Diclofenac and/or knee injections

suziekettles

I have been taking diclofenac of and on for low back pain for around 6 years, so far no side effects. About a year ago I realised that each time I stopped taking it (to see "how" my back was) by knees were very painful, one much worse than the other. My GP couldn't find anything wrong with my knees & didn't find my history conclusive, he referred me to a physio run knee clinic at the local orthopaedic hospital (I think he only referred me because I've had back surgery, have a thoracic scolisosis & OA of my spine). My symptoms: pain weight bearing, stiffness, burning, aching, throbbing, knees feel huge & tight (but I don't think they are swollen), Baker's cyst & x rays confirmed OA in both knees "didn't look good for my age" - 49, probabally need both replacing in the future.
I had the worst knee injected (stopped dic) & responded really well, had a good 5 months relief with just a couple of flare ups. However as it has worn off the other knee has become an even bigger pain (literally!) its tolerable with diclofenac, but I'm miserable without it, mornings are ok, pain gets worse as the day progesses & depending on what I'm doing, sitting/resting is often really painful and I'm very restless; I can still do most things but a lot is a struggle. Was using an exercise bike till a few months ago, hot wheat pack seems to make pain worse.
I have a clinicic appointment tomorrow & am wondering where to go from here: carry on with diclofenac or have both/one knee injected. This is starting to take my life over. (it has distracted me from my back though!)
Do you have any advice about coping with knee pain?
Sorry to write so much, have probabally included a lot of waffle and omitted relevent stuff!

dreamdaisy

I have a different form of arthritis to you, but I do empathise with the constant knee pain. Keep on the anti-inflammatories, keep having the injections when you can, as they seem to give you good results (they never did for me, and be warned that sometimes they fail to work) and enquire about decent pain relief. If heat doesn't ease the discomfort then try cold: I used to have a pack of 'knee peas' in the freezer, they moulded well to the affected joint when required and did ease the symptoms until I got up to put them back in the freezer. The drugs I take now, however, have solved the problem of hot, fat and painful knees, now they are just painful. Unfortunately arthritis does not go away or get better: you are probably still too young for knee replacements but at least you may have that option in the future. I wish you well. DD

tillytop

Hello and welcome!

I am sorry you are in so much pain and that things are such a struggle for you. Does it have to be an "either/or" situation with the Diclo/knee injections? Just asking because it sounds as if the Diclofenac does help you so, if you can continue to take it you can "add in" other things such as the injections as needed. Are you taking the max possible dose of Diclo when you take it? I'm sure you are.

Really good luck with the clinic appt tomorrow.

Will be thinking of you.

Please do post to let us know how it goes.

Love Tilly xxx

suziekettles

Hello again
Thank you for responding.
My GP is not keen to prescribe Diclofenac long term because of the gastric and renal side effects; having said that he has never refused to repeat the prescription, but sucks his teeth & looks looks unhappy! He described it as something I should use occasionally when things were bad. So I try to use it sparingly, but recently I've taken 50mgs morning & evening.
I know there is a limit to the number of times you can have knee injections (I think the physio told me 3 per year, no more than 8 or 9 in total 'cos the cortisone softens the bones) I just want to find out what is least bad long term.
Since posting, I've explored this forum a bit more and realise what a difficult time some of you are having, sorry if I sound a bit precious.

dreamdaisy

You could also take a stomach protector with the diclo - I was on naproxen (another anti-inflammatory) and also took omeprazole to protect my stomach, you could ask your GP about those. Steroid jabs should not be given more than once every 3 months, sometimes they are but that depends on one's circumstances. Don't apologise for sounding 'precious' - whatever is bothering you is bothering you - some of us have been battling for longer but that is immaterial. We have all had our early days and early worries! DD

tjt6768

Hi Suzie, I have osteo in both knees and spine, been 2 x 75mg M/R Diclofenac for a couple of months now, along with 8 x 50mg Tramadol and 8 Paracetamol per day... They gave me Lanzoprozole for a stomach protector and so far have been ok.. Like your's not keen on the repeat script thing and have been keeping an eye on things.. It's just about easing the pain to the point where I can do things a bit.. Get a lot of breakthrough pain as well though.. I had both my knees injected for the first time a few weeks ago and it's been really effective for me, had them both done at the same time, not recomended unless your willing to go nowhere for a bit, within a few seconds of him doing them my legs seized up as it felt like he'd injected them with concrete, lol.... It lasted a few hours and was well worth it. Also told me that they can only do so many due to the brittle bones business... I don't care at the minute as my knees feel 'fresh and lubricated', better than they have in over twenty years... Just wich he could have sorted my spine and wrists (have sero neg RA in those) and hands out at the same time :shock:

Hope things go ok for you whatever happens, there are a few of us (ahem) younger ones on here, lol... I'm 42 now but had this many yrs apart from the hands and wrists jobby, that's new to me...

Be well and stay warm....

elnafinn

Hi Suzie

I have had both knees replaced in the last two years but I am older than you.... I shall be 60 very soon. I was on diclo for about 2 years and then started to get stomach discomfort so I was prescribed Etoricoxib (Arcoxia) and had no trouble with them. I found the anti inflammatories very helpful with the knee pain pre op. I was also prescribed cocodamol and was taking the maximum dosage per day. I also had two arthroscopies in one knee but got no relief from that really but others find it can help. Some consultants do not agree to do this. I found heat helpful but you could try ice, or alternating ice and then warmth. I was not offered knee injections so cannot comment on them.

Take care
Elna x

skezier

Hi Suzie,

A welcome from me as well

I agree with Tilly does it have to be an either or? I think if there is fluid or inflammation then the jabs are a good idea and the diclo's can be good at helping to keep the inflammation down.

I got oa and the first bit xrayed was my knees. I was still in my teens and had the back got it in my 20's so have been on diclo's a very long time.....I find they work better than anything else really.

I think Lanzoprozole is the better protected to omorozole.... I certainly got some ulcers while on the omoprozole but its more complicated cus I also have crohn's and that's well able to do the ulcers as well.

I used to take the 50's as and when but over time it became necessary to do the 3x a day and then moved to the 150 slow release. they are meant to be kinder to the digestion.

See what they say and then see what you would like to have done is what I tend to do. Nice to meet you and good luck. We do a half decent pocket duty as well if needed? Cris x

tillytop

Hello again Suzie and hope you had a positive appt today.

In terms of the GP not being happy about prescribing Diclofenac long-term because of potential side effects - all I would say to that is that it's not him living with the pain!!!! Me, I would rather be able to manage the pain now, rather than not manage it just in case I have problems with the drug later on. I took Diclo at max dose for many years without a problem but now I find that I can only tolerate it for a few days before my stomach starts to complain. That said, as soon as I stop it, my stomach is fine again so no long-term problems with it. As the others have said the important thing if you are using it regularly is to take a stomach protecting drug as well (I take Lanzoprazole 30mg). Aso, as Cris says, the 75mg "modified release" Diclofenac pills are potentially easier on the stomach so might be worth mentioning this to the doc (I think they are "coated" whereas the 50mg tablets aren't).

I have been thinking of you today and hoping it went well for you.

Love Tilly xxx

suziekettles

Thank you for all the responses, I'm touched that you've all taken the time.
What a day! I checked the clinic was "on", then tried to book a taxi, but they were taking no bookings (roads are dreadful here, little evidence of any gritting, havn't attempted taking the car out since before the weekend & parking is almost non existent at the Royal Orthopaedic Hospital)so I decided it was walk or not get there.....Its only a 20 minute walk, but today it was a trudge of just over an hour.
And the boiler started making a noise like a ship's funnel, turned it off, not serious fortunately - the pipe that drains a bit a water away from the boiler was blocked by ice, had to pour lots of boiling water over to defrost/clear it Back in business thank goodness!
I've had the bad knee injected, the capsule was "tight" & it was a bit sore, taxi home, told to rest it, it feels very stiff & rigid, but I know I've overdone things today.
The pysio is not keen on long term diclo use either, but is happy to inject my knnes indeffinately if I can go 6-7months between injections. I don't think they understand or are very realistic about pain & the way it affects every aspect of your life, paracetomol, yoga, swimming & riding an exercise bike just doesn't help (oh & glucosamine, I'd stopped that after reading somewhere that NICE don't think there are any proven benefits) I know it sounds a bit wet, & I get frustrated with people who wont do anything to help themselves, but working, walking the dog, running a home, even with a helpful family takes a lot of time up!
Anyway, hope this gives me as much relief as the lst injecton did. It just feels a bit depressing that this is life until knee replacement, there doesn't seem to be anything inbetween. I do understand why they put it off as long as pos, I did think it was more straightforward than it is, he talked about complications & that they only last 10 years. They don't seem to do arthroscopies in Birmingham (not for this anyway) I was told there aren't enough benefits over a joint injection??
Time for bed!
Take care & keep warm
Love sk

suziekettles

skezier, what is a "pocket duty"? I have a whole new vocabulary to learn!
Love sk

tillytop

Well sk - what a day you had yesterday!

Hope the boiler is behaving itself now cos the last thing you need is a boiler breakdown in this cold weather isn't it?

Sounds as if you had a positive appt and, at least now you know where you stand with the joint injections etc. What will you do about the Diclo d'you think? Cos if it really does help you it is well worth considering I reckon. You say that you have been taking Diclo off and on sk, but general opinion is that it is more effective if taken regularly which is something to bear in mind perhaps.

You ask what "pocket duty" is. Well it's AC forum speak for supporting someone when they go for an appt or are dealing with something difficult. So, if someone starts a thread on the forum, asking for support, everyone volunteers to go with them in their pocket, usually bringing with them all sorts of peculiar/useful things (the past we have had champagne, strawberries, VERY smelly cheese, string, and I think, at one point, fish sandwiches!!!!). People on here have great imagination and sense of humour!

Really hope that the injection works for you as well as the last one did sk.

Love Tilly xxx