Chronic Knee Pain

[BlueCobra33]

I have been suffering with Chronic Knee pain for 15 years now and I am still at a loss as to best deal with it. I have recently gone back to my doctor as I had noticed a significant change in concentration when I took the tramodol (despitet this being on a prn basis) I am now on 30/500 Cocodomol 4 times a day and 10mg Amytryptiline once at night. This also seems not to be working and my eyes feel heavy the vast majority of the time. I have tried physio, accupuncture, cortozone injections all to no avail...tens I found helpful if worn all day though with my line of work it is impractical and dangerous.

I am concerned over riding my motorcycle while on this medication however this is my only mode of transport and I need to get to work each shift. I can not afford to miss work and have no other transport available to me. I am also concerned over not being able to do my work effectively due to loss of concentration and the fact my knees seems to be getting worse...I am in pain each day and it slows me down significantly and prevents me walking any real distance; as a support worker if the individual wishes to go out I am to join them. As a "non driver" this is becoming increasingly difficult, especially as the nicer weather is coming in, they are wanting to go out more and walk more.

Can anyone reccomend any good painkillers or "miracle cures" worth trying? Or other ways around my impeding issue with work? I can't drive due to my knees not liking to be in a bent position so hand controls are pretty much the only option however I can not afford lessons or controls (never mind the car!) on my wage.

Any advice muchly appreciated. Hugs to you all.

[backisbad]

Sorry, cannot offer any suggestion that will greatly relieve any pain without a side effect of sleepiness, suggest you talk your problem through with your GP and discuss pain management. It didn't help for me, however, have heard it has worked for many. Had some respite with hydrotherapy and acupuncture. Hope it works out for you. Best wishes.

[earthwitch]

Sounds like you need a referral to an orthopaedic surgeon to see if there is anything they can do.

If the knee problem is seriously limiting your mobility, had you thought about applying for DLA? (actually it will probably be PIP for new claims). If they grant high level mobility, then you could use it to get a motability car. The other option for work, is to ask for an Access to Work assessment - can't remember now if you do it through Jobcentre or the DWP phone line, but you could try finding out about that - that will pay for taxis if you can't use public transport for work, and other things as well.

[Calceolaria]

This may sound simplistic as you say you have tried everything - but what about wraparound knee supports in the short term, while waiting for orthopaedic assessment? I have only seen them advertised in newspapers and magazines but a Physio would advise.

[BlueCobra33]

Thank you for your support, I have had 2 ops on one of the knees to no avail. They honestly haven't a clue as to why they hurt I can't use supports as I "had" Osgood Schllaters and so I have really sensitive lump just below the knee cap - that and none of my knee caps run smoothly over the joint so any pressure cause more havoc. I had tried to claim DLA a few years back for help with mobility but they spoke to my doctor and apparently deemed me unsuitable for benefits (i'm assuming this is because I spent a long time just getting on with life limping and putting up with pain etc instead of continously going to the doctors once they announced there was nothing they could do).

I have never heard of an access to work assesment. What is this? It would help imensely if I could have help with getting to work. Luckily my service users doont tend to want to go out with me at the moment so I have a bit of time to try and get painkillers right, but transport would help greatly. Thank you.

[johnsmith]

Knee pain can be caused by muscles out of balance. The line of force instead of going though the centre of the knee goes one side or the other. A good way to study and look for this problem is to see an Alexander Teacher. Taking time to engage in Buddhist Mindfulness is also another method which helps ease the pain.

I have a torn ligament in my knee and I live with episodes of knee pain. I have learnt that working on getting the right tension in my muscles aligning the knees reduces this pain considerable. Much work involves standing with the centre of gravity going though the hip joint, knee joint and ankle joint. This involves in the early stages of learning to do this a lot of mental work.

Hope this helps

[Dammy]

Have you tried Ruta cream or ointment yet? I've just been reading up on Osgood Schlatter's syndrome and wondered whether you've ever come across this herb. Its main use is for damaged tendons and ligament tissue and in my experience is very effective for these kind of injuries. You would get it from a good health food shop or from Weleda or maybe from the pharmacy Helios in Tunbridge Wells. They will send you stuff very quickly.

You don't mention whether anti-inflammatories have been helpful or not. Do the knees both swell up or get warm to touch, or red at all? I take it that you've tried putting ice on one knee and seeing if that helps it. The idea of a few Alexander lessons is reasonable too, as you may be unintentionally walking in a way that makes it worse ! What about weight? My doctor told me recently that every pound of weight my knees don't have to carry will help my knees. Sorry not to have an instant miracle, but do get the Ruta and try it ! All the very best. Dammy

[BlueCobra33 in reply to Dammy]

I have never heard of ruta cream! I shall see if it is available in the UK. I have recently seen an advert for flexseq (something like that) and has good reveiws for arthritis so thought worth a go. I have tried a cream begining with "C" which was basically "chilli" cream, this was extremely painful and made my knees turn bright red and feel like they were on fire! needless to say I only tried one application of that!

2 of you have mentioned the Alexander lessons, what are these? My knees do not seem to inflame or become warm., I have tried Ice and though it works when the ice is on them (it numbs the knee so cant feel anything!) it is only very temporary. I used to have anti inflamatories alongside my tramadol but my doc has taken me off these at the moment (not entirely sure why but I guess its probably because its hard to tell what works and what doesnt when your using more than one at once).

[pinknosedcat in reply to BlueCobra33]

Hi, Alexander Technique is a tried and tested method of regaining the 'natural' posture you are hopefully born with. It is based on the theory that as we grow up and develop life the universe and everything (well, you know what i mean) affect your natural posture leading us in to bad habits which have the knock on affect of causing certain muscles in our body to over compensate, thus causing us potentially severe problems down the line. It is commonly used for musicians who have been over straining certain muscle groups due to bad technique...it is very successful for musicians. Another area you might like to look in to that is allied to Alexander tech' is body mapping and Andover. They are all techniques that help to re educate your body as to it's most natural and efficient posture. I'm sure John can explain it better though so wait till he replies. It sounds to me like the first thing you should do is go back to your Dr and lay it on the line, tell them exactly what's going on and that your livelyhood is in jeapordy. As for the DLA, try again. In my experience (sorry, yes it will be PIP for you I suppose) they turn down loads of people the first time they apply...i think they do it to test how desperate you are!! Seriously though they have to make allowances for worsening medivcal conditions so definitely re apply. If you need help check out benefitsandwork.co.uk/ they are extremely helpful. If you can bear it, before you go back to your GP keep a diary of how your pain is affecting your life and don't hold anything back. Chart the times that you have problems and flare-ups etc including things you have to cancel because of the pain, things you can't do, all the problems that it is causing. this will give your GP a much better idea of what is goinjg on than you going in and using subjective language. they can't argue with facts and figures. One more thing...how long have you been using the amytriptaline? From what you've written it looks like they've put you on the standard first response treatment for chronic pain...it's always Amytriptaline and cocodamol first. There are loads of other meds that can be tried to help with pain management, you need to see a pain consultant and get your self to a pain management clinic. Pain consultants are the best people to sort out your meds so get your GP to refer you on. In the long term though if your knees are deteriating you may well need to consider changing jobs to one that is less stressfull on your body. You won't get DLA because you can't do a certain job, you will only get it if you can't access any job. They will see the fact that you are doing a physical job as contadicting what you are saying about your mobility. You may want to give this some thought. they won't understand how you can push someone in a wheelchair but can't ride your bike unless you are extremely well prepared to explain it. I'm not doubting you, I just know what they'll ask from experience. Check out gov.uk/access-to-work/overview . I hope some of this is of some use to you and I really do hope things get a bit mpre sorted for you. Good luck. Heather

[BlueCobra33 in reply to pinknosedcat]

Thank you for the advice; much appreciated and I will certainly be looking in to it all.

I suppose I should have allaborated a little on my job but you have highlighted an important issue I may have when applying for anything - the assumption that a support worker is for the mobility disabled. I actually work with Personality Disorder and so the job is much less physical than you would assume, I don't do any personal care or manual handling. It is more social support that they require, and I am usually just around an average sized home doing what most would do in their own homes so nothing that you would class particularly manual labour. My issue is if they choose to go out on a social visit i.e. shopping, cinema etc - we have to innevitabley walk to bus station and around town etc...which I can do but cause pain and is frustrating for me and the client due to my slowness!

As far as my motorcycle is concerned, I sit on the back seat in order for my legs to extend as much as possible in stead of being bent up.

As I am sure you would all agree you make the most of what you can do and sometimes gritting your teeth through the pain and doing things in an odd or lengthy way is the only way to keep your independance.

I have been to pain management before but after trying everything, at least physically as opposed to medically (literally, hats off to them) they seemed to dropped me like lead balloon and left me to deal with things on my own. Curently going backwards and forwards to my doctor to try and get meds right. I have fought for quite some years not to be on regular 24 hour meds (as opposed to as and when my pain is too much to handle) and am now only just accepting that this really is the only other step to try; hence why I wan on tramadol for a few years before trying regular cocodomol, qwhich isnt working and so will be going back again this week.

Great idea about the pain diary, I had started a basic one on suggestiong from gp but you give good advice about times and writing what can and cant do etc because of it. Thankyou.

[mr-flibble]

I used tramadol and it messed me right up so I stopped using it, Codeine spaced me out and bunged me up but did little for the pain Cocodamol was slightly more effective than Codeine as the paracetamol in it aids the analgesic properties of the Codeine but again the Codeine side of the drug doesn't really cut the mustard with me, I'm now on Dihydrocodeine which doesn't bung me up half as bad and it works really well on my knee and neck pain, (I have OA in both patella and 2 places in my neck), that said its a strong pain med so there's an addiction issue with it so I'd be carful if you go onto that, so far I'm a fan of it as it also doesn't space me out as much as straight Codeine did, I don't feel drowsy on it unlike Tramadol which made me feel very odd indeed and it gave me really bad moods and did little for the pain.

As for your knee do you know exactly what the problem is?. if its OA (osteoarthritis) then think twice about having any form of flush out operation, they did both of mine and it made things much much worse, and as for magic pain med's there's sadly no such thing, you need to work out a pain management plan and part of this will be sorting out pain med's, the analgesic ladder is a useful bit of info, same goes for lifestyle, try and find whats best for you, bike ridding should OK, the biggest problem will be from the cold and damp personally I find it makes my knees hurt more if its really cold or really hot, odd I know but thats just how it is

[BlueCobra33 in reply to mr-flibble]

As far as I am aware it is not oesteoarthritis, they dont know what it is. I'm happy you found a medication that helps you, does this get rid of the pain entirely for you or do you still have flair ups? Are you able to do more of what your couldnt before the meds?

I used to love cycling however my knees have over the years decided that they dont like any form of activity that requires pressure going through them when even remotely bent! I now have a hand cycle which I bought off a mate who was upgrading, I must say it was one of the best things I did. I can now cycle without the fear of my knee preventing me getting home! Unfortunately bulky and not particuarly practicle other than specific bike rides but fun none the less.

[Dammy]

Both pinknosed cat and mr-fibble have given great info in their emails. I should have told you the full name of Ruta; it's Ruta Graveolans, and you can definitely get it in Britain. It sounds like you've got quite a lot of pain to cope with, but we all sympathise, if that helps at all ! Will be interested to hear how you get on. Dammy

[BlueCobra33 in reply to Dammy]

Thankyou Dammy, I have looked it up and you can get ointment and capsules to ingest! It doesn't seem overly expensive so I shall be sourcing some tomorrow to try. Thankyou.

[Dammy]

Hi Blue Cobra. You mentioned getting capsules of Ruta in your message. I have no experience of taking Ruta internally and have just looked it up in my herbal books. It doesn't sound to me like a good idea to take it internally, but if you take it as a homeopathic dose --say Ruta 30, I think it might help. The actual herb is pretty toxic, though in small doses it has its uses. The homeopathic dose will of course be quite a different matter. If you want to try that, I would suggest twice a day for a week or so. Homeopathics are absorbed through the mouth tissues, so you chew the tablet and let it be absorbed there; don't drink anything with it. Tip the tablet out into the lid, so that you minimise touching the others. Any more info, willingly given ! All the best, Dammy

[Kerryjess]

Blue cobra! you have been given lots of good suggestions in the previous posts which I would agree with. The DLA route is not an easy one in my experience( I have chronic back pain and OA in knees) I was turned down the first time and only last year achieved the higher mobility award after getting lower mobility twice. Even then, i have had to appeal the decision on several occasions. I would suggest that you get help from. Citizens Advice re filling in the form and if you are turned down, consider going in person to an appeal to state your case. The other help is through a site called Work and. Benefits which gives lots of practical help to fill in the forms and is well worth the reasonable fee to join.

I had arthroscopy done on my right knee twice and it helped the first time but not the second. I was then told that It was not considered bad enough yet for a replacement as I was too young ( I am now59! ) I would rather have quality of life now than worry about needing it done again as new developments in surgery techniques are improving all the time.

Definitely keep a pain diary or download an app on your smartphone which reminds you to fill in your pain symptoms as it makes it easier to go back and track the severity of your pain and how it affects you on a daily basis. All this is necessary both for GPs and for DLA. I know it is a pain, but you do need to keep seeing your GP so that he/she realises the impact on your daily life.

I hope you get some relief soon.

[BlueCobra33 in reply to Kerryjess]

I agree with you on the knee replacement thing - surely it is better use to you now than when you are much older? I know someone in his twenties that has had both knees done so the age thing is a personal cop out in my oppinion. You are right with the good advice too - I have had much good advice and I am very greatful to you all. My doctor has now refered me to the orthopedics for further investigations as is concerned we are only masking the pain (or trying to at least!) she has given me morphine patches to try - I am only on day one and so far my pain doesnt appear to have changed however it takes 3 days for the full effect so fingers crossed. I have been advised not to change anything else as otherwise we will not know what is working and what is not but ruta is certainly something I shall be investigating in the future. Once good thing about this morphine patch is that it lasts seven days! I had downoaded a pain app on my tablet but was a bit of an inconvenience however had not considered using a phone app oddly so I have now downloaded to help. Thank you all. you have offered great advice . I wish you all health and less pain.