Confused and in pain

jackie61

I'm relatively new to all this arthritis stuff, though I've sufferred pain for several years. About 15 years ago a consultant rheumatologist said I had probably got some fibromyalgia. Five years ago an orthopaedic surgeon said I had slight arthritis in a hip (from an X-Ray) I've been a horse rider for 30 years but now I have to give up as not only is my right hip and adductor muscles giving me extreme pain but I am also now in constant pain from my left knee - I'm nearly 51. I've been having appointments with a chiropractor and sports massage therapist for 6 months now and its helping a bit. My GP gave me some exercises to do (which the sports therapist said were more suitable for "older" people and not someone active like me) I've been booked on to to see a NHS physio, which I don't hold out much hope for as I had physio for my hip a couple of years ago and that didn't help at all. I was told to get an exercise bike, which I did - and injured my coccyx - more pain!! My GP gave me codeine so I could continue to exercise and ride my horse a bit, but it made me sick, so I tried, naproxen, which didn't work, neither did diclofenac, so I tried one of my husband's gout pills - indometacin, which takes the edge off the pain,so I take those now with lansoprazole, but only when its really bad.
I also wear a stabalised knee support every day, which helps.
I've not been offerred a scan or X-Ray because my GP "thinks" it's osteoarthritis and has to follow this protocol. So I'm going along with it so I can get to the bottom of it - eventually. By the way the pain is on the inside of my knee and feels like someone's pushing a screwdriver into it - even hurts when I'm in bed, but some days are better than others. I try to have a short walk most days, during my lunch break, as I have a sitting down job and the exercise does help when my hip and knee become stiff.

Soretoe2

Hello Jackie,
Sorry to hear of problems.
Personally I don't understand why the gp isn't sending you for an x ray at least, that can then lead on to a scan. There is no criterea that I know that osteoarthritis preculdes an x ray. It's how they diagnose it after all!
Also pain in the knee can be referred from the hip, you mentioned that you have arthritis starting there. So again an x ray could confirm whether the knee is arthritic, referred pain from the hip or perhaps a cartiledge problem.
Although it sounds like arthritis because it's on the inside of the knee.
It is always best to keep any joint moving that has a problem. Gentle non weight bearing type though. Supports can help especially if you are doing something strenuous but make sure you leave it off for a good part of the day. The muscles become weak otherwise and this can lead to more problems in the long run.
If your walking is impaired and you are in a lot of pain you should try the gp again. Or even another one if it is a multi doctor practice. You should not be left in so much pain. There are other pain meds you could try and I'd push for an x ray if I were you. Perhaps your husband/friend could go along with you for moral support.
You mention your age. The menopause with declining hormones can affect the joints in some ladies.
Good luck with the physio. Physio can be very helpful but also it can be a non starter for lots of people.
It's a miserable business sometimes getting diagnosis and help on the NHS. Once you've been 'labelled' though things usually improve with treatment options.
Best wishes to you, Joy.

stickywicket

Hello Jackie. You've got some good advice there from Soretoe2 so I won't bother repeating it except to emphasise that you can always try another GP and also I wouldn't dismiss the 'old people's exercises' too readily. What benefits depends on your needs not your age and, if you are underusing some muscles due to pain, they need strengthening even though you may be very active in other ways.

frogmorton

Hi Jackie

Lovely to meet you. Sorry you are feeling a bit in limbo at the mo

Have you told the GP that the meds haven't helped at all, but that your husbands do? The only reason I mention it is incase they might be doing you any harm in other ways. Just to be on the safe side - sorry if i sound like a a nag :oops: I think indomecatin is a Non-steroid anti-inflammatory and long term use can give you stomach issues.

Most of us take something to protect our stomachs for this (omeprazole/lanzoprazole for example). I am so sorry l sound like I'm giving you a right lecture when you've found something that helps....so sorry.

I have had an idea though - if funds allow - can you have a private X-ray? These cost about £75 I think. The chiropractitioner you are seeing may be able to arrange it. I had one or two about 30 years ago when my back started playing up, via the chiro I used then.

I really feel for you being an active sort of person The walks in your lunch hour are a very sensible idea.

Love

Toni xx (nag :oops: sorry)

barbara12

Hi Jackie
And welcome to the forum, only I am sorry you had to find us in the first place.
The others have said it all really, if the pain is too bad, I would ask to be referred to a pain clinic.
Wishing you well with everything xx

jackie61

Thankyou all for your advice and kind words. It felt good to get it off my chest!
I told the GP that the indometacin seemed to work best and she prescribed it for me (I also take lansoprazole) I had a stomach issue last year when I'd been taking Ibruprofen and ended up with the camera down the throat (which I'd rather not repeat). I think the muscles in my legs are quite strong from horse riding and I do my own exercises every day. The weird thing is that when I've been riding -although in pain during the ride and very stiff when trying to get off (I have to have help getting on and off) - the same day and next day my pain is very much reduced, coming back a couple of days later with a vengeance. Have to see what happens when I stop riding completely which will be very soon. I decided to stop at the end of this season and my horse is ready to retire as well.
The chiropractor had suggested an X-Ray but he hoped the GP would refer me for one. I will have the physio with an open mind,then go back to my GP and if it doesn't work, then hopefully the next step will be for the X-Ray. My problem hip is on the right side and my bad knee is on the other, so this can't be referred pain can it?

JoeB2

I think a Physio referral may be very useful to you for several reasons.

Firstly, as a general rule, Physios tend to do much more thorough Musculo-Skeletal examinations than the average GP (assuming the GP examined you at all !). Such an examination may well reveal the origin of the problem.

Which brings me, rather neatly, to my second point.

You say that you have pain within the hip and knee of opposite sides. This is rather interesting as it suggests to me that somewhere you have a biomechanical issue and your structure is attempting to compensate. Although the natural tendency is to look, in the first instance, towards the spine it could equally be originating from something such as a degree of Pes Planus (flat feet).

A Physio will often begin their Physical exam by spending a moment just looking at your normal stance with you in your underwear. This will often reveal any structural variations or abnormalities wherever they may lurk.

Obviously, the degree to which they are able to utilise this expertise is, at least in part, dependant on the amount of time they are allowed for an appointment. However, in my experience, Physiotherapists being a reasonably assertive group when dealing with NHS management, appointment times tend to be on the generous side.

Finally, apropos Osteoarthritis and X-Rays .........

................. when people (including GPs, hospital consultants and others) talk about Osteo-arthritis what they often really mean is Osteo- Arthrosis, which is physical wear and tear on the joint surface(s). This will almost inevitably lead to Arth-ritis which is inflammatory response of the joint surface and, usually, the surrounding tissues.

A certain degree of Osteoarthrosis / Osteoarthritis in some wieght bearing joints as we age is so common it could almost almost be considered "a variant of normality".

As you are 51 years old (and active) your GP probably thinks it is a safe assumption to make without subjecting you to an X-Ray. The fact that you have responded to an anti-inflammatory drug would tend to support that assumption and would probably be considered an acceptable medical practice.

Whilst X-Rays can be useful they are rather limited in what they reveal. The degree of change in joint structure seen on X-Ray examination will often bear little resemblence to the degree of discomfort or pain experienced by the patient. Hence the old adage "Treat patients - not test results".

I appreciate your Chiropractor has expressed his desire to see an X-Ray. Unfortunately I know almost nothing of Chiropractic training and practice so I would not want to speculate as to how they perceive it may be of use in your management.

However, currently in many NHS Trusts Physiotherapists are able to order X-Rays (and other tests) if, after discussion with the patient, it is believed that it may be of benefit. Hence it may be worth asking for their opinion.

Do keep in mind that pain is the body's natural warning sign that something is amis. Therefore, whilst anti-inflammatory drugs and analgesics (pain-killers) can be extremely useful one needs to be very careful (in the absence of such a warning signal) not to inadvertantly create a greater problem.

Ultimately this consideration needs to be borne in mind whatever the nature of the therapy.

Lest you think I have some allegience to the Physiotherapy profession ...........I would assure you that I am not a Physiotherapist !!

I hope this is of some interest.

Good luck with it.

frogmorton

Hi Jackie

Like you I find exercise actually HELPS me with my pain if I can do it that is!

I am so glad you have got the right meds prescribed now and that your stomach is being protected properly. I agree about cameras :shock: NO WAY!!!


Arthur I was very interested to read your post - very informative
Shame that in our area you get 6 weeks physio @ 1 hour a week no time to assess gait or anything really. Also you are referred for 'one' thing despite the very real possibility that more than one issue might well be connected.

Love

Toni xxx

jackie61

Thank you Arthur for your comments which I will take on board.
The chiropractor always checks my back at the start of each visit to ensure it is "aligned" and puts it right when it's not.
I hope that the physio will be able to diagnose my problem.
Arthritis runs in my family and my dad's recently had new knees, which is something I certainly don't want any time soon (the new ones don't last long enough, at my age I could end up having 3!) But a friend of mine has had an arthroscopy to shave off the rough bits and I wondered if this is something that may be suggested for me. If so, the sooner the better.
What you said about painkillers is true - one GP wouldn't prescribe them as they just mask pain, but the other one was happy to give them so I can continue with my life, but am still careful what I do.
The GP also suggested that a steroid injection could be tried - but I've not heard of a good report about them, people I know who've had them say they only last a few days and not worth the pain of the injection!
Does anyone else have any experience of them?

stickywicket

I love steroid injections. They've always worked beautifully for me though I think the more you have, the less effective they become and you do have to rest up for 48 hours to get proper benefit.

I also love TKRs My first 2 went in in 1981 and one was replaced 2-3 years ago. The other's still there and not looking bad on the last x-ray.

JoeB2

Cortisone (Steroid) injections can be a godsend but should be treated with a degree of caution and a large amount of respect. There are rarely any issues arising out of their occasional use. However (frequently) repeated use can sometimes cause problems.

This is an area where some GPs have as much, if not more experience than some Rheumatologists - I know of one GP who holds a periodic clinic specifically for this procedure. This enables him to fully discuss with the patient and consider all of the options before going ahead. It may be worth asking if your GP surgery offer a similar service.

I think what I am trying to communicate is that whilst Cortisone is not a magic wand, it may still be worth keeping in mind as an option, and it is just possible your GP may be descended from Merlin.

You mentioned that your friend had an arthroscopy "Shaving off the rough bits".Whilst this is an entirely reasonable description, I cannot help but wonder if this was undertaken for the repair of a traumatic injury and resulting damage to the cartilage and / or ligament rather than for the management of joint Arthrosis.

However there is a procedure that may be of interest to you described here - ( http://tinyurl.com/8csgnb3 ) and here - (http://tinyurl.com/8k2zunx ). These articles are now quite old and I have no knowledge of whether the procedure has been widely adopted and, if so, for what indications. Perhaps this is something you may be interested in researching further.

There is a fair amount of anecdotal evidence from patients who find supplementing with Gucosamine Sulphate useful. It may be worth discussing this with your GP to find out their thoughts.

Unfortunately there have (to the best of my knowledge) only been a couple of "Double-Blind Placebo" based trials and, even then, the number of patients ("cohort") involved was small so one cannot really extrapolate. Interesting nonetheless.

If I recall correctly both these studies were undertaken in Scandanavia and I have seen the (peer reviewed) papers published somewhere online.

Two final thoughts before I shut up and disappear into the ether (we wish !)...............

...........if you are carrying any excess weight (which, from what you say, I doubt) it is well worth the effort of trying to lose some or all of it.

Additionally if you smoke (it's God's gift, I know - I still miss it every day !!) then try to reduce or quit. The latter (among other things) interferes with Collagen renewal which we all need for healthy joints / connective tissues.

However I'm sure neither of these applied to you and so I only mention them for the benefit of others.

Good luck.

Arthur

jackie61

Thanks Arthur, you are correct - I have never smoked and I'm not overweight (maybe a couple of pounds would be good to go though!)
I have taken Glucosomine for several years and don't really know if it has any benefit, would I be worse if I didn't take it? it's hard to say - only thing I can say is that my horse has also been on it for at least 5 years and he's now nearly 30 and can still do a 15 mile ride being generally sound, he has slight arthritis in a back foot but it doesn't stop him enjoying life! so if its good enough for him it is good enough for me. Though I could stop taking it and see what happens I suppose!
I may consider the injections after the physio.
I will let you all know how I get on.

JoeB2

I was interested to read about your horse and their treatment with Glucosamine - Veterinary friends tell me they have been prescribing this for a several years with encouraging results.

I suspect, in your case, taking Glucosamine has actually helped mitigate any joint changes. On that basis, if it were me, I would be considering an increase in the daily intake (assuming this is safely possible - with your current strength preparation).

Recently I have come across some encouraging (but anecdotal) reports of additional benefit when combining Glucosamine with a supplement called Celadrin (http://tinyurl.com/9fytrf5).

I did some basic (paper) research on this supplement - there have been a few papers published. I actually think this reported increase in efficacy is more likely due to to Celadrin having a mild anti-inflammatory effect than true pharmacological synergy. However it is defintely worthy of some serious consideration.

I would add that I have no vested interest in either of these products beyond that of an interested patient.


Arthur