AF, Warfarin, and Tramadol

Hiya guys and gals,

I posted on here a while back about shoulder pain, sleepless nights et al. Many, many of you gave me some great insights for which I am grateful. I think the general consenus supported my GP's view that this pain wasn't so much AC joint related but tendon/rotator cuff related. I maintain my exercises/stretches and hope for the best/plan for the worst !! At the moment no Xrays on left shoulder. I survive with shoving notable quantities of 30/500 CoCodomol (prescription grade) down the neck. Went to bed last night scoffing CoCod and in so much pain I forgot to take my night time doses of AF meds .... Grrrrrr !

My GP has prescribed Amitriptyline one to be taken at night but that was a helpful but unwise choice as it gave me diahorrea. Bus drivers and diahorrea are NOT the best mates !! I told dear GP that I'll stay with the CoCod.

Unfortunately, as we move further into the dead season, my pain becomes more alive and ( its now 4.45am) and the pain not only woke me but it was eye watering to a degree I've not experienced for a long time. More CoCod down the neck !!

I think the CoCod isn't cutting it. I seem to remember when I came round after knee replacement surgery they gave me some sort of liquid morphine but that didn't do anything for pain relief. I'm sure they then gave me Tramadol. So, my question to you is this ..... has anyone with paroxysmal AF ( but highly controlled) using Warfarin tried any particular level/grade of Tramadol for pain relief - were there any side effects ? Did it fix the pain is also relevant !

Yeah, hey ho, I know driving a bus for 10 hours will be aggravating my shoulder but in these circumstances I am always pain free. No problemo ! Its always at night and although I'm having some success in changing my sleep position it doesn't always happen. I am coming to the view that maybe its time to start smelling the roses.

Your thoughts, insights, wisdom would be appreciated.

John

[jeanjeannie50]

Morning John. I'm sure that turning the steering wheel and general movements when driving a bus can't be doing your shoulder any good. It could be a repetitive strain injury. I'm sure you must have thought about retiring. What about doing that? If your shoulder then got better there is sure to be lots of volunteer jobs for a driver e.g. for disabled people, or the National trust. Just an idea.

By the way, I know that paracetamol work far better at relieving pain for me, than anything else, including morphine

Jean

[Hidden in reply to jeanjeannie50]

Morning Jean,

Thank you for your comments. Of course you are quite correct that no matter how well ergonomically designed bus driver cab positions are these days, the constant push pull is taking its toll on my shoulder, both actually but the left is worse. Yes retiring and smelling the roses or fresias is figuring in my mind at the moment. Some 20 years ago I fell off a bungalow roof ( in Sydney) and although I didn't do anything reasonable like breaking anything I did shift the collarbone on the side that hit the deck. So, the two boney bits you can feel at the lower neck ( whatever it is called) the right side lies higher into the neck than the left. I was warned all those years ago that it was inoperable ( back in those days) because of its proximity to an artery and that it would cause me collar bone/shoulder problems as I aged. That whole area is basically out of alignment.

Most nights I am beginning to have some success modifying my sleep position. I am naturally a restless sleeper BUT some nights are worse than others. My natural preferred sleeping position is on my left side. So its all very much a bit of a pickle.

I don't really want to expand my party bag of drugs so I think I'll give your suggestion a try and see how it goes. Most nights with a modified sleep position I can get 7 to 7 and half hours decent sleep BUT gosh, when I can't like last night ..... wow! Problem is it all varies week on week, and very much dependant on weather changes too. When my digital weather station tells me humidity is increasing and barometric pressure falls then I know I'll have issues.

I'll write more in response to CD when I get back from Chiropractor ( a long standing appointment I have had - nothing to do with last night). Thanks again.

John

[CDreamer]

Morning John, so sorry you are suffering but I agree with Jean - repetitive strain agrrevating a previous injury = inflammation = pain.

My shoulder pain completely went away after COVID and I was astounded, as did pain in wrist from Carpal Tunnel after I fractured my wrist earlier in the year. My GP put it down to 3 weeks total rest whilst recovering and several weeks recuperating. I’m now back doing most things and guess what - my shoulder pain has returned (although not to the degree it had) because I wasn’t doing all the activities that gave the pain.

John I know you love your work and it keeps you going but I would be very hesitant to get onto your bus if I knew you were not sleeping and/or taking heavy duty pain killers which are not going to fix the problem, only cause many more from the meds.

I also found that paracetamol really helped when pain at it’s worst with the inflammation and to help me sleep so I would take 2 soluble paracetamol late afternoon and another 2 just before bed. Didn’t take the pain away but helped enough that I could sleep as long as I didn’t sleep on left side. I also uses a small cushion/pillow to support my left arm when sleeping on my right side - that also helped, along with physio exercises.

Sorry to be blunt and I do sympathise.

[Hidden in reply to CDreamer]

Hiya CD,

Don't worry about being blunt 😀 Yes, you and Jean are pretty right. I have been wrestling with stopping. Next week I start leave so I have got some two weeks or more I'll just be driving my shopping car - and then not very often.

These bad attacks(like last night) are not very frequent but bad news when they happen. I don't need my tracker to tell me when I have a bad night of pain. What it does do is tell me heart info too which enables me to decide when to ring in sick and not drive my bus.

Be assured I never drive after a bad night. There are too many criminal charges that can be brought to bear on bus drivers. Fortunately, I only work 4 days, soon to be reduced to 3 and as and when we can get more drivers down to 2.

My problem is my brain is still super active and it hasn't yet accepted that the skeleton isn't up to it any longer 😂😂

I am already having a measure of success with cushions exactly as you describe and trying to sleeping a different way but it seems I always gravitate to my left side. I do my exercises/stretches but not very good at maintaining a routine. I see my Chiropractor every 3 weeks for ongoing maintenance on shoulder and upper back.

Anyway CD, thanks for your thoughts- time is nigh to smell the roses and/or Fresias.

John

[Desanthony]

They probably gave you oramorph after your knee op along with other tablets I had codeine phosphate tablets and I think paracetamol as well as couldn't take anything due to AF meds. the pain was still just about bearable even after 20 - 30 mins when the pain meds should have kicked in - then of course I did my exercises and during and after that couldn't wait for the time when I could take the pain meds again. I am allowed co-dydramol when necessary at the moment but try and stick to the odd paracetamol. Remember anything with the co suffix has codeine and can cause stomach problems so if taking long term you may need medication for that (it is a vicious circle of medication to treat the effects of medication sometimes) I sympathise with you as I have various chronic pains, back, neck feet and hands - (feet and hands from arthritis) and nothing works better than the wonderful voltarol tablets which they took me off a long while ago due to some research in America so in our health area it was taken away from anyone over 65. Then co-proxamol was taken away after I had managed to keep on it for a couple of years after it had generally been withdrawn - nothing worked as well for me as those but wouldn't be able to take them now with AF anyway. You may find some help from physiotherapy or a chiropractor or even acupuncture. Anything is worth a try when available medication fails.

All the best

[Hidden in reply to Desanthony]

Hi Desanthony,

Thanks for your comments.

I'll keep at the back of my mind your comments although I must say I haven't had stomach problems with CoCodomol, some constipation, quite minor and usually fixed by eating a date or two.

Yes, I see a Chiropractor at regular intervals, just for mobility maintenance and then I have my bog standard exercises/stretches. Must say though I am now considering Iburofen - I haven't gone down this track yet as I am on Warfarin. However, I think the time is nigh to give it a go. I am so stable with my INR on Warfarin and I self test at home for my INR that my INR Nurse finds me boring. ( Mind you, she hasn't been out on the booze with me yet

😂😂😂😂). Mind you as CD and Jean have said driving the bus is no doubt aggravating my shoulder.

Thanks again for your thoughts.

John

[Jalia]

Hi John, I've been prescribed Tramadol in the past for a particularly excruciating episode of knee pain . I'm afraid it did very little to help and left me spaced out. 3+ years down the line I now have very bad hip and knee pain ( needing surgery. ..) and have been prescribed Butec patches , stronger than morphine I believe. These are applied weekly. I've found a marked improvement and can get a few hours sleep at a time ( usually) . Worth looking into ?

[Hidden in reply to Jalia]

Hi Jalia,

Thank you for your comments. I just clicked on your username ...... gosh, I do remember your previous user name from years ago. I think you are referring to way back when, when AFA used Yahoo, long before HU. We have probably been on here since maybe early 2010. It was at that time I met ( in a virtual sense) BobD and MarkS and I think Jean and CD and a few other old hands ( perhaps I should rephrase that and say long standing members

😂😂). I think back in those halcyon days I traded as 'Aussie John'.

Considering everyones thoughts I rather think Tramadol is way down the list of options. I am sorry to read of your ongoing hip and knee problems. I must say having my knee replacement was a game and life changer - good as new, just that I can't kneel as if I had my natural knee. Still my life doesn't need me to kneel anymore

😂.

I'll look into the Butec thingy.

Thanks again.

John

[Jalia in reply to Hidden]

Yes John, 2010 was about the time, not long after my first ablation . I could have done with lots of advice before that and there really was nowhere to obtain it! I used to search US websites. It will be interesting to hear if you find Butec useful.

[Rubymurray25]

I was put on Tramadol whilst also on Amiodarone ( AF ) for a severe neck pain. It did the trick but really made me spaced out and made my sleep apnea machine ( CPAP ) 33% less effective so had to come off it after 48 hours and stayed on co-codamol . I finished up having physio and acupuncture which took two weeks to get to an acceptable level of pain and a further 4 weeks to be signed off. The Tramadol did not affect my AF . Good luck going forward.

[Hidden in reply to Rubymurray25]

Thank you Rubymurray25,

Your user name reminds me of an Irish singer from the late 1950's.

The last thing I need is to be spaced out so thanks for pointing that out. I am doing my physio inspired exercises and stretches fairly regularly. I also have 3 weekly 'maintenance' sessions with a chiropractor. Looking at everyones thoughts on Tramadol I think I'll stay with the basic stuff, paracetamol or CoCodomol - not together obviously but one or the other. Certainly I am finding weather changes can influence the degree of pain alongside sleeping position.

Thanks again.

John

[Rubymurray25 in reply to Hidden]

My name is actually Max but my beloved dog was called Ruby Murray ( cockney slang for curry and yes indeed the singer ) . I used a heavy weighted neck brace frozen in the freezer which worked fairly well but was told by the physio that is should be a heated one!! Wishing you well . Max

[stoneyrosed]

Hi, I had exactly the same shoulder injury a few weeks ago. Rotary cuff similar to a frozen shoulder. I used codeine and I watched exercises on you tube, stand facing the wall, start low and crawl your fingers up the wall and down again, repeat ten times. I did these 2x a day and within two weeks the pain was completely gone. Hope that helps.

[Hidden in reply to stoneyrosed]

Hiya stoneyrosed,

Thanks for that input. Must say I used the YouTube technique for exercises following my knee replacement years ago. I'd forgotten about the value of these short YouTube videos. I'll give it a try.

Thanks,

John

[Auriculaire]

I have taken Tramadol for my hip pain and post operatively . The latter for about 8 days every day. It works well for me painwise but my guts don't like it and when it is wearing off it makes me itch. I never took it at night so the itching from the day dose wearing off was not conducive to sleep! It also made me a bit somnolent but again taking it at night that would not matter. I did find that the 50mg that I was given after the first hip op last Dec did not work so well after being given 100mg slow release in the clinic after the op this Sept. I am very reluctant to take it other than occasionally. Today is one such occasion as I go to see my surgeon and have to have x rays beforehand. The chairs in the clinic are like instruments of torture and last time he was running nearly 2 hours behind! I would definiely consider retiring. I have bad arthritis in my right wrist but it only really manifests when I am using it a lot. Rest it and it goes away. It will be back once I can garden again!

[Hidden in reply to Auriculaire]

Many thanks Auriculaire,

Interesting your comments on 'guts' ! The last thing I need is to have that too - I have more than enough problem with food I eat and guts reacting and then triggering AF. Yes, the thought of retirement ( for a second time) is going to receive more attention. Next week I take annual leave and won't be seen again until the first week of January. Nice

😂

Thanks,

John

[Dollcollector]

I have taken tramadol for very bad pain and found it worked well. As it isn't an anti inflammatory it doesn't affect your stomach and is suitable if you have a.f. lt is an opiate so when you stop taking them you need to do it gradually as you can have very bad withdrawal symptoms. You need that strength of medication for very severe pain. Paracetamol is just for mild to moderate pain and won't have much effect.

[Hidden in reply to Dollcollector]

Hiya dollcollector,

Thanks for that. I guess it comes down to assessing the level of pain and what it is. I have no problem getting to sleep, sometimes I actually sleep 7 hours or so BUT mostly the pain in the shoulder is bad enough to wake me up and cause me to get out of bed and move around the house, calling on the help of CoCodomol in the process. I think I am in the category of mild to moderate pain. I was given Tramadol back in the day following returning to my room after knee replacement surgery which I would describe as acute pain by comparison. My Cocodomol is prescription grade 30/500.

Thanks,

John

[108Optimist]

I get atrial flutter. I am not on warfarin. I sometines take tramadol. I definitely can't sleep on it. It lasts about 6 hours. I find the flutter happens less when I take tramadol. It's 50/50 whether you would tolerate tramadol at night and whetherit would be effective for you. They do make sustained release.

[Hidden in reply to 108Optimist]

Many thanks for that. At this stage I am going to stay with what I have but will be favouring the paracetamol options discussed by others. Since we've had a dry weather spell, and much lower humidity down as low 48% the pain has eased considerably.

John