Arthritic knee, back and anticoagulants

[Finvola]

My husband has recently developed AF and has until now used Piroxicam gel for arthritic flareups in his knee and back. This supplements his morphine patch as and when necessary for bad pain. Morphine helps with nerve and tendon pain from his back injury but the arthritic pain pushes through.

As he will probably be prescribed an anticoagulant, I worry about how he will cope during flareups of arthritis.

I would be interested in anyone's method of coping with the pain of arthritis, the necessity of averting an AF stroke and the interaction of NSAID gels such as Piroxicam (Feldene) with anticoagulants.

[wilsond]

I am prescribed Voltarol topical gel for chronic back pain but I've not been able to take NSAIDs in tablet form. Not had any problems using the gel but not always effective . Anticoagulants are so important but come at a price!

Hope your husband gets on OK xxx

[Finvola in reply to wilsond]

That is good to know and gives me hope for his treatment. NSAID tablets are definitely out - he has avoided them since I was diagnosed with AF. Thank you wilsond.

[wilsond in reply to Finvola]

I wondered also if cortisone injections are also ruled out? Xx

[Finvola in reply to wilsond]

Thanks for that - will check that out.

[JaneFinn]

Sorry I can’t be any help, but I do sympathise because I have yet to find any pain relief for my arthritis and chronic nerve-pain. That’s not just because of Apixaban, though- it’s partly because of my own intolerance to many meds, so I hope that you may get some helpful replies from people who have found a solution. I feel sure I’ve seen someone posting that they were told the NSAID gels were ok, just not the tablet form, but I could be wrong.

Here’s hoping… Jx

[Finvola in reply to JaneFinn]

Thank you Jane - I'm so sorry for your pain, having watched my husband suffer for 4 years now. We tried a TENS machine which helped relax the muscles and an ultra-sound device which didn't help much with the nerve pain though. Best wishes xx

[wilsond in reply to JaneFinn]

I am prescribed Voltarol gel for chronic back pain with no issues xx

[BobD Volunteer]

My GP told me years ago that topical gels are fine as litle enters the blood stream. Not aware of any changes to that advice.

[Finvola in reply to BobD]

Thanks Bob - I wondered if there had been any updates on that advice - sparingly and infrequently. Good to know.

[Qualipop in reply to Finvola]

I've been told I can use piroxicam gel but not tablets which I can't use anyway because of their effect on my stomach. A TENS machine is also fine but not around my heart because I've had a heart attack.

[Finvola in reply to Qualipop]

Thanks Qualipop - it's good to have other people's confirmation of topical NSAID being safe.

[Qualipop in reply to Finvola]

I have 4 different spinal conditions which have put me in a wheelchair and taking oxycodone now for 20 years. Although that partly controls the nerve pain , it does very little as arthritis develops in my shoulders, hips and knees so I use piroxicam in those areas.

[Finvola in reply to Qualipop]

I've been reading as much as I can find about pain relief and it seems that more than one approach is needed - just as you say, one drug helps in one type of pain, but not another. It surprises me that oxycodone doesn't help with the arthritis pain - that bears out my husband's experience as the morphine patch doesn't really address the arthritis pain either. Piroxicam does though. Thank you Qualipop.

[Qualipop in reply to Finvola]

Oxycodone absolutely isn't supposed to work on nerve pain but it does for me. I'd gone through everything on offer;they either didn't work or had terrible side effects. The two things they always offer for nerve pain is gabapentin and amitriptylene Amitrip turned me into a zombie. I was doped out of my mind. Gabapentin did nothing at all except make me seriously suicidal. Because I can't take anti inflammatories , I've found very little to help the arthritis.

[JaneFinn in reply to Qualipop]

I’m similar with those 2 nerve pain meds, qualipop, it’s so hard to find anything that works and I can take. My neurologist keeps trying to persuade me to retry amitryptylene despite a bad experience. He doesn’t believe it causes arrhythmias, but it can. Gabapentin can (for some at least) have a terrifyingly mind/mood altering effect, can’t it? I’ve not had oxycodone suggested but might be worth a try from what you say! Similarly, because of the no anti inflammatories, I can’t find anything I can use for arthritis pain.

Though I do find that each consultant seems to dispute whatever isn’t in the interests of their particular speciality. Eg my neurologist and rheumatologist are very dismissive of the idea that any drugs they want to prescribe are unwise/prohibited to take with asthma or AF or when on anticoagulants, and always make out like I’m being difficult. I find it very stressful!

[Qualipop in reply to JaneFinn]

I've tried amitrip at least 10 t imes because they insisted. I was given oramorph before the oxycodone but was allergic to it. My new pain consultant says there's nothing left now a part from CBD and that is not recommended with heart problems. Trouble is opiates cause long term problems; they are very reluctant to prescribe them and over time ( 20 years for me now) they s top working as your body gets used to them. Mine now only lasts 1.5 hours instead of 3. IT has also affected my digestion; very slow food transit and chronic constipation. It's not a good option except for short term relief but hey didn't know that when they started me on it and you can't just stop. Withdrawal is horrific.

[JaneFinn in reply to Qualipop]

Argh that sounds awful 😞 I’m so sorry. They really should have told you before you started, so you could have made an informed decision. (And then they wonder why we don’t trust their assurances!) x

[Qualipop in reply to JaneFinn]

I'm sure that over 20 years ago they simply weren't aware of the long term effects and the addictive qualities even though it was given by a specialist pain team whilst an in patient in hospital. They had to do something, I was s creaming with pain and couldn't even stand up. The fibromyalgia I had for at least 10 years before that was nothing in comparison. I could cope with FIbro; exercise helped a lot but once the damage to my spine started there was no other option.

[JaneFinn in reply to Qualipop]

Oh that sounds horrific 😕 And you’re right, in that case they had to do what they could. Sounds like you’ve got a lot to contend with, and you’re always so helpful and supportive to us all on here. Jx

[Qualipop in reply to JaneFinn]

Thank you that's so kind. I have had 30 years now of just getting on with chronic pain- what else can you do? You do learn to live with it ( with bad patches of course).

[Finvola in reply to Qualipop]

I'm so sorry to read of how much you have to deal with, Qualipop and I second what Jane says - your contributions are always helpful and supportive. xx

[Qualipop in reply to Finvola]

Thank you. As for the pain, why worry about what you can't change? It's a waste of energy. You just adapt to it.

[Hidden]

I can empathise, I too have arthritis both osteo and rheumatoid. Cocodamol takes the edge off, occasionally use topical gels but find TENS machine helps with lower back. I take edoxaban for PAF. I've got an assessment in March to decide whether to try methotrexate or not. Really not keen on sound of its side effects but told it will help with OA pain too. On waiting list for other knee to be replaced and losing weight also to help joints. TENS may be worth a try if not tried yet. Take care 🦊x

[Finvola in reply to Hidden]

Thank you for your input - yes, a TENS machine helped with back spasms and he does have co-codamol to take when the pain is really bad, but it is limited because of the morphine patch. I feel he needs to talk to a pain consultant but that is probably in the future after the AF is sorted out.

A friend in her early 40's was prescribed methotrexate for severe pain and was able to return to work as a sports physiotherapist and her joy of extreme sports. Best wishes with the knee.

[Hidden in reply to Finvola]

Thank you 🦊x

[femalegannet in reply to Hidden]

I too have osteo and inflammatory arthritis and use nsaid gel at night. Ive been on methotexate for some years and have it by injection which i do myself. no real side effects for me this this way which was why i chose to do it. its helped a lot and is supposed to stop it worsening although not sure how/whether it helps the OA pain.

Since starting with PAF recently and started on Edoxipan (and statins when im ready) I was told the gel was ok. I was surprised to be told to stop the fish oils i'd been taking for years to protect my heart ! saves me money anyway. Im not sure I'd sleep very well without amitriptyline (even with it sleep is iffy) and they have left me on it. Because of all the other issues I've not been put on anything to help with tachycardia (which is what i was referred for) walking across the room can increase my heart rate to the high90's. No cardiology follow up either. As far as i know Ive had no more than 6 episodes of PAF since july 23, mainly at night.

sorry rambled a bit there, i was trying to be reassuring re Methotrexate.

[Hidden in reply to femalegannet]

Your opinion and experience much appreciated ty. Take care 🦊x

[Qualipop in reply to Hidden]

Methotrexate is one I've never come across. I'll have to do some homework. I agree, TENS is really good for lower back. You can use it on knees but the wires are a nuisance.

[Silvasava]

I noticed you say DH has nerve pain, I am on Edoxaban and the usual cocktail of meds but have been prescribed Amitriptyline for Neuralgia, might this be an option for him?

[Finvola in reply to Silvasava]

Thank you - will check that out.

[Qualipop in reply to Silvasava]

Does it help you? I've been given it at least 10 times. It never helped but even a half dose made me like a zombie. I also tried nortriptylene; its forerunner but that was the same.

[Silvasava in reply to Qualipop]

It's subsided enough to make it bearable. I can eat and talk without feeling I've been tasered! I take 10mg at night and manage a reasonable night's sleep. I don't seem to have any side effects. I think it's probably one of those meds that either helps or is useless.

[Qualipop in reply to Silvasava]

I know a few people for whom it works without side effects. Sadly not for me.

[doodle68]

Hi Finvola 🙂 I have severe pain from osteoarthritis in my lower spine and right hip, I can only take paracetamol as a painkiller co codamol makes me ill.

I have found alternating heat and cold on the painful area helps , I bought a large gel pack on Amazon that bends around limbs, that goes in the freezer and I use a covered hot water bottle.

Stretching excercise help too, there are lots online for various areas of the body.

[Finvola in reply to doodle68]

Thank you doodle - my sister-in-law introduced us to a fango-kissen which is a mud-filled plastic cushion which we heat in the microwave. My husband swears by it as it wraps around his knee as you describe and loosens the muscles and tendons. I'll have a look for the stretching exercises. xx

[2learn]

Hi, I really sympathise as I have chronic back and shoulder pain. I found osteopaths always worked, but they won't do anything now cos I'm on apixaban. Some people say acupuncture works, I may try it.

I find medics are useless with arthritis/nerve pain, it is too easy for them to say it is arthritis without investigating to find the actual cause and trying to treat it. Athletes have all kinds of ops to sort out joint problems and use a lot of tape for enough support to compete, whereas if you're older the doc says arthritis, take some pain killers and go away. Treatment of arthritis pain has not improved in 100yrs, some indictment of medical profession.

[Finvola in reply to 2learn]

So true - pills for ills which is why I would like to have a holistic approach to his overall medication - which might happen if/when he starts an anticoagulant. We really are in a bind with not being able to take oral anti-inflammatories.

[2learn in reply to Finvola]

Hi, just thoughts. has he had it scanned and diagnosed. Is knee replacement an option. If not on anti coagulants I'd give osteopath/chiropractor a go.

[Finvola in reply to 2learn]

Thanks for that thought 2learn. His knee injury was MRI'd with meniscus tear and OA but the consultant said at that time that exercise and pain meds were the best option. Chiropractic was very helpful early on and diagnosed an untracked patella but things have deteriorated in the intervening time.

[Qualipop in reply to 2learn]

I'm pretty sure there's been very little research into treatment of pain in 50 years. Every pain consultant I've seen in 30 years has only ever offered the same things. Research has started into CBD but it's very slow especially on the effects on the heart. It's all very well saying do some gardening and get exercise . It certainly helped my fibromyalgia but when you have physical damage causing the pain you simply can't do that. There's a huge difference between muscular pain and nerve pain.

[Finvola in reply to Qualipop]

So true - my husband was advised to go back to swimming, which he loved but he was met with a blank stare when he said that he could neither get into the pool, nor get out again.

[Qualipop in reply to Finvola]

Our physio dept used to arrange swimming where they had a hoist to get you in and out of the pool but that's been one of the cuts. I stopped going because it was simply too difficult and too painful to get dressed and dried. I was too exhausted afterwards to get home