Painkillers

[hughessmith]

I don't seem to read any posts about painkillers. I was in pain while reducing from 15mg to 12.25 and was prescribed Solpadol 30mg/500mg which I have found quite effective even only taking 2 and maybe 4 per day. What painkillers do others take if at all?

[Amkoffee]

Typically PMR pain does not respond to pain medication. I have had lower back pain for 13 years and because of that I take opiates. And yet my PMR pain is not affected At All by the opiates. So I am surprised that the medicine that you take helps at all with your pain. I wonder if some of your pain that you're experiencing is not PMR at all but maybe something in addition to PMR.

[DorsetLady PMRGCAuk volunteer]

Hi,

As Amkoffee says painkillers don't usually have any effect on PMR pain, although I think in Kate Gilbert's book she does say she took them to help relieve her steroid withdrawal pains. So maybe that's what your pains were, rather than actual PMR.

[piglette]

The painkiller for PMR is steroids! I am surprised that Solpadol helps PMR as it is made up of mainly codeine and paracetamol, neither of which seem to be much use for PMR, but can help other aches and pains. As Dorset Lady said they may be useful for steroid withdrawal symptoms. It seems quite a strong drug to take daily though if it is prescribed for PMR by your doctor. Long term opiates are not a good idea unless absolutely necessary.

[Smell65 in reply to piglette]

Does anyone find massage helps?

[PMRpro Ambassador in reply to Smell65]

I use massage for myofascial release - doesn't do much for the PMR itself but can help a lot with what I call add-ons.

[HeronNS]

I hadn't heard about this drug before, but dr google describes it as a powerful drug - I hope you do not take 2 or 4 of them every day? One can build up a resistance to codeine and eventually become dependent, and acetaminophen taken regularly can lead to liver damage. It might be safer to reduce more slowly to avoid the withdrawal pains, if that's what they are. And if you have aches and pains that are not directly related to PMR inflammation (a lot of us do) there are non-drug ways to help. Some people like various kinds of massage. Others find that taking some magnesium is helpful. I've received a lot of help from my physiotherapist, dry needling for example.

[PMRpro Ambassador]

As the others say - very possibly because for most of us painkillers do nothing for PMR. Paracetamol and codeine certainly are unlikely to - some people do find that NSAIDs (nonsteroidal antiinflammatory drugs such as aspirin, ibuprofen or naproxen) may help but they are contraindicated with pred as the risk of gastric irritation is increased significantly.

4 x 500mg of paracetamol is the maximum recommended dose and in itself may cause liver problems if used regularly - there is a very narrow gap between maximum therapeutic dose and a dose that is risky. Prednisone itself puts some stress on the liver so if you are also taking other liver-metabolised drugs or drinking alcohol you do need to be careful.

[hughessmith]

Thank you for that. I shall stop the Solpadeine immediately and assume that the pain is withdrawal pain as I have posted elsewhere. I have gone back up to 16mg from 12.25mg using the dead slow routine as there was no improvement. I have been on 16mg for 3days now with very minor improvement, should I continue for a few more days or go up further?

My blood tests taken 2 years ago were inconclusive, and I have read here that is fairly common, but does make me wonder if there is something else involved here

[PMRpro Ambassador in reply to hughessmith]

I think a lot of people do have other muscle problems going on at the same time.

What dose did you start at and what was your response? Dramatic and fast or partial and slow?

[hughessmith in reply to PMRpro]

I started at 15mg because the rheumatologist advised it. I stayed on that for a month, then using the dead slow method started at 13.5 and 12.5 over about 6 weeks. I was never ever free from pain and you advised me to go back up to where I had been comfortable. I had not been comfortable at 15mm which is why I am trying 16mg, hence the question above on whether to persevere at 16mg for a bit or go up again now.

[PMRpro Ambassador in reply to hughessmith]

Is your doctor prepared to let you try 20mg? If you tried it and it wasn't any better than 15 you could go straight back to 15mg. But until you have all the existing inflammation under control it is difficult to reduce.

[hughessmith in reply to PMRpro]

Thanks for that I will contact him. What did you think about 16mg for a few more days?

[PMRpro Ambassador in reply to hughessmith]

Is it working?

[hughessmith in reply to PMRpro]

Not really but I thought a few more days and it might

[moskin in reply to hughessmith]

Hello,

Are you saying you have only had blood tests 2 yrs ago,they certainly need checking .

[Hidden]

I have another post about using diclofenac, an NSAID anti-inflammatory. It was completely effective until I got my PMR diagnosis (my GP thought I had an orthopedic problem) and was switched to prednisone. The prednisone did not work or was at best insufficient, so I continued to take diclofenac as needed (basically about 1/2 the dose) and it continued to be very efficacious. During my second week on prednisone, my rheumy recognized that it needed help and added methotrexate. At the end of the third week (after two doses of methotrexate), I suddenly stabilized and don't need the diclofenac.

My rheumy is somewhat perplexed about how well the diclofenac worked, but said one reason it's unusual may be that all the doctors are so focused on prednisone that they don't use it any more. Oh, I also was on percocet prior to prednisone, and it did nothing to relieve pain. Only the diclofenac was effective.

[PMRpro Ambassador in reply to Hidden]

I'd have thought the obvious thing to consider is that whatever it is you have it isn't necessarily the PMR we talk about on the forum. After all, there is no way you can confirm it, there are no definitive tests.

The literature does often mention using NSAIDs for less severe cases of PMR but most of us have found that they barely take even the edge off the pain and do nothing for the stiffness.

[Hidden in reply to PMRpro]

Well, at the same time I have had a large drop in SED rate (79 to 29), and a reduction in CRP. At my initial diagnosis, the rheumatologist left room for doubt because I had been doing well on just diclofenac, but now is convinced that the diagnosis is firm based on lab, symptoms, and results. And, as mentioned, I no longer need the diclofenac. Next week is my first taper (20 down to 17.5), so will be another test.

Another thing that didn't work for me is opioids (also pre-rheumatologist) - did nothing at all for pain even when it was extreme.

I guess my only point is that if prednisone isn't doing the job, perhaps worth trying some other anti-inflammatories even if they are deprecated at present.

[HeronNS in reply to Hidden]

Augeydoggy, I had never heard of diclofenac so did my usual of checking with dr google and apparently it MUST NOT BE TAKEN WITH METHOTREXATE so it's just as well you were able to stop taking it relatively soon after starting the mtx.

everydayhealth.com/drugs/di...

[Hidden in reply to HeronNS]

I certainly don't advocate taking those two together, but Dr. G exaggerates a little because the interactions cited generally apply to cancer-level dosages of methotrexate. Even so, the interaction level is "serious," and requires close monitoring by doctor. I am not taking the diclofenac while on the methotrexate.

Also, it is fairly safe to take diclofenac with prednisone, and that is what I was suggesting. For me, the diclofenac stopped my pain, while the prednisone knocked down my SED rate. Under the methotrexate, pain is slowly returning so I am not sure how we will address it going forward.