pain control and methotrexate

[Doodlereggie]

hi all

Just want to run something past you as you have helped me so much over the past year with your knowledge.i met a lady at church last week and again today who was diagnosed with ra 2 years ago.she has not seen her rheumatologist since then she is on methotrexate which she thought was working for her.i then asked her if she was taking any pain meds,and she shocked me by saying yes,tramadol 4 times a day plus a morphine patch.is this usual,or would this usually mean her inflammation is not under control with the methotrexate.she says she it taking 15 tablets a day,but when I asked no omeprazole etc which also felt like she was not getting the help we mostly get.

She is today hardly able to walk with a very painful foot.i do not want to interfere,and am not sure how to help her,but know she should get better care than this.should I not get involved(not in my nature to be quiet)! or advise her to push herself forward and make a fuss if necessary,as I know we mostly would!Sorry to burden you with this problem,but you are very wise on all to do with RA.thanks everyone.Joan xx

[Runrig01]

So it’s not uncommon for people still to rely on analgesics, especially if the RA has caused any damage to the joints. I myself use a butrans patch and take tramadol as needed. My sacroiliac joint is fused, and tendons that attach in that area are stiff, and muscles can’t relax. My ribs are fused to my spine, and I have no chest expansion, and same issue with ribs around the ribs. So pain is part of my life. On top of this my knees and toes are all subluxed. Many are lucky and diagnosed early before damage occurs, others are not so fortunate. If she’s getting terrible foot pain, it might be worth suggesting her rheumatologist may help. If they don’t hear from you they assume all is well. I wouldn’t force it though.

[Ashley1014 in reply to Runrig01]

I would simply ask her if she would mind hearing your advice. I honestly am quite jealous that she has a provider who is actually providing pain relieving medications. I’m advised to just use OTC pain relievers

[Doodlereggie in reply to Ashley1014]

I too have only been told to take paracetamol over the last 25 years of RA ,but,of course I am glad now the latest JAK meds have worked and I am not reliant on pain meds.It is such a fine balance,isn’t it.My best friend just gets repeats every month for morphine patch and is totally reliant on them.if the chemist is late she starts getting the shakes etc.Someone else to worry about!x

[Doodlereggie in reply to Runrig01]

Yes you are so right,she is the sort of lady to suffer in silence and not make a fuss!I will see how she is on Tuesday when I see her and go gently x

[Joannos]

I don't like that she hasn't been back to rheumatology and had a review, perhaps it should be suggested.

[Doodlereggie in reply to Joannos]

I will advise her on Tuesday to make an appointment,and will go with her if she wants.However,as she is a new friend ,I will tread gently,as I am prone to barge in where angels fear to tread.!x

[BoneyC]

I wonder if this lady has any other medical problems other than RA? Is she elderly, does she have OA, is she in need of a hip or knee replacement but trying to manage the pain with pain killers?

To be taking 15 tablets a day sounds like she has lots of other health issues alongside RA.

[Doodlereggie in reply to BoneyC]

“Thanks for reply.She is about early 70s,I think.She seems o.k apart from a very swollen and painful foot,so I will probe further when I see her on Tuesday.That is too many painkillers.i think.x

[Happy5]

Hard not to be concerned for this lady & want to aid her. For me being in pain means I'm in a flare and I always contact my RA team for help. Last visit I saw the specialist nurse (so kind too) gave me an intra muscular steroid injection then started the ball rolling for me to start biologics. Started them 6 weeks ago and pain hasn't returned like it was.

Not seeing or hearing from her RA dept for 2 years is odd as where I am it would mean I 'd be discharged from the dept. So think I'd kindly say you're surprised she's not seen any one at RA dept , and has she thought to contact them to aid her in alternatives to reduce her pain? I also say it's usual for a review at least every 6 months, especially as new meds are developed to improve treatment.

All the best.

[Doodlereggie in reply to Happy5]

Thanks for reply.She said her last 2 appointments were cancelled and she is waiting to hear from them.I think that they assume she is doing o.k. on methotrexate if she doesn’t make a fuss,but from my experience,you have to try at least 3 dmards before they will offer biologics etc because of the cost.

She appeared not to have any knowledge of what can be on offer,if you push a bit,but we on here know the ropes ,as we have learned so much over the years!!x

[welsh12]

She needs reviews bless her if she is taking tramadol also as its addictive and hard to come off thank you for looking out for her

[Doodlereggie in reply to welsh12]

Thanks for reply

She really does need a review,as the painkillers she is taking I think are not the solution for RA long term,but are a bit of a cop out and cheaper than the brilliant meds available today.They could possibly add another med for RA in or offer her prednisone course if having a flare.She did not even know what a flare was,so I am sending for all the NRAS booklets for her to read,as they are excellent xx

[ruth_p]

It really doesn’t sound right to me that she hasn’t seen her rheumatologist since being put on mtx and the fact she is taking such strong painkillers while still having pain sounds like she is not fully controlled by the mtx. You should gently suggest she needs to get in contact with her rheumatology department to get some advice.

[Doodlereggie in reply to ruth_p]

Thanks for reply.I am going to work on her gently over the next couple of weeks,without trying to look like a know it all!x

[OSTEOARTHRITISRA]

Get doc to refer her as urgent and gp to try get pain under control as well maybe more pain meds needed combination and a med reiview ,she should have been seen by rumatologist specially on the methotrexate, 2 years is not right ,It is common for lots to get strong pain meds as well

The

Gp Usually prescribes this

The

Omeprazole again gp if required nt everyone needs is if she does the gp should prescibe that or an alternative,

Lots also have Chronic long term pain as well

Everyone is different and some are on pain relief long term ,it is fine as your under gp supervision as gp prescribes that some are even on tramadol and opoids etc and can be common , She should be under rumatologist supervision as well as on methotrexate and an appointment is needed asap if not complain in that area ,

[Doodlereggie in reply to OSTEOARTHRITISRA]

Thanks for your reply

What worried me about the pain meds was that she was prescribed them,not by her g.p. who would monitor them but by the hospital,where she has not seen anyone for 2 years.Seems criminal to me.Talk about falling between the gaps.x

[Janelily]

I do take omeprazole and have done for years. I was given it as I hav e GORD, but your question is unrelated to that.I do know that omeprazole or lamiperizole is given to line the stomach, to protect the stomach from some medications.

I'm afraid that's all I know.

[Doodlereggie in reply to Janelily]

Yes you are quite right,they usually give it to you to line the stomach when you are on anti inflammatories.i am quite worried about her.x