Diclofenac

[Jakey67]

When I was first diagnosed in May, in conjunction with prednisolone, I was also prescribed Diclofenac 3 per day. At the time I didn’t really know why but now see it’s a pain killer. Looking into it there are warnings about stokes and heart attacks and recently the bad press has got worse. I have had some palpitations recently but they can be entirely coincidental as I had them 6 months ago and ECG showed nothing of concern. I now notice the packet on dosage advice says “reduce when you can” a bit ambiguous.

My questions are a) if the steroids are controlling pain ok can I reduce Diclofenac b) can I just stop taking it c) can I substitute/ask doctors/pharmacist for something else. Any help much appreciated.

[PMRpro Ambassador]

If what you have is PMR then in the vast majority of cases diclofenac will do zilch, like any other NSAID in PMR. If you are on pred, then NSAIDs are not recommended in addition because both on their own can cause GI problems, both together increase the risk. The 2015 Recommendations for the management of PMR actively discouraged they use of NSAIDs in PMR because the adverse effects outweighed the benefits.

The way to manage pain in PMR is to take an adequate dose of pred - if a couple of mg more of pred makes you pain-free, why add another medication of any sort to try to reduce the pred dose? They inevitably come with their own baggage of adverse effects, some of which can be far worse than those of pred. Here in Italy the Pain Clinic specialist has a hissy fit at the idea of my taking even ONE low dose of ibuprofen a day - what she would say about 3x diclofenac I have no idea. But it has NEVER been offered to me and we have truly struggled to manage some of my non-PMR pain. When a bit more pred does the job - I get everyone's blessing.

[Jakey67 in reply to PMRpro]

Interesting response thanks, yes I have PMR.

[Jakey67 in reply to PMRpro]

Since your response I tried reducing diclofenac and the result was pain. Could be coincidental I will repeat the exercise. Problem with taking more pred is currently on 12.50 and due to taper next week. Bit of dilemma.

[PMRpro Ambassador in reply to Jakey67]

I think your doctor needs to put their thinking cap on because when NSAIDs help a lot it does cast some doubt on it being PMR - possibly a polymyalgic presentation of an inflammatory arthritis but there are no other signs at all so it can be a difficult call initially.

[Odosmum]

I was given diclofenac on it's own and then as Arthrotec - a preparation that offered stomach protection - 30 years ago when I was diagnosed with Rheumatoid Arthritis. I took it for very many years until it became considered not a good idea to prescribe. It remains the best anti-inflammatory (for me) that I have ever taken and worked exceptionally well for the early days of my disease.

All that said, I absolutely agree with what PMRpro says about taking NSAIDs for PMR. I too have PMR - it started 23 years after my RA diagnosis, while I was taking Leflunamide for my RA - and prior to diagnosis and Pred, tried all sorts of OTC painkillers. My experience is that the NSAIDS were ineffective and that I had some relief from the Cocodamol 30/500 pills I was being prescribed anyway.

[Jakey67 in reply to Odosmum]

Thanks. I tried dropping the dose to just one tab result pain.

[Odosmum in reply to Jakey67]

Well, we could go back and forth about whether or not you do have PMR, but the bottom line is if the Diclofenac works for you then you should take it and make sure your doctor knows that it works. I would be concerned about protecting your stomach if you're going to take it long term though.

[Bcol]

Hi, looking back on your posts you said, three months ago, that since starting Pred you hadn't needed any painkillers. Your journey downwards with Pred, has for many here, been extremely fast. If you are in pain now it is possible/likely that you have reduced to a level that is too low to control the inflammation. Has anything else happened in that time that would/could be a cause of this extra pain? If you do have something else, as well as the PMR, it may be worth looking for something other than an NSAID to help.

[Jakey67 in reply to Bcol]

Thanks. I was on 15, reduced to 12.50. Had a flare been up and now back on 12.50 due to reduce in a few days which will be interesting. I certainly talk to the pharmacist about alternatives.