What pain meds for flashes of pain?

Hi again all - sorry for firing questions left right and centre. I've been having these intense flashes of pain all day in the knuckles and palms of my hands like contractions almost - used to get them when all this began last year but haven't had anything like this in ages really. They make me gasp but then go so you can't quite believe in them.

What should I take? Ive already had 2 amitriptyline so hoping they will kick in soon. I've got Naproxen and Tramadol but never tried the Tram before and am a bit scared of it and Naproxen is okay although it gives me fluid retention My feet have been doing it on and off a bit in the toe area too. Is this a flare-up I wonder - I've never had one like this before so I don't really know? Nothing looks more swollen than usual but my ESR was 50 on Monday. Hoping it will just burn itself out somehow.

21 Replies

  • Have you tried a wax bath?

    IF not they are amazing for hand pain. If you look up wax bath on the tags you will find previous blogs with all the details off were to buy them etc. But I would really recommend. It's the only thing that helps my hands x

  • Hi TildaT, The pains you describe sound like 'resting pains'. I get them as part of my 'flare-up' routine. (The gift that keeps on giving!) Really a question for your medical support team (GP/Nurse etc.) however, I am prescribed Solpadol (prescription only) 30/500 for those episodes and that works for me. Your Tramadol is prescribed to be your form of pain relief - but maybe your GP needs to review this. He/She may be concerned about possible addiction. Agree though, scary stuff!! Hang in there.

  • I thought I understood Tramadol was not addictive, that is the advantage to taking it. Remember we had a discussion about addiction and that if you are having moderate to severe pain, taking a med as perscribed will not become addictive, as your bodies' endorphins will interrtupt that cycle of dependency.

  • TRAMADOL (Wiki) 'Long-term use of high doses of Tramadol may be associated with physical dependence and a withdrawal syndrome'

  • Wonder what is considered a high dose? As in pretty much all these drugs, moderate or even low doses are usually effective. So far, Tramadol hasn't become a "street drug", atleast not around here. But, we always have to be aware of what we swallow! I would be happy to pitch it all, if only the RA would just lay down and shut up :) !

  • Thanks both - yes I'm a bit nervous of Tramadol - so many people say it make them go a bit nuts. I almost took one but opted for paracetamol instead. Does zilch for me but the resting splint and Amitriptyline seemed to get me through the night. OH pointed out that I keep the tram and other stuff in reserve for when pain is scream worthy. This was just gasp worthy on and off.

    Re the wax - have got one up in our studio but the wax needs changing as its got a bit fluffy and lumpy. The best thing is the hospital OT one like a deep vat I can dip my hands in up to elbows and then the wrap it all for me. I have an open invitation but haven't had time to take it up again yet.

    I keep thinking that this is going to be a flare up but it's just very slowly getting a bit worse each day that's all. Maybe just that MTX is dulling it or that I took one tablet less 2 weeks ago. Do others find that the MTX effects, good and bad, wear off by end of the week just before taking the next dose? Do let me know if tramadol works better than other stuff for you anyone. The woman GP who prescribed it always asks me how I've got on with it when I see her but I'm too much of a wimp to try it yet. Waiting for a screamer! TTx

  • Tilda, I'm no stranger to pain, Tramadol works for me very well, do you really want to experience a "screamer"?

    and yes, the MTX begins to wear off a couple days before it's due again. L.

  • No I don't want to wait for a screamer really Loret but it is still just low level pain (unless my pain threshold is very high these days?!) and don't need it yet. Thanks for info telling me that the MTX does lose it's potency by the end of the week though - wasn't sure if I was imagining this but if you say it's real then I know it is! TTx

  • Hi Tilda,Sorry you havntt been feeling well,hope your flare doesnt materalise!!

    Tramodol did nothing at all for me no side effects, but no effect on any thing else

    either.I find co =codamol a very good painkiller.Ive still not been diagnosed but was reading on the net that a lot of the diseases over lap one another and are very difficult to diagnose,hence the long wait.I too, am scared of new Meds [LYRICA] after reading the info. Everything that could go wrong is listed to the extent of CROSS EYES had to laugh thats all i need.HAVE A GOOD EASTER

    PAT X

  • Hi TT,

    ask away, and don't apologise, if you get some help on here, and it helps ease your mind, it has got to be worth it, it is the support on here that is so invaluable.

    I was on tramadol in 2009 it tends to make me drowsy, and my GP prescribed it just over a month ago, with 8 paracetamol a day. I have tried co codamol and co dryamol but they mess up my stomach really bad, the wax bath for the hands sounds good. I have a hot water bottle wrapped in a towel and place my hands on a pillow with a water bottle on for a little while, and then take a painkiller and try and have a nap, that kind of settles me down. Know what you mean about the mtx wears off by the end of the week, am due to try sulfazine next month, I am like you on meds have not tried, all i can say with the tramadol, is that if after say a couple of doses you feel you cannot cope with it then it is not for you. I hope you find something that eases the pain for you soo, Take care, Paula x

  • Tilda dear, It does sound like you are cooking a flare, esp. with a sed rate of 50! Don't be afraid of the Tramadol, it's very well tolerated, if you want to try it for the first time, take it a bed time. In the morning, take it when you first get up and keep to every 4-6 hrs, You will be pleased with the results. The primary idea is to live without interferring pain, which means you are probably not getting enough anti-inflammatory action either. Good luck, girl! L.xxx

  • I take 2 Tramadol, along with 1 Gabapentin, every 4-5 hours. Some times it works so well, I forget to take the next dose, then I pay for it with big pain for about 3 hrs, as it takes an hour and a half for it to work. Good luck, I sure do hope you get on the best regimen for you. Lxxx

  • Thanks Loret, Paula and Pat (hey it would be great to see a different pic of you Paula and Pat because you're both green silhouettes and hard to distinguish?!).

    I went to my son's gig late last night and only got home at 1.30am as we had to give him and his pals and a huge bass amp a ride back home. So no amitriptyline for once and I still slept okay although went into deep freeze mode even though it wasn't very cold in the house - so I went to sleep with bed socks and my arthritis gloves on and piles of blankets. Consequently woke at about 5am expiring with heat! So weird this body temp thing now - I seem to get so cold all the time - hands and feet worst of all. I might be wrong but I don't think this is a big flare up yet and I still haven't tried the tramadol.

    My ankles (left esp) only hurt when I walk up and down or turn them and my wrist the same. I think perhaps the problem is that I went down a dose the week before this at the instruction of the other GP and now I'm paying the price even though I moved back up this week to 15mgs at the instruction of my usual GP who explained that with my ESR at 50 and returned symptoms I needed it - depression or not. I'm really hoping I can move up a dose this coming Tuesday. I'm beyond worrying about the mood changes or the hair thinning or the funny spots now and just want to get back on track feeling better in my joints again. TTx

  • Hi Tilda, on Thursday my nurse told me that I should take my pain meds regularly irrespective of the pain level - I am guilty of letting pain build up in small increments until it suddenly goes crazy. I am getting along just with paracetamol at the moment but, once my wrists start to twinge more, I use the Tramdol alone or along with the paracetamol. I had to ask them as I felt I had slipped backwards with regard to pain management. She said that this disease requires a steady drip drip of pain meds until our blood results or clinical condition demonstrate that we are in remission and then it's more of a "whatever you feel is necessary" situation regarding pain meds. Tramadol does make me tired but it was much worse when I first took it and is lessening now. Still waiting to see if the Meth helps me and taking my fourth dose tonight. Hope you get relief soon.

    Julie x

  • I'm sure this is right for you Julie but I'm now 5 months into MTX and had reached a stage where I just kept forgetting what tablets I'd had and when so I dropped all of them a few months into MTX. I had a small flare up when I stopped taking them for a few days but since then I've been fine.

    Now I only take amitriptilyne. I asked my GP and he said this was fine for me because my liver function got a bit raised and he felt that being on these pain meds for six months might not be good for my tummy/ gallstones etc. I don't have a rheumy nurse and my GP knows I don't take anything unless I really need it so I feel I should just stick to his advice for now as hes the only medical person i seem to have access to.

    He did say that these drugs can lose their eficacy after a bit with long term use. I've got them all in my drawer with a flare list for what I can take together if I think I'm flaring up. I just never quite know when that may be though?!

    I did take ibuprofen and co- regularly for the first 8 weeks of the MTX though as instructed - same as you are doing. Hopefully you will feel the benefit of the MTX very soon.

    TT x

  • Ah sorry Tilda, we all seem to be told different things! I haven't been told about keeping up with them while taking Meth in particular but am scared to let the pain get a grip again as I wouldn't be able to go into work. I'm ever hopeful for success.

    Julie x

  • Well I'm very mindful that I'm not seeing a rheumy expert all the while but my GP is pretty up to date on most things I find and guess we are told different things partly because we are all different people with different med histories etc. Don't stop taking them until you're confident that the MTX is working for you - as I'm hoping very much it will. TTx

  • Hi all

    As Tilda says, everbody is different. It can be very helpful to compare experiences on the forum, but I think really in situations like this the answers will always be very specific to personal circumstances, so probably more useful to seek advice from someone medically trained, than to draw on other people's experiences, though I appreciate this is difficult over Easter!

    If you have a medical query and are unable to get hold of rheumatology nurse or GP a pharmacist can sometimes help with advice on medication and you can call NHS Direct for some medical advice. Their helpline number is 0845 4647.

    I hope you are able to get this pain under control soon.

    Kind regards


    (NRAS helpline)

  • Thanks Victoria - I know that it's important not to rely on this site for medical advice but sometimes it is more expedient to get advice on how certain drugs might make us feel also. But thanks for the NHS direct number anyway. I'm waiting for my GP to return my call today - fingers crossed I might be allowed to move up a dose on MTX or start a new DMARD.

  • hi first time on hear, for me , just reading about all the bits, i was in pain with my feet for 2years, was sent for a m,r,i scan, then was told i have r.a. was put on methotrexate tablets, but then make me feel sick, all the time, i am now on the injection, but still get side effect, sore mouth , eyes, headache, and get very tired, not sleep to good, as get a lot of pain in my feet, i only have be giving, co/codamol. as tramadol, make me ill., but if i take to much co./codamol, then that that it effect, feel like i am just left, to get on with it,, i see, that amitriptylin,,is taking by some of you , i have not been offered , so was thinking would to help me to ask, my g.p. about it,

  • HI Missmopp - welcome to this site forum - you should try putting a question or a blog on the HU homepage as this is quite an old post of mine and noone else will see it - you will be very warmly welcomed if you go to the main page. Sorry you are having lots of pain still. I'm slightly less pained each time I rise a dose with Methotrexate (MTX) but then the good effects wear off and it comes back so now trying to get seen by my rheumy again and it's an uphill struggle although my GPs are really working hard for me. I love Amitriptyline but go to Gina's question on the homepage because it certainly doesn't suit everyone. Tilda xx

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