KNEE ARTHRITIS - General principles of managing Osteoarthritis of the knee :

Anyone use Tramadol - - Posted by Trev (Trev), 15 July 2004

Hi everyone,
I have unicompartmental osteoarthritis in my left knee.
I wear an unloading brace for about 14 hours every day which helps a lot.
Until recently I've avoided using painkillers other than the over the counter type but recently the pain has increased quite dramaitcaly.  This has affected the way I walk and am now starting to get real problems with my right hip.
After visiting my G.P. he prescribed Tramadol to be taken as and when needed.
At first I was on a permanent high and had a headache, it was like being half drunk and having a hangover at the same time. This all stopped after about a week and everything was fine, the pain virtually dissapeared.
Now I find I am starting to increase the dosage to releave the pain.
I've read that these tablets are adictive but my doctor does not see this as a problem.
I've only been using for about a month, and then only when really have to so that I do not become dependant on them.
Has anyone had bad experiences with Tramadol?
I'm told it's quite limited what I can take as I had a stomach ulcer about 14 years ago and a lot of the drugs agrivate the stomach.
Any advice would be appreciated.

Trev.
Posted by hmaxwell (Heather M.), 15 July 2004

Tramadol is listed as a very weak, synthetic narcotic, so it's not thought to be addictive in the sense that you will be holding up liquor stores to get money for a fix!  And to be honest, people who are in real pain on a chronic basis don't often become addicted, especially when they are conscientious about the meds, don't take more than prescribed, and are monitored by a doctor on a monthly or bi-monthly basis.  

There is such stigma out there about pain medication, but if you are in the situation that you are young, have bone on bone pain, and there is little that can be done to help you because of your age, then you are the classic type of patient who can be helped by some of the medications out there.  Doctors have recently revised national medical guidelines to include pain as the fifth vital sign--as important as your pulse or temperature in determining your overall health.  Chronic, untreated pain will wear you down and make you ill in so many ways--depression, imbalance of necessary brain chemicals, inflammation, sleeplessness...the list goes on and on.

I would recommend that you see a pain management specialist.  Not because your doctor isn't currently helping or anything, but because the pain management specialist is someone with advanced training who can offer a variety of medications and treatments that will improve your quality of life.  He/she can also address your concerns about addiction and prescribe alternative medications like Tramadol, along with SSRI's which can boost the pain relieving properties of other meds.   My PM doctor also does acupuncture, prescribes massage, gives me test treatments like Lidoderm patches that have proved to be VERY helpful, and in short is an ally who is on my side and working hard to improve my quality of life.

You are in a unique situation with the ulcer, which is why I would recommend seeing a PM specialist.  I've had great success with mine.  I resisted medication for almost 18 months, during which time I had 7 procedures on my left knee--an average of one procedure every TWO MONTHS.  I was miserable and had no life.  I was reluctantly prescribed painkillers by my OS, but like you didn't want to take them until I absolutely needed them.  

But that's the exact wrong way to take the meds, and you shoot yourself in the foot by doing it!  Once I was in a formal PM program, I was able to get twice the relief with half the dosage simply by NOT waiting until I couldn't stand the pain any more.  I've learned so much since starting this program, and it's really distressing to see I wasted so many months in serious pain, doing everything wrong because I was afraid of the medication.

Pain is a very complicated thing, and often ingorance and fear lead us to do things that we think are better for us, but in reality we are working at cross purposes and denying ourselves the relief we need to get back some quality of life.

Anyway, to go back to your question--I had absolutely no problems taking tramadol.  I took it for over 6 months on a daily basis, and when the time came I stopped it without issues--but that's because it was no longer working for my pain and I had had additional surgery.  It works well for mild chronic pain, but I'm bone on bone in several spots on my knee--the kneecap being the worst offender--and the pain was just too severe for Tramadol to address after my last surgery.  If it works well for you, then keep taking it with your doctor's supervision!  We have such a Puritanical undercurrent in this society--if something helps us and makes us feel good (i.e. reduces our pain so that we can function) we are instantly suspicious of it!!  The idea that narcotics should never be used for chronic, non-malignant pain patients is fast becoming antiquated.  Huge advances have been made in arthritis and pain research, and these show just how backward some of our thinking really is.

A really good resource for you to consider is Arthritis Today magazine--they have an online version.  http://www.arthritis.org/resources/arthritistoday/

This magazine goes through many of the discussions about narcotics and other mediations for pain relief.  While taking a narcotic painkiller is certainly not what you want to do right out of the gate (the best thing, everyone agrees, is to use the least potent medicine that helps you), it is no longer accepted blindly that narcotics can't or shouldn't be prescribed at all--especially to patients who are too young for other treatments like a TKR.

Hope this information helps you.

Heather
Posted by Knee_Queen (Knee_Queen), 4 December 2004



I only used tramadol for two weeks post-op after my TTT/LR in september and then again intermittently just before my first few physio appointments before I was offered acupuncture treatment in the NHS. You really are in a difficult situation at the mo- I couldn't imagine having to rely on tramadol for long periods of time.

I didn't get the feeling of being unusually happy on the tramadol but maybe thats becuase I had had plenty of morphine whilst in hospital for the first four days post op!!! I did feel very fuzzy headed, sleepy, dizzy, nauseus, confused, forgetful and had hot flushes whilst I was taking it and if I had to take tramadol for any longer I think I would have had difficulty in doing simple everyday things. The worst thing was just throwing up without barely any warning even though I was taking anti-sickness meds too. Just before my physio appointments I'd sit down in the hospital cafe to have a drink or something, but then I'd completely lose track of time and on a couple of occasions I didn't even know why I was supposed to be at the hospital!!!!

I was scared but relieved to be offered acupuncture as a treatment but it meant  I had to come off the tramadol asap (which also gave me stomach cramps and worse due for several days to related side effects of the tramadol). Afterwards I felt better in myself and gradually over the last 6 weeks my appetite has increased again. Of course, if you are in so much pain that you can't come off pain meds without some other kind of alternative then its a very difficult situation.

Have you ever considered acupuncture to help manage the pain, it seems like you've nothing to lose at the mo!!!! Even though I'm a complete needle-phobe I managed to go through with the treatment and I've found some pain relief, but it has also helped with scar tissue and ROM post-op, so it may be worth a try!!!!

Good Luck

Heidi
Posted by Trev (Trev), 12 December 2004

I'd like to say a big thank yo to both Heather and Heidi.

I've just returned from a trip to Spain and although the weather is cool by Spain's standards (15 - 19 Degrees) I't is still a lot warmer than hear in the U.K.
Whilst away the pain in my knee reduced quite dramatically and allowed me to cut my medication by a huge amount. Now that I am back to cold wet England I'm starting to increase the amount of pain releif again.

Heather,
You comment on monitoring by a doctor monthly or bi- monthly. My doctor does not seem to be concerned and has told me to apply for repeat prescriptios without seeing him as he says there is nothing else he can do. Perhaps it's time to change my doctor.

Heidi,
I have never tried accupuncture. I am one of those sceptcal people who has always been unsure about this.
However in light of your personal success I might give it a go.

Thanks for your help and advice.

Trev.
Posted by Knee_Queen (Knee_Queen), 14 December 2004



Good Luck  

Heidi

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