Pain relief or staying on top of pain?

Mat48 Member Posts: 1,075
Hi - I wonder if you can advise me. I have RA (quite recently diagnosed) and was on ibuprofen x3 400mg tablets a day. This seemed to keep the inflammation down quite well while I was awaiting diagnosis. Now I'm on Methotrexate - slowly going up to 15mgs with rheumy review end of March. When I was taking the ibuprofen I quite often forgot to take the middle day dose and felt unhappy about taking so many pills - I was also taking a stomach protector and thyroxine and Amitriptyline other pain meds and was starting to feel fogged up. Also I wanted to see if the methotrexate was working and couldn't tell. So I came off all my medicines apart from the essential ones and then my stomach became very sore - possibly gallstones possibly ulcer the GP said. So after that he advised me to only take ibuprofen when I was flaring. I managed fine without additional pain meds or NSAIDs for just over a month having decided to just put up with discomfort and low level pain.

But I've had a couple of flares over the past 2 weeks - one so bad it actually made my fingers drift even more so I got up in the morning and found my hands had changed shape visibly. I saw my GP and was given Tramadol and Naproxen - at my request, having been advised by other RAers that these are good for many sufferers. He told me only to take them if I was in pain or started to flare up because otherwise he said it would make them less effective and also make it harder to tell if the Methotrexate was working. So I took them for a few days and have now come off and so far I'm just aching a bit if I do stuff with my hands.

What I want to know is does the Naproxen/ NSAID actually limit the damage that the disease can do to joints by reducing inflammation or would the damage happen regardless and is it really just pain relief? I've never understood the role that NSAIDs play in reducing the inflammation. Surely if they are taking down the inflammation then they are also slowing down the disease in the same way as the Methotrexate? Mat
If you get lemons, make lemonade


  • helpline_team
    helpline_team Posts: 3,605
    edited 30. Nov -1, 00:00
    Dear Mat,

    Understanding the role of your different medications can get complicated and you may find it helpful to talk to someone who is expert - generally that's the rheumatology nurse. We are not medically qualified so I'll try to do my best, but the nurse is much the best person for this.

    If you are wanting to know how well your drug regime is controlling your arthritis it may be worth taking a leaf out of the rheumatology department's book - asking how you are feeling - and the questions are quite broad. How has your pain been? What are your energy levels like? If you've kept a pain/health diary looking back over the months then that's ideal to look over. Next comes the technical part - the monitoring of your blood results. The rheumatology clinic staff will have certain results that they watch particularly depending on your situation. They may have a target that they are aiming for in your treatment - i.e. to bring down certain inflammatory markers (ESR or CRP etc) and to keep an eye on other blood levels to make sure that your system is tolerating the treatment.

    My layperson's understanding is that anti-inflammatories don't have a big role in controlling the disease, but that they are often important in helping your quality of life. Often the doctors will try and keep their use controlled to reduce the risk of side effects.

    Some general information is around about the role of omega 3 fish oils and lifestyle and diet in helping reduce the need for anti inflammatories in people with RA. See our booklet on 'Healthy eating and arthritis' and Report.ashx

    I hope that's helpful. Do come back to us if you'd like to talk things over or have some more information.