Hello there. I am really struggling to manage my levels of pain and am finding this really depressing. I was diagnosed in August 2011 and after having to stop taking Mtx and Leflunomide due to side effects I am now on Hydroxychloroquine. I have only been on it for 3 weeks so I know it's too early for it to have worked yet. I just need to somehow get through the next few weeks/months until it takes effect. For pain relief I am taking Tramadol at night and co-codamol 30mg x2 twice a day in the daytime. I am also on Naproxen as well as some other drugs not related to pain. I'm sure that when I first started the Tramadol it worked better than it does now. My GP said that my expectations have got higher.......and I wasn't really sure what to make of this comment. He said there is nothing more that he can give me at the moment. I'm not sure whether to challenge this or just learn to put up with the pain I am experiencing. I have gone part time at work on light duties due to RA but am struggling even with this because I am finding the pain unbearable. Please can someone offer advice about whether I should be asking for different drugs to relieve pain. I really value the opinions of people on here because you really do understand what I'm going through. Thanks from Naomi.

Hi Naomi

Sorry to hear of the problems you are experiencing with pain and the affect it is having on you.

It sounds as though your GP was right to suggest that levels of pain relief requirements were now increased beyond those that you were previously given. Our bodies can become addicted to the meds and as time goes on we need a greater input to cope with the same pain. With all pain relief the objective is to keep it topped up throughout the day and night to achieve maximum benefit.

Naproxen is an anti-inflammatory and the maximum dose is 1g a day (ie 2 doses of 500mg). This should help to control inflammation and therefore pain too. Tramadol is a morphine salt based drug which acts on the brains pain receptor. Co-codamol comes in different strengths, all with 500mg of paracetamol per tablet; some with 8/15/30 or 60mg codeine (the latter comes with 1000g of paracetamol). Co-codamol acts on the sensory nerves and motor neurons. You can take a maximum of 2 cocodamol every four hours up to a maximum of 8 a day. Spread at regular intervals throughout the day they should offer an effective level of pain relief. It needs to be kept topped up every four hours for maximum benefit.

The next stage of pain relief would be the opiates such as morphine but it seems your GP doesn't feel this would be appropriate at the moment; you are already on a strong combimnation! Perhaps in order to relieve the pain and possible potential joint damage now might be the time to take time off from work and give your body the rest it needs. The pain is there for a reason, it is a warning signal that the bodies needs are not being met. With RA there is only so much the drugs can achieve and they do tend to work much better with rest added in.

Just a thought, I have learned a lot from asking questions (always in trouble at school for asking too many questions ), but if you are given info you don't understand ( My GP said that my expectations have got higher.. ) do ask for an explanation. At the end of the day you need that information to treat yourself correctly.

Hope you get some relief soon.

Lyn x

Hi Naomi,
sorry to hear you're struggling with pain. If your inflammation markers are high, can you ask for a Depo injection to tide you over til the hydroxy kicks in? I find they help and I am able to reduce pain meds while their benefit lasts.
Hope things improve for you very soon
Diane x

Hi Naomi

Sorry to hear you are still having huge pain problems. I agree with Lyn but would also add that when all pain relief stopped working for me, I was given oromorph for break through pain. However, as this is morphine based, your GP may be unwilling to let you try it. Maybe for now, steroids are the way forward.

Take care

Love Jeanxxx

Naomi

Getting RA pain under control can be a real trial and error.

I know our local hospital has a Pain Management Clinic which I believe is very good. Could you ask your GP if there is a similar clinic in your area?

Jackie
xx