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Author Topic: Painkillers that work ??  (Read 5450 times)

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Offline mikeks

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Painkillers that work ??
« on: October 11, 2010, 06:58:33 PM »
Todate on my right knee I have had arthroscopy Dec 08, Total Knee Replacement June 2009, revision TKR surgery June 2010. All have failed to eradicate the intense pain that led to the start of this process. Today the pain is excruciating and apart from more physiotherapy and painkillers the hospital is of little help. Does anyone know of any painkillers that will work ? I am currently on Tramadol and Paracetamol. Before these was on Diclofenac and Co-codamol. None really help.

Offline knee always hurts

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Re: Painkillers that work ??
« Reply #1 on: October 11, 2010, 07:43:07 PM »
Hello,

Given that you describe the pain as excruciating, the only class of drugs that would likely be helpful would be the opioids.

http://en.wikipedia.org/wiki/Opioid

Tramadol and Co-codamol both contain opioid ingredients, but perhaps they are not strong enough. If your doctors think that this is going to be a chronic and/or incurable condition, then I think you really need to fight to get the pain medication you need. If your current doctors won't help you, look for someone else. I think the problem tends to be that opioid pain medications are generally scheduled substances, which means that doctors who over-prescribe the medication will find that they draw the attention of their country's drug enforcement agency. But persistent excruciating pain is precisely what these drugs are for, so I would imagine that you could find some doctor willing to help you out.

I would suggest reading that Wikipedia article and perhaps doing some of your own research on the options available, and then discussing that with a pain management doctor. You might also consider anti-depressants or anti-anxiety medications, as these conditions amplify the perception of pain, thus causing you more suffering.

Good luck!

Offline dm

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Re: Painkillers that work ??
« Reply #2 on: October 12, 2010, 06:35:11 AM »
The only thing you can try that's over the counter is to alternate ibuprofen and acetominophen every 4 hrs, to try and break the pain cycle. Don't recommend this for more than 24 hrs, but it may help. If the codeine containing compounds aren't strong enough (parcetamol or co-codamol I believe) and the non-narcotic tramadol just isn't touching the pain, then you need to get in touch with your doctor about something stronger.

Here in the US, painkillers with codeine are not available over the counter, like they are in the UK.

If you just had surgery today, and you can't reach your surgeon for a call-in to the pharmacy for something stronger for the pain, then perhaps a visit to the emergency room is in order, you shouldn't have to suffer.
multiple arthroscopies 2/00,3/01,6/01,1/03, 12/07,10/10. chondromalacia, severe medial joint space narrowing following 3 partial menisectomies, chronic pain problems, kneecap problems, OCD lesion, failed mfx.

Offline Vickster

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Re: Painkillers that work ??
« Reply #3 on: October 12, 2010, 07:55:08 AM »
Acetaminophen is paracetamol :)

If you have ongoing severe pain, I would ask your GP to refer you to a pain specialist (assume you are in the UK)
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline kscope09

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Re: Painkillers that work ??
« Reply #4 on: October 12, 2010, 10:15:11 AM »
What about morphine patches?  My grandad has them on his back all the time.
Feb 08 Inurred right knee
18 months of physio, knee tracking but knee still painful
Aug 09 Scope - Small tear in acl, fragment found in postereo-lateral compartment, suprapatella and lateral plica and small defect in mfc.
May 10 Right knee feeling better but left knee causing trouble as a result o

Offline Lottiefox

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Re: Painkillers that work ??
« Reply #5 on: October 12, 2010, 10:34:30 AM »
Apart from just considering drugs I'd be asking why the pain is still so bad; is this to be expected after a TKR and revision and will it/should it settle as the knee heals this time? I know TKRs can bring varying degrees of pain over varying lengths of time, but it may be that you're still having relatively normal pain levels after the traumas the knee has been through.

This doesn't help manage it though I accept - have you considered anything like acupuncture, massage therapy, etc in combination with drug regimes? A pain management centre should look at things holistically if you can get a referral. Personally for me, the only thing that helps OA knee pain is Celebrex, but doctors are wary of this due to the Vioxx withdrawal but it works for me and I have no adverse effects with blood pressure etc.

Hope things improve

Lottie
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline kscope09

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Re: Painkillers that work ??
« Reply #6 on: October 12, 2010, 12:30:27 PM »
Does celebrex really wrk?  I got an advert for something called celabolin that said it could protect cartliage and significantly reduce pain and it was supposed to have celedrin in it.  I nearly ordered some until I googled it and found from tiehr forums that it was just a scam and the drug doesn't exist.

If celebrex works then I waqnt some.  I've got all the classic arthritic sumptoms but they won't diagnose me with it even when they admitI've got the symptoms.

Anyway, have the docs said you should still ahve some pain or are they all telling you that you should be pain free by now?
Feb 08 Inurred right knee
18 months of physio, knee tracking but knee still painful
Aug 09 Scope - Small tear in acl, fragment found in postereo-lateral compartment, suprapatella and lateral plica and small defect in mfc.
May 10 Right knee feeling better but left knee causing trouble as a result o

Offline Vickster

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Re: Painkillers that work ??
« Reply #7 on: October 12, 2010, 12:34:59 PM »
What about morphine patches?  My grandad has them on his back all the time.

Morphine is pretty full on and addictive/habit forming.  Certainly, age and lifestyle needs to be considered when going down that road

Celebrex certainly worth a discussion as Lottie says but use is retricted both from a cost and adverse event risk point of view.  I'd be asking to see a pain specialist tos discuss all the possible options.
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline Lottiefox

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Re: Painkillers that work ??
« Reply #8 on: October 12, 2010, 02:17:51 PM »
kscope

Celebrex is an NSAID - a COX2 inhibitor rather than a COX1 inhibitor as found in naproxen etc. COX2 is the inflammatory element linked to things like arthritis rather than COX1 which is also responsible for the good stuff we have in our guts. Hence why things like COX1 NSAIDs can cause gut issues. COX2 NSAIDs were developed to lower the risk of gut problems, but Vioxx was withdrawn as it was linked to elevated heart attack risk. Personally I have fewer symptoms on Celebrex than any other variant of drug but the concept of life long pill popping til I need a TKR isn't one I relish. It can other insidious side effects...but having relatively normal knees is worth that at the moment.
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline dm

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Re: Painkillers that work ??
« Reply #9 on: October 13, 2010, 10:25:58 AM »
The guy really ought to just show up at the er and demand that they do something. so that they give him a referral to orthopedics, to at least get the ball rolling, so they at least get him in the queue for a referral to pain management, since he seems to be being ignored by his current physicians. Nothing else seems to be working.
« Last Edit: October 13, 2010, 10:30:53 AM by dm »
multiple arthroscopies 2/00,3/01,6/01,1/03, 12/07,10/10. chondromalacia, severe medial joint space narrowing following 3 partial menisectomies, chronic pain problems, kneecap problems, OCD lesion, failed mfx.

Offline Vickster

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Re: Painkillers that work ??
« Reply #10 on: October 13, 2010, 10:53:59 AM »
Unfortunately, the system doesn't really work like that in the UK as all referrals happen via the GP (gatekeeper within the system, even for referrals to private specialists).  Most GPs won't rx strong opioids with specialist direction, hence need to see a pain doc :)
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline Feely08

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Re: Painkillers that work ??
« Reply #11 on: October 13, 2010, 11:07:35 AM »
After 15 surgeries in the UK and US I have had quite a few different types of painkillers. The best one by far is a drug called Percocet. It is rarely offered in the UK but is very common in the US. Your GP should be able to prescribe you it if you ask him. I would be more worried about why you are in so much pain, and not to worry you but, you might want to go and see your consultant and check that there is no infection etc. As I know from my own experience that they only time I suffered a lot of pain was when I had an infection.

In my experience of some of the other drugs:

Morphine just makes you feel sick
Codoamol is ok but makes you constapated
Diclofenac is a good anti-inflamatory but doesn't do much for pain and can cause internal bleeding
Celebrex is also a good anti-inflamatory and is an ok painkiller has been found to be unsafe and their are links to it's use with heart attacks and strokes
Ibuprofen is a good anti-inflamatory
Paracetamol is probably the best painkiller on the market and you can take up to 1000 mg three times a day

I hope this helps

Mike

Offline knee always hurts

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Re: Painkillers that work ??
« Reply #12 on: October 13, 2010, 10:03:07 PM »
Just from personal experience, I have to second Feely08. A few years ago, I had an absolutely horrid back problem that kept me up a whole night in agony. I took some Percocet, and it took the edge right off, and I drifted happily into sheep jumping fence land. The percocet contains acetaminophen/paracetamol as well as oxycodone, but I'm not sure how much the acetaminophen is going to do for severe pain. But I had taken ibuprofen, which was useless for the problem, and the percocet worked.

Offline mikeks

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Re: Painkillers that work ??
« Reply #13 on: October 16, 2010, 09:17:42 PM »
Thanks everyone for your responses. Since my last post I have seen my Consultant again and he now thinks that after looking at more Xrays  that muscular contraction during the healing process on the right side is pulling the kneecap into contact with the upper new joint and said that Cortisone injections  would resolve and eradicate my pain.He does concede that by now I should be pain free !!!!!  In fact the injection has resulted in the worst ever 14 days I have experienced, the pain is now as intense or even more worse than ever if that was possible  :-[ and is now affecting my normal sleep pattern.

Offline knee always hurts

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Re: Painkillers that work ??
« Reply #14 on: October 16, 2010, 10:04:10 PM »
Wow, that is sad to hear. I think someone had a good suggestion in an earlier post. Get thee to an emergency room! If you're in that much pain, maybe they'll be able to help you out. Let's hope that the doctor is right and you'll eventually be out of pain. But for now, you shouldn't have to suffer.