Prescribing policies

sc2tm

I am posting this because of prescribing problems being xperienced by my mum. She was a reasonably fit and healthy woman in her late forties when she started to develop arthiritis. She has had arthiritis for about 15 years, and had a knee replacement about 12 months ago, and is probably going to need the other knee done in a couple of years.

She had been given Feldene which she found to be very good for about 10 years. Then for about the last year the doctors refuse to give it to her, despite her talking to the GP and the senior GP at the practice at least 4 times. They even discussed it at the monthly surgery meeting. She has resorted to buying it with private prescription while abroad, but as she hasn't been out of the country following the knee replacement she is running out, and is getting her sister to send some, but even that might not be straight forward.

I am worried about the pain my mother experiences, and although the side effects can be nasty, my mum has not experienced any.

I wonder why the doctors have to treat everyone as if they are stupid? You know best about what your body is experiencing, and i know the pain can be unbearable for her. Its very distressing for and my family. Why does my mum have to resort to clandestine self medication?

Her muscles in her arms have also been thinning for about 5 years now, and the medical profession can't seem to get to the bottom of it. I just see her wasting away.

Sad and distressed in London.

dreamdaisy

Hello, it's nice to meet you and I am sorry to hear about your mum. I presume she has OA, yes? I don't, and I haven't heard of Feldene, so I cannot help as such, but there are few options when it come to treating OA - surely they could give her another drug? What did the Feldene do that was so good? DD

barbara12

Hi and welcome to the forum
I am so sorry your mum is suffering, I must say I haven't heard of feldene, has your mum been referred to a pain clinic, if not she must ask her gp to refer her, there are different meds that could help.
please let us know how she gets on
Barbara x

sc2tm

Hi, nice to get a reply so quickly,

Yes my mother does have osteoarthiritis.

The trouble is that none of the alternatives get rid of the pain.

She is taking so many tablets, I don't think the medical profession is brilliant at knowing what each hand does. She was so nervous before the operation, which was scheduled for late October 2009, that she did not sleep for a week. I sat in the waiting area with her for around 4 hours before she was due to go in to theatre. Then in the pre-op checks the registrar came out and said her electrolytes, sodium etc were too low on account of them prescribing her diuretics for her blood pressure. This meant that they had to cancel the operation, and he sent a letter to the GP to change her meds to get these back to normal before they could operate in case of blood loss/complications.

She took about 3 years to psyche herself up to get the operation done, and for her to deteriorate enough to face the inevitable before she went though with the operation. The poor blood test results meant that she had to go through 3 months of anxiety before they let her have the op, not before the whole surgery team had moved to another hospital!

dreamdaisy

We are all taking too many tablets, one way and another. What did the Feldene do, tho? DD

sc2tm

It is a NSAID. So the doctors worry mainly about stomach ulcers with prolonged use.

From wikipedia:

Piroxicam is a non-steroidal anti-inflammatory drug of the oxicam class used to relieve the symptoms of rheumatoid and osteoarthritis, primary dysmenorrhoea, postoperative pain; and act as an analgesic, especially where there is an inflammatory component.

dreamdaisy

There are others that do a similar thing, so I wonder why they haven't put her on one of those? Unfortunately an anti-inflammatory on its own probably won't be enough to shift the pain, and even combined with a pain killer (such a mis-nomer, the pain is never killled) the pain will not entirely go. It doesn't, not with arthritis. Arthritis of any form is a progressive, degenerative illness: there is not a cure, and tho joint replacement can help it may not provide the full answer. I was taking anti-inflams for years, together with Omeprazole, a stomach protector: has your mum been prescribed these or something similar? I have to go to work now, but I will be back later, if you have any more questions. You could also ring the helpline: they cannot give you any medical advice but they may be able to help with information about alternatives to Feldene. I wish your mum, and you, well. DD

skezier

Hi sc2tm,

Welcome to the forum.

The tablets Ive heard of... but not in humans but drugs are interchangeable an they certainly can really help.

Have they been withdrawn for your Mum or withdrawn from use?

Its a horrible situation but its clear what they are givig her isn't working and possible not strong enough?

What you really need is one professional listen t you! Has she got an ortho consultant that she is seeing regularly? h and is she under the pain clinic cus a good one can really help.

I do hope she can get some real help and that you too are coping cus its hard for the people watching as well. Nice to meet you and have you tried ringing the helplines here? They might know how you can break the stalemate. Cris x

sc2tm

Hi Cris,

The thing is the Feldene does work, but they are worried about "possible" side effects with prolonged use being worse than pain, and thinking that the pain will go with other medication. The only other reason I can think of is that Feldene may be more pricey than alternatives. A few years ago she was put on the generic medicine, which did not relieve the pain at all when compared to the branded Feldene. They changed it back, but then withdrew the prescription about two year ago.

There was a time she was going every week or fortnight to say that the other pain relief meds were not working, and I know she had it changed at least 5 times. I have even been to many appointments with her, but it seems that they either don't know what to prescibe, or are not sure what they are doing.

To be honest I am bit at my wits end. I worry about the long term, and how she can deal with the pain. I don't know if there are alternatives.

Sonia

frogmorton

Hi sonia

You can search for non steroid anti-inlfams to see which she hasnt tried....I am on arcoxia and find it really good. Othere s swear by diclofenic....

I do feel for your poor Mum and am glad yto hear that she has you to support her when she goes to the docs.

The other idea is could she be referred to a 'pain clinic'? If you ahve them your way....they may have some ideas and often have ideas that GPs don't.

Good to meet you

LOve

toni xx

skezier

Hi Sonia,

Oh flower it must be getting to you so much. Your Mum as well cus constant pain is so wearing.

I have a lot of pain and the best thing for me has been the pregabalin...... It intercepts the signal from the nerves to the brain and can help big time if it suit you.

I wonder if they could try your mum on that?

Its always the way... you find something that works and they take it from you... Sonia too often it seems to come down to costings.....

What this forum and the people in can do is be there and you an your mum can know you not going through all this alone.

I honestly think you need someone on your side.....

Call the helplines here cus they might know what you can do as well as give you someone kind and understanding to just talk to.

Hang in there flower and maybe the nerve blockers could help your Mum? Leaving you a ((( ))) and a promise your not on your own. Cris x

hileena111

Hi, Couldnt think what feldene was for a while then when you mentioned pirixocam the penny dropped. Pretty sure they were one of th nsaids that were banned a few years ago....something to do with heart attacks....help.....anyone else remember this?
Love
Hileena

cthornley

Hi
I'm sorry to hear that your mum's not having a great time
I have heard of Feldene but I've only used it in a gel

I actually think it is more to do with the prolonged use - the side effects they are worried about are not just possible but probable in older people especially if they have been taking the meds for prolonged periods of (medically anything over a year is generally considered prolonged) - Feldene is highlighted as a high risk drug in certain groups of people for cardiovascular, serious heart problems and stroke - the risk increases the longer you take it and the older you get, in fact Feldene is contra-indicated for the elderly

Feldene is actually a low - mid range priced NSAID even tho its branded and you can get the same drug in generic form which is even cheaper so I doubt that price is really the concerning factor, there are cheaper alternatives but there are many many widely prescribed much more expensive ones out there ( to put it in perspective the NSAID I currently take costs more than twice as much as Feldene and its no way near the most expensive one ...I've been reading my dr husbands BNF, which is a book of all the drugs available, there effects , contraindicators side effects and costs...weirdly fascinating)

I think you need to go with her and talk to them calmly and with an open mind as to what the alternatives are - It may be that they are reluctant to put her on any NSAID , but ask about alternatives including using other drugs to protect her stomach with NSAIDS - remember they aren't actually painkillers, they are anti-inflamitories (which can help with reducing the amount of pain but don't "kill" it if you know what I mean) THere are many many alternative in pain relief and NSAIDS the important thing is that they do something and not leave her high and dry - You can't insist that they give her a particular drug but you can insist that they help her - and by that I mean sort her out

Sorry I've rambled on too much I hope that there is something useful in there
Good luck
Chrissie