150mg qd

That's quite a stew. And as you can see, there is nothing in that mix for my chronic pain.

I take a Senior Yoga class for people with arthritis.
Tried acupunctiure and it helped MILDLY with my back pain only
I swim
I walk
I rest
I watch my diet
Drink I-2 glasses of red wine daily
Quite smoking 3 years ago (Still sneak one sometimes. Don't say it!)
Must use a cane
Cry out of frustration a LOT because I hurt too much to do anything I enjoy like yard work, gardening, puttering in my Koi pond and in September of 2012, finally had to admit my job as a CNA at Harborview Medical Center in Seattle was something I could no longer do.
The loss of these pleasures and my work at the hospital, which gave my life real meaning, have been taken from me because of this damn disease. I  believe with less pain, I could return to SOME of these pass times and my quality of life would improve and my depression may lessen.

I think I will look for another rheumo or consult with a pain management doctor. I really feel like I'm at my wits end with this.

I doubt you will read this, but it felt good to get it out anyway.
Linda    


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Avatar_f_tn
Hi greenlydia,

I just finished reading your comments. So, your rheumo wants you to
try Celebrex. I would caution you against taking Celebrex. My mom
who is also suffering from chronic pain due to a back injury she sustained
from a bad fall eight years ago, was also prescribed Celebrex by a
surgeon who is an expert in pain management. Well, my mom was on
the Celebrex for only two days. She felt very ill on the Celebrex and
went off the Celebrex by herself as it was making her symptoms worse.
Yes, I've also heard that Celebrex has cardiac risks, didn't know about
the g i bleeding. My mom was very ill on Celebrex and she told the
pain specialist/surgeon at a well known hospital that she no longer wanted
to take the Celebrex and that it made her feel extremely ill. I've also heard,
haven't been able to confirm this rumour , that Celebrex has been taken
off some pharmacy shelves. Hope this post helps. Eve
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1193998_tn?1265121197
Hi there,

It sounds to me like you need to find another doctor or a pain management clinic who will work with you on finding the best pain relief options, including careful use of opioids. It seems to me you've exhausted all other options and your research is solid. If it were me, I would "fire" the doctor who refuses to treat you as a partner in your own treatment.
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