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Newly Diagnosed, Should I Ask For Pain Med?

Newly Diagnosed, Should I Ask For Pain Med?

I was diagnosed Nov 2 and started Plaquenil. End of December my hips and shoulders started bothering me. Now it's at the point where I only sleep about 2 hours and then wake up hurting (I'm a side sleeper), roll to other side, sleep about 2 hours, roll to other side, repeat, repeat. I'm not sure if I should be asking for pain management this early in my diagnosis. Thoughts, suggestions?

A myRAteam Member said:

There are several good pain relieving otc available.. I use any unconventional "legal" means that give me relief for just a little while.. My chiropractor has given me wonderful relief with a tense unit bio freeze, moist heat and warm gel ultrasound.. He's shown he me how to imitate moist heat with just a moderately wet towel and a plastic bag..after you've gotten it wet and wrung out put it in microwave for a minute then into plastic bag.. Use where needed. Take care:)

posted about 5 years ago
A myRAteam Member said:

By the way (just in case it sounds like it), I don't own any stock in any drug companies or anything like that. I've just learned a great deal about all of this over the years....and I dont; want to sound like I'm suggesting that any of the meds are without risk. There has never been a medication yet made that doesn't come with risks and the RA meds are no joke. It's just that RA is no joke either. Under-treatment is as bad as over-treatment (only you can decide the right balance point for you -- but to do that you need to understand it as much as possible) And it's not just a joint disease. The inflammation effects all the parts of our bodies, it's just that our joints are the "favored" target and the places that hurt and where the damage is most easy to see.

Anyway, to finish up: I'm really glad that the Diclofenac helped (It's one of the meds I takeand it's a very helpful NSAID and pain-reliever)...but I have to confess to being a little confused about why your rheumatologist only has you on Plaquenil and now also Diclofenac.

It really is pretty standard to start one of the DMARDs early...

None of my business, obviously. I really just...well...I didn't like that image of you being only a few months into this, and having to deal with that amount of pain (most of the people on this site have had that experience too often ourselves, I suspect)...and thinking it must be really scary....and understanding why you'd be jumping conceptually to pain-relief rather than better disease control....Don;t get me wrong: pain control is vital. Your life with RA will be much, much harder without having the pain under control as much and as often as possible...but it's the disease-activity that is driving the pain. That is where the real control...the real, most normal life will come from...

OK. I'm worried I'll overwhelm you, so will stop. Just...well...the more you understand about why this is happening...or rather WHAT is happening in your body, the better you'll be able to control it.

Wishing you all the best.

posted about 5 years ago
A myRAteam Member said:

Part Two of Two:

Short answer: I don't think the real issue in what what you are describing is whether or not you should be on a pain medication regimen. If Plaquenil is all that you are on at the moment, thenrealmissue is that you I should be on a far more aggressive immunosuppression and anti-inflammatory regimen so that the disease is causing you less pain.

You need to be in your rheumatologist's office today (yesterday for that matter) and get your meds changed around. Your rheum will probably want to put you on a short burst of steroids (probably prednisone, maybe solumedrol, though there are others) while a more aggressive overall regimen is started (they usually take weeks to start kicking In, whichi is why the doctors often "bridge" you with steroids.

There is nothing wrong with Plaquenil mad a medication, by the way, but it is rarely enough to suppress RA adequately all by itself.

You need to get into to see your Rheumatologist right away if you are in this much distress. It's what they are for. And if you have a rheumatologist who won't just fit you in when you are having a bad flare, then you need a new rheumatologist. Good luck and I hope you are feeling better very soon.

posted about 5 years ago
A myRAteam Member said:

Heather, by all means ask your RA doc about pain management. You need your sleep to assist you in handling your RA. I was on Plaquenil only briefly as I was allergic to it. Then I was on Chloroquine, which was very helpful. However, Big Pharm stopped manufacturing it, so my dose of Methotrexate was upped
by 1 pill. I am glad that the Plaquenil helps you, but ask for help. There is no need for you to suffer from lack of sleep.

posted about 5 years ago
A myRAteam Member said:

My pleasure, @A myRAteam Member. I can't tell you that RA gets easier, but learning how to deal with it does. I promise. Not that you asked, but I can't stress enough how important it is to have a really, really, really good rheumatologist (technically great, compassionate AND accessible). There is no one "right" way to deal with any of this stuff, but it's really important to understand as many of the concepts as you can so that you can and your Rheumatologist can make the best decisions for you as you go. I felt/feel so terribly to hear of how much pain you are/were experiencing (thus my super-long reponses).

In the "Old Days" (ending 12-15 years ago, before the invention of the first "biologic DMARDs" - for "Disease Modifying AntiRheumatic Drugs") the accepted strategy was to gradually increase the intensity of the treatment as the symptoms worsened over time...which meant starting with an NSAID (aspirin, Ibuprofen, Diclofenac, etc..."Non-steroidal-anti-inflammatories"...then adding in steroids when the NSAIDs no longer gave enough relief, etc...

But all that time, the inflammation that was causing the pain was causing bony destruction of the joints.

So when the biologic DMARDs were invented, the whole approach changed. Now, the ACR (american College of Rheumatologists) strongly recommends aggressive therapy from the very start, because the DMARDs can significantly slow and even stop the bony destruction (which is permanent. Once it happens, it is permanent). That's why most people who are newly diagnosed are started on a regimen with a DMARD (usually something like Enbrel or Humira -- part of the first group of DMARDs that were developed) plus a complementary "regular medicine to increase it's effect. There have since been a whole bunch of categories of DMARDs developed...which is good, because they all seem to stop working after a year or two or three and not everyone has as big a response to specific ones ("RA" is probably, really a whole spectrum of related disorders rather than just one very specific disorder....they're all just too similar to distinguish so we call it all RA...and it doesn't matter much in 2016. IN 2020?? It may make a difference then. Even more tailored therapies are on the horizon).

posted about 5 years ago
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