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sara
09-19-2006, 09:05 PM
Hi there,


let me clarify that with "mild " lupus i mean the symptoms are mostly joint pains and fatigue and there is no organ involvement.

My queries are :

1. how much painkiller a day is considered safe to control joint pains? i take diclofenac ( on full stomach and with an antacid) once daily in the morning but still get stiff by night.

2. Is it safe to take painkillers everyday in the long run to control the symptoms?

3. when does one decide its time to switch to other forms of medications like plaquinil, steroids, immunosuppresents etc...

I know that its a question for a rheumi, but i have a GP who doesnt think twice about starting steroids or other medications saying it all depends on how i am 'feeling' which is a very subjective term. Obviously, i would feel great if there was absolutely no symptom but for me the ability to move around and perform the daily cores without too much hassles and minimum medication would also serve the purpose..

4. Lastly, i know that steroids are more powerful painkillers than NSAIDS but do they also check the progress of the disease?

thanks in advance

Morpheus
09-19-2006, 11:39 PM
Hi sara, I'm not sure either about any of these things.
However with regards to pain killers i take them as needed.
Sometimes up to three times a day (i use tylenol)

I think you should definitely spealk to your rheumy :)

Quarterhorsegal
09-20-2006, 05:10 AM
Sara,

The type and amout of 'pain killers' that can be taken varies for each person. There are different types of pain medications and each has its advantages and restrictions.

NSAIDS (nonsteroidal anti-inflamatory drugs) include medications like diclofenac (Voltaren), ibuprofen (motrin,Advil), naproxen (Aleve), nabumrtone (Relafen) and many others. This class of medications controls pain,fever,and inflammation. Inflammation can be a big cause for pain and can cause damage in joints, ect, so one of the benefits of these medications are their anti-inflammatory effects. This is a large class of drugs and the effectiveness of each varies from person to person. One may not work at all for you, but another can work great. Stomach upset is a common side effect of these medications. Taking them with food may help. Persons with a hisory of GI bleed should be cautious when taking NSAIDS. These medications can also affect kidney function, so those of us with kidney involvement need to be cautious also.

Acetaminophen (Tylenol) controls pain and fever, but has no effect on inflammation. It is a good medications with relatively few side effects, BUT, acetaminophen is toxic to the liver in high doses. The recommended max is 4000mg/ day for people with a healthy liver. This is important for people treating chronic pain to remember as many pain medications contain acetaminophen.

Steroids like prednisone can be helpful in pain control because of their strong anti-inflammatory effects. These medications have the potential for many side effects, including the GI and kidney effects I mentions with the NSAID group above.

Narcotic pain medications are obviously good for controlling pain, but may not always be the best choice. Some of their limitations are their lack of ability to control the cause of pain like inflammation. The addictive nature of this group of medications is often a concern of doctors when prescibing them, especially for chronic pain. Many of these are combined with acetaminophen, so when taking these it is important to watch your total daily dose of acetaminophen.

Akkkk, late for work. Hope some of this helps. :D
I

sara
09-20-2006, 10:56 PM
Hi !

your extensive info about painkillers really amazed me.It has answered some of my queries although i wish i could get answers to other questions as well.. thanx once again for taking time out and providing the info...

take care







quote="Quarterhorsegal"]Sara,

The type and amout of 'pain killers' that can be taken varies for each person. There are different types of pain medications and each has its advantages and restrictions.

NSAIDS (nonsteroidal anti-inflamatory drugs) include medications like diclofenac (Voltaren), ibuprofen (motrin,Advil), naproxen (Aleve), nabumrtone (Relafen) and many others. This class of medications controls pain,fever,and inflammation. Inflammation can be a big cause for pain and can cause damage in joints, ect, so one of the benefits of these medications are their anti-inflammatory effects. This is a large class of drugs and the effectiveness of each varies from person to person. One may not work at all for you, but another can work great. Stomach upset is a common side effect of these medications. Taking them with food may help. Persons with a hisory of GI bleed should be cautious when taking NSAIDS. These medications can also affect kidney function, so those of us with kidney involvement need to be cautious also.

Acetaminophen (Tylenol) controls pain and fever, but has no effect on inflammation. It is a good medications with relatively few side effects, BUT, acetaminophen is toxic to the liver in high doses. The recommended max is 4000mg/ day for people with a healthy liver. This is important for people treating chronic pain to remember as many pain medications contain acetaminophen.

Steroids like prednisone can be helpful in pain control because of their strong anti-inflammatory effects. These medications have the potential for many side effects, including the GI and kidney effects I mentions with the NSAID group above.

Narcotic pain medications are obviously good for controlling pain, but may not always be the best choice. Some of their limitations are their lack of ability to control the cause of pain like inflammation. The addictive nature of this group of medications is often a concern of doctors when prescibing them, especially for chronic pain. Many of these are combined with acetaminophen, so when taking these it is important to watch your total daily dose of acetaminophen.

Akkkk, late for work. Hope some of this helps. :D
I[/quote

[/quote]

ButterflyRN
09-21-2006, 04:42 AM
I would definately go see a rhemuatologist even with it being mild lupus. you want to see someone who understands your disease because they deal with it more. GP's are great for the everyday things, but lupus is a breed of it's own. I think you'd find it beneficial to see a rhematologist!

Quarterhorsegal
09-21-2006, 02:08 PM
Sara,

Thanks for the compliment. So you know where I am coming from, I should tell you that I am a pharmacist with over 5 years clinical experience managing acute post surgical pain and chronic pain. I certainly donít have all the answers, but I do know a bit about pain medications. I am sorry I did not address all of your questions earlier, but I was a bit pressed for time. Let me try again.

1. how much painkiller a day is considered safe to control joint pains? i take diclofenac ( on full stomach and with an antacid) once daily in the morning but still get stiff by night.

-Most medications have a maximum daily dose, specific to that drug, above which it may not be safe to take them. Some drugs last longer in the body and should only be taken once or twice a day. Some last for only a short time and should or can be taken more frequently. If you are experiencing stiffness or pain at night, it may help to ask you doctor if you can take the voltaren twice a day or if he/she can recommend something you can take more frequently if you need it. Remember that there are many different drugs in the NSAID category and different ones work better for different people.

2. Is it safe to take painkillers everyday in the long run to control the symptoms?

-Pain medications, like all drugs, have risks and potential side effects . When used for chronic pain it is important to keep in mind the maximum dose and the possible side effects associated with whatever medication(s) you are taking. Managing chronic pain is a continuing process and it is important that you talk to your doctor before increasing or decreasing any of your doses as many adverse effects can be dose related and many pain medications should not be stopped too fast. Also, non-drug and natural product treatments can be very helpful in the management of chronic pain, so donít rule them out, but again discuss them with your doctor as they too have limitations and risks.

3. when does one decide its time to switch to other forms of medications like plaquinil, steroids, immunosuppresents etc...

-You are right. This is a question for your Rhumie. If you are experiencing more pain, or new symptoms, it may be time to adjust, change, or add to your medications. Keep in mind that there is a big difference between treating your pain and managing your disease. You could probably take enough pain medications to keep you out of pain, but that does not mean your disease is under control. It is very important that you communicate any worsening or new symptoms to your doctor so that together you can manage your disease as effectively as possible. If your GP is treating you for symptoms that you think the Rhumie should be treating, talk to your Rhumie about when and for what symptoms he wants you to contact him directly.

4. Lastly, i know that steroids are more powerful painkillers than NSAIDS but do they also check the progress of the disease?

-Steroids are strong anti-inflammatories, and can therefore be very effective for pain associated with inflammation. Steroids also inhibit the body's immune response. Because Lupus is an auto immune disease, steroids can 'check' the progress of the disease to some extent. However, steroids are also associated with many adverse effects and should be used only when necessary at the lowest dose possible for the shortest length of time possible.

Whew, this must be a record for the longest post ever. I do tend to carry on, sorry. Anyway, hope I did a better job of actually answering your questions this time.

Laura

sara
09-23-2006, 01:01 AM
[quote="Quarterhorsegal"]Sara,

Thanks for the compliment. So you know where I am coming from, I should tell you that I am a pharmacist with over 5 years clinical experience managing acute post surgical pain and chronic pain. I certainly donít have all the answers, but I do know a bit about pain medications. I am sorry I did not address all of your questions earlier, but I was a bit pressed for time. Let me try again.

1. how much painkiller a day is considered safe to control joint pains? i take diclofenac ( on full stomach and with an antacid) once daily in the morning but still get stiff by night.

-Most medications have a maximum daily dose, specific to that drug, above which it may not be safe to take them. Some drugs last longer in the body and should only be taken once or twice a day. Some last for only a short time and should or can be taken more frequently. If you are experiencing stiffness or pain at night, it may help to ask you doctor if you can take the voltaren twice a day or if he/she can recommend something you can take more frequently if you need it. Remember that there are many different drugs in the NSAID category and different ones work better for different people.

2. Is it safe to take painkillers everyday in the long run to control the symptoms?

-Pain medications, like all drugs, have risks and potential side effects . When used for chronic pain it is important to keep in mind the maximum dose and the possible side effects associated with whatever medication(s) you are taking. Managing chronic pain is a continuing process and it is important that you talk to your doctor before increasing or decreasing any of your doses as many adverse effects can be dose related and many pain medications should not be stopped too fast. Also, non-drug and natural product treatments can be very helpful in the management of chronic pain, so donít rule them out, but again discuss them with your doctor as they too have limitations and risks.

3. when does one decide its time to switch to other forms of medications like plaquinil, steroids, immunosuppresents etc...

-You are right. This is a question for your Rhumie. If you are experiencing more pain, or new symptoms, it may be time to adjust, change, or add to your medications. Keep in mind that there is a big difference between treating your pain and managing your disease. You could probably take enough pain medications to keep you out of pain, but that does not mean your disease is under control. It is very important that you communicate any worsening or new symptoms to your doctor so that together you can manage your disease as effectively as possible. If your GP is treating you for symptoms that you think the Rhumie should be treating, talk to your Rhumie about when and for what symptoms he wants you to contact him directly.

4. Lastly, i know that steroids are more powerful painkillers than NSAIDS but do they also check the progress of the disease?

-Steroids are strong anti-inflammatories, and can therefore be very effective for pain associated with inflammation. Steroids also inhibit the body's immune response. Because Lupus is an auto immune disease, steroids can 'check' the progress of the disease to some extent. However, steroids are also associated with many adverse effects and should be used only when necessary at the lowest dose possible for the shortest length of time possible.

Whew, this must be a record for the longest post ever. I do tend to carry on, sorry. Anyway, hope I did a better job of actually answering your questions this time.

Laura[/quote


laura , you are a brick !!!! thanks a tonne

MARYCAIN
09-23-2006, 07:35 AM
I do have multiple-organ involvement and other problems, so I can tell you first hand that with lupus treatment, as with any medication, you have to weigh the risks against the benefits, and decide whether you will benefit enough from the drug to risk the possible side effects.

There is some evidence that in people with no organ involvement, the use of plaquenil may retard the progression of the disease into organ involvement. The evidence isn't strong enough yet for the ACR to incorporate this recommendation into their practice guidelines, but many rheumatologists are recommending plaquenil to their patients with mild lupus for this reason. Plaquenil can also help improve joint pain and fatigue. It can take several months to see improvement. There are potential side effects, including GI problems and vision problems, so it's important to talk about these with your doctor. Plaquenil can be extremely dangerous for young children - so if you have kids, it's critical for this medicine to kept absolutely out of reach. If you have psoriasis, plaquenil can trigger a severe flare. However, for many patients plaquenil is considered safe for long term use and it is often the first DMARD (disease-modifying anti-rheumatic drug) prescribed for lupus patients. DMARDs are a class of drugs used in the treatment of rheumatoid arthritis and lupus to slow the progression of the disease.

Drugs such as Imuran and CellCept were originally developed for transplant patients to prevent them from rejecting new organs. Because they work by suppressing the immune response, they also help lupus patients. The downside is that suppressing the immune response leaves the patient vulnerable to infections. There are also other side effects and druf interactions.

As quarterhorsegal pointed out, steroids like prednisone are extremely effective, but they have so many potential side effects that you should avoid then if possible. They are useful in the short-term to bring a bad flare under control, and may be a necessary evil for some patients.

There are some non-medical things you can do to help your joint pain - many people find that water aerobics or other water therapy helps. Swimming and other exercise that doesn't put stress on your joints may help you maintain strength and range of motion. I know it's hard to even think about exercise when you're dead tired and hurt all over, but it is important not to let your joints stiffen up - that will just make you hurt more. Alternating hot and cold therapy can help painful joints and muscles. A lot of gyms and ymcas offer classes for people with arthritis - talk to your doctor about what's right for you. Tai chi amd mild yoga exercises improve balance and flexibility and also help relieve stress, which is a big factor for lupus patients.

I agree with some of the other posters that it's a good idea to see a rheumatologist even if your lupus is mild. Most gps and family practice doctors don't see enough lupus patients to be really up-to-date on current research and treatment.

The Arthritis Foundation website and the about.com/arthritis website have a lot of resources about managing joint pain and arthritic symptoms that might be helpful

sara
09-23-2006, 08:40 PM
i absolutely agree with you to combine non medical alternatives like yoga along with the necessary medication. I too have been through the usual medication route like prednisolone, plaquinil, methotraxate one after the other ever since i was diagnosed and i suffered the side effects from all of them.Its been several months since i moved to this new place and i have been told that finding a good rheumi here would be a next to impossible task so i have to carry on with the GP until i find one. i havnt experimented with the diet yet and have been contemplating going for a gluten free diet ( i am not much of dairy or meat person) just to see whether it actually helps or not but i guess my adulation for wheat products is too great to allow me to give them up :lol: .

thanks for sharing the info and expressing your views..