If you suffer from pretty much any sort of Arthritis, auto immune such as RA, PsA, AS etc, or good old OA, the wear and tear sort of arthritis, you are no stranger to pain. One thing I have noticed over and over in support groups around the internet and in person, there seems to be no end to myths, legends, falsehoods and sometimes outright fright about narcotic pain medications. I cannot say that I was forever immune to this, when I was first diagnosed the RA, Sjogrens, Reynauds and PsA several years ago I was scared to ask for, or take Narcotics. Then I found this site and an article by Lene, who would come to be a very good friend of mine. This article got the wheels turning for me so to say and I did a lot of research on Narcotics and found out some very interesting information.
I started with pain meds pretty much like everyone else, OTC was my starting point as I tried to stop the pain of what I and my PCP thought was OA. I tried Advil, Tylenol, Ibuprofen you name it. None of it really worked. Once I was officially diagnosed with RA I stepped up a bit to RX Ibuprofen and Voltaren Gel. These also had little to no effect, as my pain continued to ramp up, I was needing a stronger ally in fighting it, but I was also concerned about side effects and addiction. After reading Lene's post I made an appt to speak to my PCP and my Rheumy. Both assured me that narcotic pain meds ARE safe to use if used correctly. Any sort of side effects can usually be found very early in your use of them, and addiction is actually a very LOW risk. People that are fighting heavy duty pain, need heavy duty pain medication to level the playing field. I left the Rheumy's office with an RX for Darvocet (no longer available on the market).
Darvocet worked somewhat for me, it at least took the edge off the beast, and we slowly worked up the power charts of this drug. Before long I was moved to lower dose Percocet and Vicodin. The Vicodin (Hyrdrocodone) worked very well for me and I stuck with it for a long time. I started out with the 5mg dose. Vicodin is part Opioid and part Acetaminophen. As with all pain relievers though, eventually your body becomes accustomed to the dose and the pain reduction effectiveness starts to wane. I moved up the chain of Vicodin, 5mg-7.5mg-10mg until even the 10mg was not very effective. I really appreciate my Rheumy and PCPs take on these medications, they know very well they only work for so long until you no longer receive the full benefits of the drug. They questioned me on the effectiveness on every visit, and when appropriate moved the dosage up. It truly bothers me to see people posting on support groups, in obvious pain, that they have been on low dose Tramadol or Advil for years. I always urge them to please speak in depth to their doctors. Please remember that your doctor KNOWS you are in pain BUT they do not know how MUCH pain you are in There is no reason to not be fully honest with your doctor. If you are in severe pain, TELL them! I am certainly not saying that everyone needs to be on heavy pain meds, but I do feel that many people try to be "heroes" and not tell the doctor how bad the pain is, are scared to talk about the pain due to the fear of addiction, or simply are seeing doctors that do not believe in pain management. (don't get me started on THAT!)
As the top end of Vicodin began to fade on me, I tried the pill form of Dilaudid and then moved on to 60mg Morphine Sulphate Slow Release twice a day, and 5mg of Oxycodone for break through pain as needed. I have been on this combo, with one tick up to 75mg of Morphine, for nearly a year. This has been my magic bullet of pain relief, I can function again and not constantly think about pain. I still HAVE pain, but it is a dull thud now instead of a screaming presence. I follow my doctors instructions to the letter, he stresses how important it is to STAY AHEAD of the pain. Waiting for the pain to peak, then taking a pain med will never work. To fight severe pain, you need heavy duty pain meds and you need to take them at a steady rate. I do not drive within hours of taking any of these, my wife generally drives as is with the condition my feet are in. And I am very careful to stay out of dangers way. These are controlled narcotics and they DO affect you, however if you truly NEED these pain meds they are not going to affect you as they would a person taking them just to obtain a "high".
The danger of addiction to narcotics for people who are truly in need of them has been stated to be only around 1 percent. The problem with narcotics is the unofficial, recreational use of them that we hear of all the time. When was the last time you heard on the news "RA patient enjoys a decent day due to taking regular doses of Morphine?" All we hear is the person who abused the drug and crashed a car, or worse. I, for one, am very thankful I was open and honest with my doctors about pain levels, and they reciprocated by treating my pain as one of the symptoms of my disease. I do take random urine screenings to protect the doctors licenses, and assess my pain levels to them on every visit. It is a small price to pay for days of moderate pain vs the pain I remember and still occasionally encounter. At least now I know I have a weapon to fight back.
If you are in constant pain, it affects your daily rituals, your relationships, your work, your sleep, your LIFE! I implore you to talk to your doctor about pain management, or find a doctor that will assess your need for pain medications. Don't think that you need to suffer daily and your only hope is a bottle of OTC pain relievers. Be honest and open about pain, and you too can have days where the pain is just a distant thud you can easily overcome. Keeping the pain to yourself will end up just hurting yourself, and the caretakers around you.