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NanMac
Regular Member


Date Joined Mar 2007
Total Posts : 71
   Posted 5/29/2007 10:26 AM (GMT -7)   
Anyone have a suggestions on what to try? I have tried Tylenol3, Tylox, Vicodin, Percoset. These all make me very nauseous and vomit. I would rather live with the pain. After surgeries in the past I took Percocet & a precriptoin antinausea drug called fenerall or fenigan I think. When I mentioned this to the Rheumy told me to take Dramamine with the Percocet. Not a go mix for me. I felt nauseated and had a killer headache the whole next day. I seem to be very sensitive to pain meds and I have to work so I can't be high. Is there another class of pain meds that don't have this effect? I can't take other antinflammatory drugs because I am on Prednisone.
I may finally get some kind of Dx. on Thursday because my Rheumy finally saw me during a really bad flare after weaning off the Pred. He ordered bone scans, MRI and CT scans. Hope I can find a long term med that will aleviate my symptoms. I can't seem to spell today, I think my brain might be having a flare also.
NanMac

erin.K
Veteran Member


Date Joined Mar 2005
Total Posts : 3148
   Posted 5/29/2007 10:55 AM (GMT -7)   
:-)  hi nan
forgive my sp & grammer...hands r bad.
 
those pain meds u listed are known 4 causing wicked nausea & vomiting.  + dizziness as well.
 
does food make a difference? eating a fair amnt before percocet?
 
Emotrol is a nice OTC antiemetic.
RX for N/V i use Tigan & meclizine.
 
pred makes me very nauseous.  i tend to hurl when i taper off of it. mad so the pred plus going off of it could be causing a lot of the nausea & sickness.
 
y can't U take nsaids? do U have a bleeding problem?  or is it cuz your BP?  it's not totally contradicted to take pred + an nsaid.  when U feel up to it...lemme' know about that...curious.
 
cox2 meds (i started celebrex again last week) R a bit "nicer" on the GI tract.  they're not narcotic either.
 
Arthrotec worked great 4 my joints...but i had to stop that, it did work great however!
there's Voltaren & misoprostal that R suppose 2 protect the stomach....{i'm just throwing things out in the air here tongue }
 
i also take an opioid, Dilaudid, for pain (along w/ pred/celebrex/diclofenac) dilaudid has been OK....no nausea or queeziness...i've been taking it a year or 2...so there's no "high" or loopy feeling.
the immunosuppressants i'm on i think help a lot w/ the pain (that is i'm hoping they do).
 
U may find that a combo of quite a  few meds is what it takes to control your pain...a lot of it is probably inflammation, so percocet, vicoden, etc....those really wouldn't help much cuz they hold no anti inflammatory properties.  BUMMER!
 
the best to you
erin
Arthritis Forum Moderator & Co-Pilot
Active Severe Rheumatory Arthritis. AS. Crohns Disease. A.Chiari Malformation & right brain venous anomoly. Partial Complex Seizures (under control!). MVP & Tricuspid Valve Prolapse. Rheumatic heart & lung. Kidney Stones (oh joy). Previous Lymes Disease for 10 years.
Meds: Remicade infusions 600mg Q3weeks; Intra-articular knee injections; 6MP 50mgQD plus 75mg weekly; Mesalamine 4GramsQD; Prednisone 20mgQD; Entocort 9mgQD; Meclizine; Augmentin; Tigan 300mg; Reglan; LidoDerm; Diazepam 5mg; Rozerem 8mg; Diclofenac; Celebrex; Percogesic; Dilaudid 4mg. 


The Bear
Regular Member


Date Joined Mar 2007
Total Posts : 364
   Posted 5/29/2007 12:01 PM (GMT -7)   
Hi nanmacwelcome to the mad cave. I don't particularly recognise the names of your drugs as we have dfferent names for most over here in the UK.However, t may be worth looking at the constituent components of your drugs - there may be one that is ncompatable with your body. Am not a RA but OA [with pd] so I don't take similar drugs. However I do take arthrotec 5 and notice the difference when I stop taking it for whatever, but thee may be something there you don't like or doesn't like you.
Can you get dihydracodeine over there on script? I take 8x30mg a day and again, although it feels like they are not doing much good re pain management, it is only when I stop them that I know just how much they help yeah [there is also a smalll withdrawal problem with them but just like a bad cold].
 
Hope things work out well for you.
Stay well
The Bear

Keah
Veteran Member


Date Joined Nov 2003
Total Posts : 7314
   Posted 5/29/2007 12:12 PM (GMT -7)   
Nan,
First, I'm thrilled that your Rheumy has gotten on the ball! Sometimes we really need to get in there when we're at our worst. I'm afraid that after seeing so manypatients day after day, they become a little immune to our complaints until they can really SEE it for themselves. I hope that having all these tests done will get you on the road to real relief soon.

There are so many different things that can be tried to give you some pain relief. However, I think you're dealing with the wrong Doc for that. Sure, a Rheumy can prescribe adequate methods of pain relief, but for someone as sensitive to meds as you are, they are not the best choice. HAving your Rheumy treat your pain is almost the same as having an eye doctor treat your arthritis. Sure, he could do it, but not necessarily with the optimal treatment.

Get yourself a referral to a real Pain Managment Specialist. These are anesthesiologists who are specially trained to treat only the pain. When my pain got too bad to handle, I made an appt at the Pain Center affiliated with my hospital and that was the best decision I ever made. My Rheumy would only treat me with Ultracet, which for me caused serious insomnia and didn't help much with the pain. Although my PCP did give me Vicodin, I was concerned about the amount of tylenol I was consuming on a daily basis. The Pain Center was a God-send.

Not only do they treat me with the appropriate level of oral pain meds, but I've had cortisone injections into several joints to help with the inflammation. I've also done some epidural injection to relieve the spinal pain, trigger point injections to relieve muscle spasms, radio frequency treatments to stop the nerve pathways from transmitting pain signals, steroid injeciotns into tendons and even Botox to relieve some particularly bad muscle spasms. In addition, I've had some real medical massage and something called MAtrix therapy which is a combination of massage and something like a longer term TENS therapy. I honestly can't say enough about how helpful the Docs and PAs at my Pain Center have been. I now have better pain relief than ever!

So please, look into what your options are for a Pain Doc. I can't possibly explain how wonderful it is to have a Doc whose only concerned is that I feel good. Granted, I realize that I'll never be pain free and some of my meds do have some minor side effects like forgetfulness, but that's the price I have to pay since I already have permanent joint damage. At least I can get to the store and do some of the activities of daily life now. Before i had pain relief, I spent most of my days in bed.

Best wishes.
Keah a.k.a. Wormy
 God helps those who help themselves.
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Keah
Veteran Member


Date Joined Nov 2003
Total Posts : 7314
   Posted 5/29/2007 12:25 PM (GMT -7)   
Hey Bear,
 
Yes, we have a sinilar drug here. It's called Tylenol (generic name: acetaminophen or paracetamol) and it is followed by a number.
Tylenol #2 has 15 mgs of codeine, Tylenol #3 has 30mgs of codeine and #4 has 60mgs of codeine.
 
The problems with using this med as long term pain relief is two-fold. First, this is a very short acting med and dosing needs to be done every 4 to 6 hours, as needed. Second, there is concern over the contin ual dosage with acetaminophen or paracetamol. Too much of that can result in liver and kidney damage. This is why it's considered better to seek pain treatment from a Pain Specialist when dealing with chronic pain of any type. Longer acting meds, without substances like tylenol or other NSAIDS is far better and easier on the body.
 
I don't know much about your health care system, but if it's possible, you should research what other options there are for you to treat the pain on a long term basis.
 
I hope you are successful.

NanMac
Regular Member


Date Joined Mar 2007
Total Posts : 71
   Posted 5/29/2007 1:51 PM (GMT -7)   
Thanks for your responses. I tried the Ultram and I had very fitful sleep due to weird dreams. It didn't really help the pain much. Tylenol doesn't do anything for the pain and I am medicated for HBP. I have taken alot of advil (I know its bad for BP too) in the past but the Rheumy told me not to take it with the Prednisone. I started to take Pred. again to help me get out of this flare. It is day 4 and it is starting to work. I hate the way it makes me jittery, increases my HBP and makes it hard to sleep at night but today I only feel the pain mildly in my back, neck and elbow. I end up taking a slleping pill about 3/week. I don't seem to have a sensitivity to them. After I visit the Rheumy on Thursday and we make a Dx and hopefully a long term plan I will consider pain managment. I need to figure out something to help me get by as I must work or my family doesn't have insurance. I do have the summer off so I hope to get things under as much control as possible so I don't miss so much work next year. If anybody has any other suggestions of pain meds. I would love to hear them.
NanMac

curley
Veteran Member


Date Joined Mar 2005
Total Posts : 4305
   Posted 5/29/2007 6:06 PM (GMT -7)   
I am on duragesic pain patch's and I have oxycodone for break through pain and so far it has worrked for me. There are so many meds I cannot take due to the fact that I have crohns.I hope that you get some relief from the pain.
Curley
.........
 


The Bear
Regular Member


Date Joined Mar 2007
Total Posts : 364
   Posted 5/29/2007 11:41 PM (GMT -7)   
Hi Keah. yes we have tylenol here under the name cocodomol with the maximum codeine dose 30mg and 500mg of paracetamol and for the reasons you mention I don't use it. I use straight dihyhdracodeine 30 -60mg x 4 daily. Paracetomol is a fine general short term analgesic but does have these long term effects you mention. What I was\wondering is do you have access to the straight codeine? The concept of a pain specialst is great but we don't have them for people who are not termed 'seriously ill' enough to warrant access to them. Most areas have specialist pain nurses but tey are not the same thing. My MD doesn.t prescribe straight codeine to just anybody, only those who she thinks [and hopes] won't abuse them as on the streets they can go for up to a dollar a time by heroin addicts who can't get a score or by those who misuse them in their own right.
There are parts of your system that, despite needing insurance to access t, shames ours and that is the access to testing and the type of kit avaiable. HAving a health service free at source is one thing, having it fully fundd with all hte right kit everywhere is totally another. Scanning equipment is left idle through lack of traine operatives or chronic underfunding. There is regional and area 'post code' [zip code] health care. My medis for pd are not available to people living in Scotland and I wouldn't expect the average MD to know about them. I had to inform by neuro about them. So although we have a wnderful health service for many reasons ts strengths are also its weaknesses.
It is still raining American rain here in downtown Apsley.
Stay well.
The Bear

erin.K
Veteran Member


Date Joined Mar 2005
Total Posts : 3148
   Posted 6/2/2007 10:20 AM (GMT -7)   
dear missie
 
there are soooo many misconceptions about pain meds and "addiction".  to add to that scrutiny, the media,  people who buy and sell potent pain meds illegally, and people & teens who use them for "recreation" are to blame for the big fuss about narcotic pain therapy.
pain meds, if used for PAIN...the chances of developing an "addiction" are slim. 
now...you definitely can become DEPENDENT on them!  sure!  that does not mean you are an "addict" or have a problem.
it's just like with prednisone & other steroids...when you have to use them for a long time, the body becomes physiologically dependent on them.  therefor you have to wean slowly off of them to avoid withdrawal.
 
regarding what you mentioned, codeine is far more potent than darvocet (which is why w/ codeine many times one must wean/taper off of them) Darvocet is a pretty decent pain med.  i was taking that for over 2 years until i became tolerant to it and it didn't work any longer.
 
not all cities in the US will have pain management physicians.  it may need some research if you live in a rural area.  do talk to your GP about it. i am sure he/she can refer you or gear you toward one.
 
best wishes
erin 
Arthritis Forum Moderator & Co-Pilot
Active Severe Rheumatory Arthritis. AS. Crohns Disease. A.Chiari Malformation & right brain venous anomoly. Partial Complex Seizures (under control!). MVP & Tricuspid Valve Prolapse. Rheumatic heart & lung. Kidney Stones (oh joy). Previous Lymes Disease for 10 years.
Meds: Remicade infusions 600mg Q3weeks; Intra-articular knee injections; 6MP 50mgQD plus 75mg weekly; Mesalamine 4GramsQD; Prednisone 20mgQD; Entocort 9mgQD; Meclizine; Augmentin; Tigan 300mg; Reglan; LidoDerm; Diazepam 5mg; Rozerem 8mg; Diclofenac; Celebrex; Percogesic; Dilaudid 4mg. 


NanMac
Regular Member


Date Joined Mar 2007
Total Posts : 71
   Posted 6/2/2007 10:54 AM (GMT -7)   

I am learning alot about pain managment from you'll. My state licensing board will require that I take a 6 hour pain management class next year. I hope that what I learn will help me understand more about controlling it. I know my rheumy would work with me to control pain by giving me another pain med but I need to work and I don't like how the meds cloud my brain and usually make me sick. Has anyone tried acupuncture? Would acupuncture be a modality that a Pain clinic might try? If you have been to a pain clinic what modalities do they use?

NanMac


elcamino
Veteran Member


Date Joined Sep 2005
Total Posts : 1744
   Posted 6/2/2007 5:26 PM (GMT -7)   
I don't take anything heavy duty for pain (no narcotics, aside from recovery from surgery), but I've took ultracet for 2 years, and more recently I've been taking straight tramadol. I think my rheumy took me off the ultracet because of the tylenol in it, combined with the mtx I'm taking along with the tb meds which all can damage the liver. I've been fine with the tramadol. No, it's certainly not perfect, but I can live with a certain amount of pain. Sometimes I need to feel it just to remind myself why I'm taking all of these drugs to begin with. Tramadol is an option, and is not an addictive narcotic (from what I understand); of course, it's not as powerful as an opiate, or other narcotic, but I definitely find it stronger than tylenol.

Elcamino
Current dx: Rheumatoid Arthritis
Suspected dx: UCTD/Early Lupus
Current Meds: Enbrel, Plaquenil, Aciphex, Ultracet, Zyrtec, Allavert-D, Zantac, Tylenol PM
Past Meds: Relafen, Vioxx, Mobic, Voltaren, Sulfasalazine, Entocort, Prednisone, Humira, Reglan

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