Which pain killer

[Caulkhead63]

Which pain killer is the best to use? Paracetamol doesn't seem to work very well. My hips have been hurting a fair bit. I'm tapping down and my body doesn't like it much!

[SnazzyD]

If the pain is due to PMR only steroids will give you proper relief. Pred combats the inflammation which is what causes the pain, what type of pain is it? What makes it worse and better?

[Caulkhead63 in reply to SnazzyD]

I am on steroids and slowly cutting down. At the time of writing I'm not doing anything just sitting reading. It's a dull ache in both hips

[piglette]

It depends what type of pain you are trying to suppress. If it is PMR you should use steroids, the only answer.

[Bcol]

Hi, if it is only PMR pain the your Pred is the only things which will work on the pain. Is it possible you have dropped a bit too low and your PMR levels are increasing?

[Caulkhead63 in reply to Bcol]

I started in August on 15 mg I'm now on 11.5. is that to quick? I'm quite new to all this and it's difficult to know. All very confusing!

[DorsetLady PMRGCAuk volunteer in reply to Caulkhead63]

it may be - can you remember dose you were on when you didn’t have any pain?.. assuming that was the case.

You did say 4 months ago when you were at 12.5mg your legs ached. Has that been the same ever since then, or did they improve?

If not, then you really shouldn’t have reduced.

if you know the dose you were pain free I’d go back to that initially and see if it helps -you should know within a few days. If not you may to treat as a flare. .

Couple of links to look at -first general info - second on flares versus steroid withdrawal which may help you work out what it is -

healthunlocked.com/pmrgcauk...

healthunlocked.com/pmrgcauk...

[Caulkhead63 in reply to DorsetLady]

Thank you

[PMRpro Ambassador]

You aren't tapering relentlessly to zero - you are looking for the lowest effective dose: the lowest dose that gives the same level of symptom relief as the starting dose did. The pred cured nothing, it is a management strategy to manage the daily top-up of inflammation that occurs every morning as long as the underlying cause of the autoimmune process that leads to it is active. In the early days it is more active than it will be later and while you should be able to reduce the dose, it may not be far or very fast at first.

Hip bursitis is a common feature of PMR and if the clear out of the inflammation at the start isn't 100% and then you are able to walk more once you are on pred that may make it worse. It was part of my PMR and it was probably 3 or 4 months before I realised it was almost gone, even longer before it had all gone.

[Caulkhead63 in reply to PMRpro]

Thank you

[Bramble2000]

the only thing that deals with PMR pain is steroids. I’ve taken oramorph, long acting morphine and Buprenorphine patches and they only deal with about 20% of the PMR pain. Even prescribed anti inflammatory medications don’t do much for it, hence the treatment with steroids.

[pink123floyd]

Have you tried soluble paracetamol i find they work better as they get into the system quicker ,hope you feel better soon.x

[Caulkhead63 in reply to pink123floyd]

I'll try that. Thanks xx

[MiniSpec]

Personally I take paracetomol with codeine tablets, both in soluble and solid form for my PMR based chronic lower back pain. The paracetomol doesn't touch the PMR pain, but I find that the codeine in the tablets does have an effect. They don't remove the pain completely, but I've found that they knock the edge off it, so that I can continue to live something approaching a 'normal' life.

There are different strengths of codeine tablets available in the UK, the most well known being Cocodamol, which is 500mg of paracetomol and 8mg of codeine. Boots also do one at the same strength, and our local chemist also does a generic tablet of the same strength. Solpadeine also do a 'Plus' range of tablets that are 500mg of paracetomol and 8mg of codeine, like the Cocodamol, and generic tablets. These are all available without prescription from chemists.

There are also stronger tablets available without prescription, although you will be told not to take them for more than three days at a time or they may become addictive *. They are the Solpadeine 'Max' range. These are 500mg of paracetomol with 12.8mg of codeine, and they are available both as soluble and as solid tablets.

However, I've found that for me, taking two 'Plus' tablets or two Cocodamol tablets, means that I'm taking 1000mg of paracetomol in order to imbibe 16mg of codeine, and the paracetomol hits my liver rather hard. So instead I tend to use the higher strength 'Max' tablets, as taking just one of these will reduce the paracetomol hit on my liver, while still giving me just under 13mg of codeine, and it is the codeine that actually does the pain killing.

There is a self-limiting aspect to taking the codeine tablets though, as they cause constipation, and by the end of three days, I have no wish to be more bunged up than I already am. So I happily adhere to the 3 day rule without any prompting.

* I remember reading about a large survey that was undertaken a few years ago to discover if people do become addicted to codeine tablets. The researchers were surprised to discover that the reason why the tablets are taken affects the addiction process.

1. If taken for a headache then the codeine in the tablets did cause addiction.

2. If taken for back pain, the codeine tablets did not cause addiction.

The researchers found that people taking the tablets for headaches suffered worse headaches as the codeine wore off, so they'd take another tablet to keep the pain level down, and this led to addiction.

However, with back pain the result was different. As the codeine wears off, the pain doesn't get any worse than it was before taking the tablet, so the person taking them isn't tempted to take another tablet in order to bring the pain back to a tolerable level. Because of this, people who take the tablets for back pain rarely become addicted to them.

[Caulkhead63 in reply to MiniSpec]

Thank you

[PMRpro Ambassador in reply to MiniSpec]

All opioid based painkillers should be prescribed together with an appropriate laxative to avoid the bunging up in the first place ...

[MiniSpec in reply to PMRpro]

I agree, but these aren't on prescription, I just buy them when I need them.

[PMRpro Ambassador in reply to MiniSpec]

But they still have the same effect - so a laxative is required from the outset, far better than waiting for it to happen.

[artfingers in reply to MiniSpec]

Well, taking magnesium also helps some with constipation - I found when on oxycodone for my TKR that the magnesium taken twice daily worked to keep things " moving" along until I was off them totally. But then again I was only taking the Oxycodone sporadically (just before physical therapy).

[Jane424 in reply to MiniSpec]

I take a stool softener = polyethylene glylcol and have for years. Laxatives tend to make your bowel dependent

[readingbooks in reply to MiniSpec]

Very detailed and no doubt helpful information , but I realise you are in the UK so I am just adding that, as far as I know, here in Canada, we cannot get any meds with codeine in them without a prescription.

[Bcol in reply to MiniSpec]

Yet another thing for me to be an oddity about. I've been on Co-Codamol (30/500) since the early 1990's, might even be 80's for my OA. In the bad old days I would be on 8+ a day plus Naproxen. Nothing else was/is effective for me. They are the only tablets I use for pain, other than for PMR which they don't touch. Once I'd had my TKN my need became a lot less and for many years now a baseline dose of two a day, most days, keeps the OA happy. I take more on the rare occasions that the OA or something else gets grumpy, I've never found them addictive and the possible constipation has never been a major problem. This wouldn't suit everyone and I know that the side effects stop some people from taking them at all.

[SMH4CRNA]

I take celebrex 200mg twice per day and 1-2 grams of tylenol (paracetamol) per day. I am no longer on prednisone since the rheumatologist believe I do not have PMR since I am to young, sigh. The NSAIDS + Tylenol brings pain down from 6-8/10 to 2-4/10, but does nothing for the stiffness. When on prednisone, I did not take any other pain medication and felt no pain. Only mild stiffness in the AM. I do not recommend opioids.

[Bcol in reply to SMH4CRNA]

Would just add that Tylenol 2, 3 or 4 is an Opioid

[SMH4CRNA in reply to Bcol]

ok ?

[Bcol in reply to SMH4CRNA]

I was just pointing out that those versions of Tylenol are Opiods and not just paracetamol.

[SMH4CRNA in reply to Bcol]

Ok

[AmberAliona]

I find Co codamol is the only thing that helps when things are bad.