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Pain relief advice please

Hi All. Yet another questioon. I had an assault of RA yesterday - the worst yet. It kept me awake all night trying not to scream out loud in agony. Now it's abated and I'm left with hands that are getting increasingly misshapen - not just imagining this my hubby looked this morning and said it looks as though someone has hammered a wedge in between each knuckle and prized with all their might. I told him that is exactly how it felt all night and my ulnar joint (think that's what it's called) was so swollen and hot in middle of night that it was twice it's normal size and the pain even made me throw up at 4am. I took one 15mg codeine and one 500 mgs paracetamol but have run out of Omeprezole (will get next batch tomorrow) and after my recent stomach problems (gallstone or ulcer forming) I just wasn't willing to risk taking any ibuprofen.

So what I would like advice on is what to ask the GP for when I see her tomorrow. I had planned to discuss getting inflam markers taken monthly but right now I need to get pain relief for emergency times sorted rather urgently so I wondered what you people on the pain front line advise. I don't think an ibuprofen would have made any difference to the 24 hour attack on wrists, knuckles and fingers anyway - so what shall I ask for -suggestions please? TTx

33 Replies

Hi Tilda, I think the doctor might look at what you've had in the past and give you something a little stronger.

When my hands are burning like you've described, I tend to soak them in a sink of cold water, it helps with the heat and eases them a little.

As for pain relief, do you not take any anti-inflammitories? There are some really good ones around now a little stronger than Ibuprofen.

I take 1000mg Naproxen daily with Lansoprazole to protect my stomach. Also, Tramadol x 100mg twice daily but if pain is really bad I add 1 or 2 Nefopam this increases the potency of Tramadol in the body. I also take 1 or 2 10 mg Amytriptyline at bedtime this is really useful in relaxing the muscles helping me get a nights sleep. I also get a 3mthly injection of Kenalog (steroid) at the hospital for widespread pain.

I can't remember what it's like to be completely pain free but the above helps make it manageable.

Good luck, hope the doctor comes up with something which helps.

Beth xx

1 like

Hi Tilda, my RA kept me awake most of last night.

I take Tramadol capsules 4 times a day plus paracetamol as and when required. I did try a pain killer which contained codeine but didn't find they helped.

Your GP can give you a different pain killer - morphine patches or possibly a steroid injection (I have only had steroid injection once and that was at the hospital but I think maybe your GP can give you the injection, it may be worth asking).

When my hands were really bad (before replacement knuckle joints) I found soaking my hands in cold water helped. After soaking hands in cold water I wrapped them in a small, cold, wet towel - water squeezed out as best as I could - with a larger dry towel wrapped around them to keep the bed dry. OK wasn't perfect but it helped reduce the pain to a level where I could get some sleep.

Best of luck at the docs.



Just read Beth's answer .... she obviously was quicker than me !!!!

Have taken a note of 'Nefopan' which Beth mentions, will google it in a minute as I assume that it is a painkiller. I take diclofenac, mtx. leflunamide, tramadol capsules 50mg one or two capsules four times a day (plus paracetamol).

Judi xxxx


Hi Judi

ha ha I sit with the laptop on my knee during the housebound days which so far this year has been most days.

It is a pain killer my GP gave me it during a really bad flare in my neck and shoulders, I also take Leflunomide the MTX caused to much sickness so had to stop it.



Thank-you both so much. I have only ever been offered max dose ibuprofen with Omeprezole and after that my GP seems to think it should be oral or injected steroids.

But after 6 months on max strength ibu daily plus paracetamol and codeine as and when needed i decided they weren't doing much and also found that my gallstones were kicking off. GP said it might be gallstones but is concerned it may be an ulcer forming so told me to lay off the NSAIDs for a while. I take Amitriptylne one or two but have got home too late for the past few nights and with busy days ahead decided not to bother as it makes me sluggish unless taken earlier. Also I was driving (as not drinking) and it does make me sleepy.

Diclofenac made my feet swell hugely with fluid retention and bloated me so not allowed that. Never offered anything else and systemic steroids give me terrible mood swings so thought I'd ask about local injections since my feet and knees aren't bad currently but not sure how effective they would be as it's both wrists and both sets of knuckles and fingers that are swollen. And then what would happen if I got an all over flare and needed some prednisolone or kenalog?

Re cold packs or water - the new pattern is that I seem to go icy cold in run up to a flare so my extremities are really chilled. Last night friends gave me a hot water bottle because I was so cold even though I was by their fire. Then by time I got home assault on my wirsts, knuckles and fingers had come on so badly that hubby brushed my teeth and undressed me and I spent the night screaming into my pillow.

Mostly okay when I woke up after a few hours kip apart from that knuckles are pretty inflamed and hands and wrists just very stiff. I don't know if I could have faced cold water on them but perhaps the hot water bottle wasn't a good idea although it felt essential at the time? Circulation all to pot when flare on it's way that's my latest observation. Will ask GP for something stronger as I don't want to take anything 24/7 that isn't necessary for me and tummy pain on top is the last thing I can face! TTx


Tilda, I am now reading these comments after having made mine, so I will interject here. Think you need to consider that you DO need something, more than one something to take 24/7, and that is necessary! Last dose at bedtime, start over as soon as waking. Keeping things under better control, especially stopping the inflammation that is eroding your bones, not letting it get to that stage as last night, then you would not need anything so strong it would knock you out or make you drowsy. The primary goal in treating RA, remember, is stopping inflammation.

Sounds like you are not taking enough anti-inflammatory meds to do the job. That is something you need to take continuously. Bone damage can occur with each flare, then it's too late, it can't be reversed by pain meds. Sorry if I got a bit preachy, but just wanted to remind you how the whole friggin mess works :( Don't you get to see a Rheumatologist, if only on an emergency basis? L. xx


Thanks Loret. The GP yesterday didn't seem worried that I'm not taking anti-inflams any more but my usual GP always wants me to take them which is why he put me on ibuprofen x 3 per day. I think they are both a bit concerned that the period of stomach ache might be an ulcer forming although I think it was gallstones. I had to push a bit for Naproxen and she said "but that's anti-inflam which you are trying to stay clear of?" so I explained that I just wanted it for occasional use. I guess you are right although so far that's the first flare i've had since October on that scale of pain. Perhaps best thing is to learn to read the signs when my body might flare and take naproxen on those days in anticipation? I have got stomach protectors at least. I need preachy - my usual GP was preachy too about me keeping on top of the pain but has eased off since the tummy episode. TTx


The cold air probably was the trigger. But still, someday soon, you really need to be managed by a Rheumatologist. Before the disease activity continues to gnaw on other bones. Your GPs are good people, they just usually do not specialize in RA, so they refer. No problem with having both types of doctors, you do need the GP for everything else.

I think I recall you do not have a local access to a Rheumatologist, on a regular basis.

Usual management of RA is to stay ahead of the pain, by taking a daily anti-inflammatory and taking pain meds on a regular (or close to it ) basis. You just should not ever have incidences like Sunday night.

It really is possible to get into the routine of taking your meds in the morning, and go about daily life and not even remember you have RA. Take pain meds to go with meals is the best way to remember, and in little time, that becomes part of the routine.

I have found I absolutely cannot go without the Omeprazole, or other anti acid forming med. If I run out, in three hours into the day, and after morning coffee, I get the acid reflux, the whole nine yards. My instant remedy is to put a half teaspoon of baking soda in a amall amount of orange juice, or lemonade, citrus soft drink, whatever you have. Or water, with a shot of lemon juice. Drink that and follow with a half glass of water. It's like dousing a fire instantly. Just can't do that daily as it is sodium. It will make you burp, instantly, as the sodium neutralizes the acid. Cool, huh? L.xx


Well I've been fretting about this all day long Loret and am wondering what to do because my Naproxen is only for flare times but I guess they don't know how much I need it so I could go for it daily. It says on the pack that it's got gastro resistent coating and not to take within 2 hours before or after any other gastric remedy so do I take it before my Omazeprole or afterwards? The other thing that is very different here is that these are prescription drugs only so the GP has to be prepared to prescribe them and it all comes out of NHS budgets - especially as prescriptions are free to those living in Scotland as I do. So if I was taking them daily then next time I need a prescription the GP would question why I was needing more so soon? It's a bit of a muddle really for me and I sense I may have to return to GP at some point to clarify what is best. My hubby points out that my hands are permanently swollen since the last flare but it's all kicking off a bit at my end between occupational therapist and physio and GP over who should sort me out for decent splints before my hands deform seriously. Ahhhh hate being at the centre of all these politics but I can't afford to pay for super expensive day and night splints privately either as I would also have to go south to have this done! TTx


I have my Omeprazole by the bed & take it when I first wake up in semi-groggy state v early, and it's usually 2 hrs then before I've actually got up/showered/had breakfast etc etc. I find if I don't take it first thing then stomach wants to play games all day. And I'd probably try the new NSAID for a few days to see how you react to it. If it helps bring hands back down to normal size then Doc will surely see that's it's needed. As Loret says, it's the inflammation that's the enemy here. Preachy Pollyx


Oh boy. Well, yes, I'm pretty sure you need to take the Naproxym every day.

Since it has a gastric-soluble coating, it will rely on some stomach acidity to dissolve the outer gel capsul, to release the drug inside. Then the outer shell helps protect the stomach.

So, I would suspect it best to take the Napro first, to give it time to get working, and as Polly says, very first thing so you don't forget it.

Then about 2 houirs after that, or after breakfast, you can take the Omeprazole. It is a time release cap, so it will continually release it's "Chemicals" all day.

Now! Don't be impatient! Give the Napro time to do its thing, may take a couple weeks of daily intake, or might be a surprise earlier. Thing is, your fingers are not going to go back to looking like there is nothing going on . Maybe someday if you can keep the inflammation away.

It is more likely to be a gradual effect. First, you may notice feeling better, even before you notice any changes in your fingers. They will hurt less, but might not look better right away.

Please don't look for side-effects. I have seen a couple people in my own group read every word of the package insert and then drive themselves crazy imagining they have some of the side-effects. keep in mind, most, if any, side-effects only last a few days, until your system adapts.

Any nausea, etc can be treated or prevented and I do not know what side-effects if any are reported with Napro. There are others here on Naproxen, they might be able to give you some info how they get along.

Yes, return to the GP soon and tell her that you and hubby discussed the whole situation and you would feel more comfortable taking the Napro every day, so she would have to re-write the perscription, or be prepared to refill it sooner. She sounds like she will go along with whatever you decide. I know it is very difficult to know what you should do, but, with reading all the other blogs here, most of them are on daily anti-inflammatorys, I know I am.

I think you are doing the right thing to protect your bones from further harm.

Many times over the years, I have said I wished I had had the anti-inflammatories, and the anti-tnfs a long time ago, I'm sure I would not have had to have 8 spine surgeries and all that titanium rods in my spine to reinforce it. I most likely would not have my right hand and wrist so badly affected. That has been a problem, noticeable 20 yrs ago.

AND, I don't want you or others, to get this bad either, No more nasty flares!

Mary and maybe it was Allanah who recently had such excrutiating pain they needed to scream, That just should not happen! Breakks my heart when I read about them.

Don't know what to do about the splints. Maybe storm the department and demand to know how soon you can expect them to be ready.:) Can't imagine why they are not.

I got mine from the Rheumy and my Ortho surgeon

\ Well kiddo, Sure hope you have some answers and feel better tonight.

Keep on keeping on, tomorrow first, and then the next day! Love, Loret xx


What about the Arava, Leflunomide? Did you go back to that, does your GP say you can or should?


Hi Loret - thanks but you are thinking of Mads not me I've never taken Arava/ Lef.

I did take a napro last night and only read your post above just now so have already taken the Omazeprole with my thyroxin but will wait until lunch time for my next napro as it says 12 hours apart between tablets an i took my first quite late last night. School half term today and I'm feeling good after a really deep sleep - must have been the naproxen and Amitryptiline following the parents evening at the school for youngest son - zonk! Fingers feel a little less swollen this morning and are definitely less stiff that they usually are. I'm following your advice because I'm terrified of another bad night and also getting worried that my fingers are definitely drifting apart a bit - it's quite visible really. TTx


hahaha , I realized that last night, late, that it must have been Mads, not you that is taking Arava. Well, now there's an idea...go get yourself some Arava! :)

So hopeful you are on the way to getting turned around. L.xxx


Ps also had forgotten to pick up stomach protector prescription from pharmacy yesterday!


poor you, that really doesn't sound good!

Do you have to wait until tomorrow? when I woke up through the night in a lot of pain my hubby went down to A&E and they gave him some tramadol to help me through the night.

When it was bad, tramadol worked best for me, paracetamol ect didn't do anything to help..

Sounds like you've had a horrific night xx


Oh Williby thanks for being so nice. It was horrific actually - I kept walking up and down to the bathroom wondering what to do and how to escape the pain. Now it's like butter wouldn't melt? - knuckles still swollen and wrists both still sore but nothing ... absolutely nothing to the pain of last night I honestly thought this is worse than labour worse than the two abcesses I've had put together. And such a shock because I haven't actually had that much pain for months since I flared on holiday in October and I was starting to think I'd imagined it all until last night. At least it's put pay to denial anyhow! And the thought of others suffering this frequently and in many more joints is unbearable.

Keep trying to work out what triggered it - had a long day yesterday - was put under pressure to attend a friend's art opening because I'm reviewing it. The weather was appalling - heavy rain with icy bits blowing sideways and I really knew I wasn't up to it deep down but he just made me feel I had to go. Then home and was resting when an aquaintance turned up unexpectedly returning a book. Then the World Cancer Day concert with rehearsal first so I was holding my homemade, wrist-friendly music folder up and singing for about an hour in total - but I wore splints throughout so shouldn't have been that as I've done more ardous concerts and rehearsals? Then went out to dinner with friends which was really fun except that by that time my fingers were all swollen and bruised looking and really hurting. Should have callled it a day then but went back to their house after for a cuppa and that's when I got really chilled and should have known that all was not good. I had to drive home as hubby had had wine but by that time I was exhausted and he had to turn ignition for me and by the time we got home I was sobbing with pain so he had to undress me and brush my teeth. Couldn't wear splints because by that time I couldn't even bear anything touching my wrist and it was so swollen and hot I couldn't find anywhere to put it. All other pains in other joints such as ankle and other wirst and fingers seemed to vanish and it was just this searing pain in one place only but all contact movement etc made me retch. Horrible but sure you've all been through it yourselves and worse many times and will think me a bit of a wimp. Have been very lucky to have such a long spell of minor stuff really.

Tomorrow I'm seeing the GP who is most human and more like a friend than a doctor. So I'm hoping she'll be the one to give me some proper pain relief if I explain why I want it. I don't suppose I'll have to use it very often but I feel like I've been emotionally assaulted today and can't shake off the terror of it happening again. Nothing this bad has happened RA-wise since I got stuck in the bath on holiday in Broughty Ferry last October when family all out for the day - so I guess I've had it pretty good for a while anyway - am grateful for that at least. TTx


hi,i was told i couldnt take ibuprofen,while i,m on anti inflam,but now for over a year now ive been on the embrel injection,its a godsend ......


Thanks Julie - am only on MTX myself but it's early days - hoping the increased dose will make a difference but after last night I'm not feeling quite so confident. TTx


I had exactly the same thing last night, Ijust lay there crying in the end just when I thought maybe things were starting to improve. I take tramadol and paracetamol but they haven't really helped. Anything codeine based just gives me a headache.

I think everything flared for me was because I got so cold despite wearing as many layers as I could get on as I went for a walk.

Hope things settle down for you soon and you sleep better tonight.



Hi Tilda,

I feel so bad for you. The pain where you want to scream out loud is horrific. I really know where you are coming form, as we all do. I have been given codeine, tramadol, naproxen, paracetamol and morphine (not all at once although I have often gone way above the max at bad pain times!) I find that codeine, paracetamol and naproxen taken daily 2 tabs 4 times a day (naproxen 3x daily) keeps me sane and working! I would like to try dropping doses but I am scared pain will return. I would rather have a few years less living than extra years of pain!

I hope the flare settles down soon for you. Take care.

Pet xxx


Oh I am sorry for you...I too have been their...its a shock and led in bed all you focus on is the pain....its like a flushing of heat into the joint and its twisitng around in agony... I am taking parcet and codine...trama knock me dizzy....I really hope you have a better day and the pain subsides .... regards xxx


Thanks Susan, Pet and Mary. Just back from pharmacy and before that to lovely GP who gave me Naproxen and Tramadol willingly with a little list of what to take if I start to flare. I explained to her that apart from deep freeze an hour before hand I don't seem to get any warning and no obvious triggers and these flares come on so fast that I can be in town and unable to turn the ignition or change gears within an hour or so of feeling okay.

She said that she gets the occasional flashes of pain in her fingers and that's enough to have her rushing for pain relief, fearing RA, so she was really sympathetic about the extreme pain I had on Saturday night that had me screaming into my pillow for most of the night. I said worse than childbirth (she's done that too) and abscess put together like being tortured really.

If I'd told my normal man GP that he'd have smiled with a look that suggested I must be exaggerating - but she just grimaced and said I could have any stuff you guys had suggested. She said personally she would probably go for something other than Tramadol - somethingcodeine she called it as the first port because she has patients who can't bear Tramadol - but to come back for other stuff if Tramadol didn't work for me. And best of all she agreed that I could take as and when rather than this business of trying to keep on top of pain by taking 24/7 - which given the sporadic nature of my RA flares and the fact that I'm really dippy and keep forgetting to take it at mealtimes - and that I have gallstone/ ulcer pain it was probably for me to hit with stronger stuff as and when occasions arise.

Feel so relieved that I've got a drawer full of powerful stuff now!

Going to blog about the practice's take on the ESR and CRP for rheumatoid patients later. TTx


Hi Tilda,

I'm glad you got some better pain killers. My GP says that the tramodol is more effective if you take it with paracetamol so I always do. Paracetamol on it's own is useless, I might as well eat smarties but it does seem to boost the tramadol. I don't take it all the time as it's apparently pretty addictive.

Has your flare settled? My hands are massively swollen but not the same constant pain as during the night on saturday, now they just really hurt if I try to use them. I feel like I've got paws instead of hands!

I'm glad you got to the bottom of the CRP thing too.



Hi Tilda

Sorry to hear you've been in so much pain! I'm glad you saw such a sympathetic GP (that can make all the difference) and that she's taken it seriously and given you some advice for controlling the pain.

You mentioned that your joints are becoming misshapen. I wonder if you are seeing an occupational therapist? If not it might be worth enquiring about whether or not you can be referred to one, as perhaps splints or something similar would help you.

Glad to hear that you're doing a bit better, and it's lovely to see the amount of support you've had from other members on here!

Kind regards


NRAS Helpline & Information Coordinator


Yes the other members and NRAS helpline people such as yourself are a Godsend thanks Vicky. I told my GP that I'd asked on here and she was unsurprised because I've told her before how indispensable this site is for me. I have got an OT and we are meant to be sorting splints out for me - she's hoping to get them paid for by our local Arthritis Care group but I am getting a little concerned about how long it's taking to research and get them ordered.

i found a company online yesterday and emailed them to ask about their different day and night splints because I think I'm needing both but not heard anything yet. This will be the third company I've approached now - no reply from the other two so I'm getting a bit desperate to be honest. Others have said they have had plaster casts made of hands for this purpose but I think the NHS budget is getting too tight for this to happen now up here. The physio did give me a splint she found but it's only one and both my hands are suffering and also it's wrap around neopreme and tends to get lose and a bit hot and it digs into the side of my forefinger knuckle after a while so not ideal. Thanks for thinking of me though! Cheers, Tilda


Hope you are feeling better with your new pain killers x


Thanks Summer. Thankfully my flare was short lived as mine tend to be to date so I haven't tried the Tramadol or Naproxen yet. It started on Saturday morning and was over by sunday lunchtime and it was really only in my wrist at it's worst. I've had this before and had to get the bus home one time because I couldn't drive but not for a while.

It felt like some hooligan had burst in with a wrench and was torturing my finger joints so they were splitting my hands apart and down into the ulnar joint - which grew a red hot lump of it's own under the swollen joint. This right wrist seems to flare up so suddenly that it's scary and within an hour I was just about screaming the house down with pain. My hubby brushed my teeth and undressed me and got me into bed but after that I was pacing up and down while he snored really loudly and the boys slept throughout my sobs - GP said I should have just woken hubby and made him phone NHS 24 for tramadol but he works nights and I couldn't have done that to him. I actually tore a hole in my pillow case where I chewed into it to try and keep from waking everyone and by 4am was retching with pain it was so bad. Then it just burnt out but in the morning my hands seemed to have shifted shape a bit and my pinky is now sticking right away from the rest (as the left pinky was already) so I am pretty sure some damage was sustained!

Do others here have these dramatic kind of flares that come and go so quickly and intensely? - it would be good to know because I don't seem to get all body flares that last for days which I'm very relieved about - this is quite evil enough for me! TTx


Oh dear Tilda, I am so sorry to hear of thismess! I'm not going to read any of the other comments, this is just what comes to my mind: I suggest you describe to your Rheumy everything you have here, and everything else, then ask her, what can she perscribe to get you settled. If you make a suggestion, or request a specific drug, she might think that is all you would settle for, yet there really may be some newer drugs that she knows of, that we don't, so maybe she would suggest you try them.

To keep trying the same meds and then going off them and then going back, might be decreasing the effectiveness, at the same time new ones become available. Just a thought. On the other hand, maybe there aren't any new ones, but there are lots of others tried and true. You know, dear friend, how much I care, we all here do want to see you get back to a better place, so flare-ups can't happen so easily. One day at a time, one hour at a time, take good care of you. Love, Loretxx ((((((((oooo)))))))


ps: I will tell you a combination that works brilliantly for me, to the point I may forget to take them when I am busy, but then am miserable and unable to move until an hour or so after I finally take them

It's 1 Neurontin, 2 Tramadol and 1-2 Vicodin every 4-6 hrs. This is from my Spine Surgeon and Rheumatologist, and it works. If I take them regularly as told, I can manage most things I need to do. Not without effort and resting and exhaustion sometimes, but it is so good, I call them my "endurance meds".


Loret I'm touched by your concern but you are in a different league of pain to me - I'm only bad when I'm bad and that has so far been relatively infrequent and short lived. I quit all the pain meds after New Year because my gallstones were kicking off and also I was always forgetting and becoming confused so probably underdosing because I would err on caution. This GP agreed that I could just knock these awful flares on the head when they arose and if I have more episodes the GPs will write to my rheumy and say disease not being controlled by this dosage. You may well be right that I should take them daily and keep on top of pain and inflammation but my instincts say that it does my insides more harm if I do what with the raised liver and the gallstones - which have now thankfully subsided. I don't see rheumy again until end of March but if I get worse then I can see him on a telly-med link or if they are really worried they will fly me down to Aberdeen where he is based in the big hospital we are under. Thanks for your concern keep bossing me I need it! TTx


Hi Tilda, the splints are done for you by the OT and made to measure, and they are a free service. When I was first diagnosed and really bad joints - fingers and wrists, I rang hospital OT that was attached to rheummy dept and they saw me quickly as I explained how much pain I was in and unable to use hands (which was true). I got an appt within 2 weeks of calling and had 4 splints made specifically for me, and 2 'off the peg'. They are brilliant and I wouldnt know what I would do without them. You can buy them but they are really expensive and not as good as the OT ones. Have you a contact number for the rheummy?? If not, if you are desperate I will send you one of mine xx


Bless you Pet - I live on an island and there is no rheumy service here - it's all down in Aberdeen. My OT works for the council run dept that sits somewhere between social services and NHS. She's a sweet woman but is nearing retirement and doesn't seem able to access the services that are required re wrists and hands. I am desperate on and off. I've had months in the run up to Xmas where my hands were virtually unusable where now I'm drawing again (I'm an artist) and the pain shifts about but mostly on the ulnar joint and knuckles presently but more discomfort than pain for the most part.

Neither physio nor OT have been in touch for a few weeks now and I am getting a bit concerned that they've forgotten me. I don't think that they have anyone who can customise splints up here unfortunately. I did find a very much more specialist company online that sounded good but it's based in the States - maybe near Loret or Tinwoman so they could go and pretend to be me (only joking I do know what a vast country we are talking about really)?! Perhaps someone here knows of outlets that sell this range?


Here's the link for you to perhaps check out and tell me what seems to be the best type of day splint and night. It's really hard to think of making yet another purchase without having tried them first or quite knowing what size I am. I have emailed OT telling her about latest flare and saying there is some urgency as I feel my hands are starting to change shape quite dramatically. I took a couple of photos of them the other night for my record and even compared to when I saw the rheumy they have changed with pinkies on both sides drifting out a bit and I can no longer straighten my right hand fully nor grip or clench but they aren't always in pain anymore - just stiff and a bit swollen 24/7 with blasts of brutal pain coming in one day bursts every now and then. TTx


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