How can you tell the difference between a flare and pain?

louisarm
louisarm Member Posts: 52
edited 22. Oct 2013, 08:31 in Living with Arthritis archive
Hi,

I have recently been diagnosed with O/A of my hip. When I went the Dr I was in a lot of pain and had naproxen and paracetamol which helped considerably after a few weeks.

I have background pain all the time (especially at night) but I can cope with it at the moment.

My question is: Is it a flare when the pain is too much?

Sorry if this is a daft question.

Thanks

Louisa
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Comments

  • dreamdaisy
    dreamdaisy Member Posts: 31,520
    edited 30. Nov -1, 00:00
    I can definitely tell the difference between my PsA flaring and my OA pain. The OA has the decency to remain at a steady level of pain / discomfort so I always know where I am with it, which I appreciate. I had a tough time earlier this year when my right hip joined the arthritis party but I've adjusted to it now. I don't associate OA with flaring, however, it varies according to the weather because that is it's nature. This is only my take on it, other OA-ers may disagree.

    When the PsA flares I feel so tired, drained, lethargic and exhausted. I sleep for England and wake up still feeling the same. My concentration vanishes, I feel generally stiff all over, the PsA pain levels remain the same but my joints feel more 'tender' (it's a different hurt to the OA) and I can flare despite the meds. A PsA flare will vary in time-length, my longest to date was three months. DD
  • barbara12
    barbara12 Member Posts: 21,276
    edited 30. Nov -1, 00:00
    Hello Louisa and welcome
    I have OA and was told you dont get flares...but I do get really bad patches when everything hurts..it last for days..and leaves me so tired
    Has for the hips I have just had my first one replaced..3 weeks post op today...I could not stand the pain any longer, I suffered for 3 and a half years after they said I needed then replaced....the pain has now gone in my new hip...I have the op pain but that is nothing compared to the arthritis pain.
    Hope I am not scaring you...just that I was so scared of this op....x
  • louisarm
    louisarm Member Posts: 52
    edited 30. Nov -1, 00:00
    Dear DD and Barbara,

    Thanks for the replies.

    I must be a bit slow but I still have trouble understanding the flare concept.

    Why was my OA so bad when it was first diagnosed that I needed naproxen, but after a course it has settled down?

    Sorry if you can't answer, but if it gets really painful again and I need to take naproxen is that not a flare?

    Is a flare RA and what arthritis DD has?
    Or is it I have been using the hip too much?

    Barbara,

    I wish you a speedy recovery. Why did you have to wait so long? Did the powers that be keep putting you off?
  • DebbieT
    DebbieT Member Posts: 1,033
    edited 31. Jul 2013, 16:04
    Hi & welcome,

    Like DD I have both OA & PsA (Psoriatic Arthritis) which is an autoimmune type as is Rheumatoid Arthritis, ours is sero-negative where as RA is Sero-positive but they are both autoimmune & these are the types that flare. It's our immune systems attacking us, we take strong medications to try & slow the disease down but we can't stop it. It's all a bit complicated :?

    The reason ure pain has lessened is due to the medication having the chance to build up in ure system so they can work in the best way possible. If it hurts in the future you may need to up ure dose so will need to see ure GP.

    I hope that helps & if I've explained anything wrongly someone will be along & put us right, the groups knowledge is amazing :)

    Take care.x
  • dreamdaisy
    dreamdaisy Member Posts: 31,520
    edited 30. Nov -1, 00:00
    I too think it's eased due to the fact that the naproxen is doing its stuff - that is a good thing. I hope you also have a med called omeprazole or lansaprazole to take first? They are stomach protectors and trust me, they are necessary to prevent gut trouble which can be a side effect of anti-inflammatories.

    If you stop the naproxen then yes, things may well deteriorate again because that is the nature of the beast. All forms of arthritis benefit from the regular doses of prescribed meds even if we feel that the benefit isn't all that we would wish. Taking the meds whether we feel we need them or not is part of the secret in controlling the disease, we need their constant drip-drip-drip.

    OA is a different kind of arthritis to the auto-immune types. As I said I prefer the OA because that is plain plumb honest in what it does and how it does it. The other sort is like a little black snake slithering around inside us, choosing its moments to give us another taste of its venom. DD
  • bubbadog
    bubbadog Member Posts: 5,544
    edited 30. Nov -1, 00:00
    DD explained the difference between a flare and what we call 'normal' pain! You do just feel totally drained and tired with a flare with the pain of your joints on top makes an awful combination.
  • louisarm
    louisarm Member Posts: 52
    edited 30. Nov -1, 00:00
    Dear All,

    Thanks for the replies.

    My GP told me only to take the naproxen only if the pain got bad. She said it is not a good idea to take them continuosly. She has not prescribed any stomach protectors.

    From what i am 'hearing' from the experts on this forum she has given me the wrong infomation as regards to pain relief. And i trust you all here more.

    Sounds like I need to go back to get some lansoprazole prescribed. Can you take that intermittently at the same time as PRN naproxen?

    Thanks

    Louisa
  • barbara12
    barbara12 Member Posts: 21,276
    edited 30. Nov -1, 00:00
    Hi again
    Its was mostly down to me waiting to get my head round the idea, I wished I had done it sooner and not let my other hip catch up... :roll:
    Has for the flares dont worry about it I am still confused, but I know that I get them now and then...your GP is right to tell you not to take antiinflams unless they are needed....some GPs dish them out without warnings..
    Wishing you well with everything x
  • 19smp59
    19smp59 Member Posts: 105
    edited 30. Nov -1, 00:00
    Hi there!

    I suffer with OA. I don't think it 'flares' like RA and other inflammatory types but I definitely go through patches when I am worse than others. Sometimes my hips will be really sore and painful other times not so and that is the same for other joints where I have OA.
    The Naproxen will have got to work and that is probably why you are in less pain now. I don't take anti-inflammatories but I take Tramadol and Amitripyline and they are working well for me at the moment.

    Suzanne x
  • dreamdaisy
    dreamdaisy Member Posts: 31,520
    edited 30. Nov -1, 00:00
    I have always been told that there is little to be gained in taking meds as and only when you need. First you feel the benefit (like now) but when you stop them it all comes back; what's the point in that? Your GP lives with the theory, it is you that will be living with the reality. Any form of arthritis is an ongoing disease, it is progressive and degenerative and the meds are meant to help slow that progression and degeneration.

    It is important to have the stomach protector, my husband doesn't bother because he only takes his diclos for a few days every once in a while thanks to gout, but, because I take one tablet daily, I do. If cost could be a problem then it may time to find out about the prescription pre-payment certificate, this can be bought annually or three-monthly. I think meds are now 7.80 per item, so you would have to calculate whether the cert. is cost-effective. DD
  • DebbieT
    DebbieT Member Posts: 1,033
    edited 30. Nov -1, 00:00
    Must say I've been on a coping skills course for chronic pain from fibromyalgia & we were all advised to stay ahead of pain coz once it gets ahead of us & the meds it's much much harder to regain control!!

    I take paracetamol, ibuprofen & tramadol daily (on advice from my rheumatologist) then omeprazole to protect my tummy from the 3 a day ibuprofen.

    Take care.x
  • louisarm
    louisarm Member Posts: 52
    edited 30. Nov -1, 00:00
    Dear DD, Anybody,

    How can the med's slow the progression of arthritis as they stop pain?

    If the pain is less (with the medication) does that mean less damage is happening?

    I realise it is progressive but lots of people seem to have athritis (not on this forum obviously)that is not too bad and they just take a paracetamol now and again. So it is not really progressive for them, or is it?

    Sorry if these questions seem silly but it is all new to me.

    Thanks

    Louisa
  • dreamdaisy
    dreamdaisy Member Posts: 31,520
    edited 30. Nov -1, 00:00
    I know you're new to this and it is very confusing, yes? Even seventeen years in I occasionally find myself at a loss. :?

    Any form of arthritis is an on-going problem. My suspicion is that those who cope with the occasional paracetamol probably don't have 'proper' arthritis - I reckon they would soon know if they did. There is a difference between the meds for OA and those for an auto-immune but the principles remain the same, as DebbieT said it's a case of 'getting ahead of the pain'. We all find our ways of doing that - and also learn to appreciate the times when we don't have to - but yes, the damage will still be occurring even if the pain is less.

    You are still in the very early days of this so I urge you not to get too far ahead of yourself. For the time being stick with the naproxen, you haven't been on it for that long but if it helps, and continues to help, then go back to the GP for the protector. Gut damage doesn't happen overnight, or within a few weeks, but it is worth bearing in mind. If I was waving too many red flags earlier then I apologise :oops: - I too am struggling with stuff. Take care. DD
  • shandy4greenday
    shandy4greenday Member Posts: 344
    edited 30. Nov -1, 00:00
    I also am still quite new to understanding when I have a flare up especially as I don't get the tiredness too bad at the moment,maybe this is due to not long being diagnosed.I have noticed I will get what I call my normal aches and pains but I believe when I get a flare up they become a lot worse with the pain levels and I can tell a difference with them.With regards to taking Naproxen or other anti-flammatory medication, when I first got diagnosed I thought the Naproxen was not making a difference and decided to stop taking them for a couple of days,I soon noticed a difference with pains and now if I am a few hours late with taking them I soon start to notice a difference so It is very important to keep taking these too.
  • ELAINE55555
    ELAINE55555 Member Posts: 123
    edited 30. Nov -1, 00:00
    Hi Louisa,

    I have RA. I get by most of the time with paracetomal. However I do flare from time to time and thats when I resort to take Naparoxen, Tramadol, Pred or basically anything I can get my hands on! I tend to keep those meds for when I really need them.
  • louisarm
    louisarm Member Posts: 52
    edited 30. Nov -1, 00:00
    Dear DD,

    I have read on some other threads the tough times you are going through.

    I am so sorry and I hope your luck changes soon and good times beckon.

    Yet despite you not being in the best of form you still manage to take the time to help other people like me.

    I want you to know your support and advice is very much appreciated.

    Thank you
    Louisa x
  • Boomer13
    Boomer13 Member Posts: 1,931
    edited 30. Nov -1, 00:00
    Hi Louisa;

    I agree with the others: taking one's anti-inflammatories and other pain meds regularly on a schedule helps them work to best effect. This is how I was taught to manage pain.

    I have PsA and OA and I agree the pain of each is very distinctive. Inflammatory types cause bodywide fatigue, feeling sick, a burning type pain in the joints and more. It causes inflammation in various tissues not just the joints. Like DD says the pain of OA is more steady and predictable, constant.

    The anti-inflammatory meds taken daily are to reduce the inflammatory compounds that accumulate in the the joints and elsewhere. In OA the inflammation relates to damaged cartilage. In Inflammatory arthritis the immune system is hyper-active and producing too many of these compounds in reaction to it's own attack on body tissues. The toxic effect of these is that over time they dissolve/break down cartilage and speed the effects of wear and tear in the joints (among other things). Reducing inflammation slows this process and as a result lessens pain. Pain also is the result of inflammatory pressure within the joint capsule; anti-inflammatories reduce this and thus lessens pain too.

    The other types of pain meds we take regularly block pain signals centrally in the spinal cord or the brain. Pain in the body creates an array of chemical signals and pain meds like paracetemol, tramadol block these signals so you feel less pain. Once you start feeling really painful and you take your meds, it can take hours for the meds to control the pain. That's why it's best to take them regularly if you have an arthritic condition causing daily pain. Time release types are best, if available.

    Obviously, these are all things we can't see and very complex; understanding it all is very challenging. Plus, there are overlapping of effects of pain. For example, severe overwhelming pain can cause fatigue, but it's cause is different than in inflammatory arthritis. It's a very complex thing with lots of factors creating the problems we experience.

    So that's my understanding of how the meds work and the difference between the two types of arthritis. I'm just a regular sufferer so my understanding is limited, mostly just experience. I'm still learning as struggle along. I hope if I've said something that is not correct someone else will jump in and correct me.

    Hope that adds to the conversation and is helpful for you.

    xxAnna
  • dreamdaisy
    dreamdaisy Member Posts: 31,520
    edited 30. Nov -1, 00:00
    Wow, hats' off to Boomer13 - what a terific explanation. :) I'm going to learn that one off by heart.

    I remember my early days of dealing with all of this - and other times too. It is a bewildering, confusing and upsetting time, there's no doubt about that. I didn't find the forum until I was thirteen years in (I began aged 37) - it was great to discover that I was not the only one who was dealing with this malarkey. My social circle are now hitting their mid 50s, the general aches and pains of aging are beginning and I'm now hearing 'I know just how you feel.' You think? :lol: DD
  • brandy192
    brandy192 Member Posts: 73
    edited 30. Nov -1, 00:00
    I have OA in both knees and take cocodamol 30/500 and ibrufen I dont find my gp very helpful but I recently asked if I could see a physio. I had a six week course of part exercise and part information designed specifically for OA knees and found this extremely helpful to me as I now understand better about exercising and controlling my pain. Maybe you would benefit from this as well. :D
  • Boomer13
    Boomer13 Member Posts: 1,931
    edited 30. Nov -1, 00:00
    I think if most people knew 'just how you feel' DD, it would be the stuff of their worst nightmares.

    I'm so jealous of those having 'general aches and pains of aging'. Not to be for most of us here, sadly.

    Sorry Louisarm, just had to comment to what DD said....
  • dreamdaisy
    dreamdaisy Member Posts: 31,520
    edited 30. Nov -1, 00:00
    Ah Boomer13, I'm sure we've all heard our fair share of ridiculous comments in our time - I know I have and have no doubt that more will come. My friends are trying to show solidarity - twerps - they don't have a clue. :) And for their sakes long may that last because none of them will be able to cope. And I shall enjoy their gloom. :mrgreen:

    I would never dream of saying to someone with MS or cancer 'Ah yes, I had a sniffle last week so I know just how you feel.' but somehow arthritis doesn't carry the same gravitas. DD
  • Boomer13
    Boomer13 Member Posts: 1,931
    edited 30. Nov -1, 00:00
    dreamdaisy wrote:
    I would never dream of saying to someone with MS or cancer 'Ah yes, I had a sniffle last week so I know just how you feel.' but somehow arthritis doesn't carry the same gravitas. DD

    Hit the nail right on the head DD.

    The cause of much extra, unnecessary grief and lament for us. Talk about downplaying our illnesses/pain. Is that supposed to stop us from worrying, self-absorption and make us feel better? If it were only that simple....

    The harder friends try to relate with their own experience, the more they seem to alienate. Why not just say they can't imagine what it could be like? I have more than a few old friends whom I now avoid for this very reason. Ho Hum, I am an Eyeore today.
  • dreamdaisy
    dreamdaisy Member Posts: 31,520
    edited 30. Nov -1, 00:00
    I reckon that being an occasional Eyeore rather than a Tigger is par for the course. My inner Eyeore surfaces every now and again, whose doesn't? The important thing is retaining the ability to boot Eyeore into touch, yes?

    I think one of the main problems we face when mixing socially is the fact that arthritis is ubiquitous. Every one we know seems to know someone who has / had it and invariably it's their granny or grandad. People seem to be aware that cancer can hit at any age, they vaguely know what MS entails but they seem to be unaware of even the basic facts of arthritis. I too was one of them - :oops: - now I know better.

    I send apologies, Louisarm, we've hijacked your thread. This does happen with 'conversations', we get side-tracked every now and again. I hope you understand. DD

    PS Boomer, I've sent you a message - are you familiar with these?
  • Airwave!
    Airwave! Member Posts: 2,428
    edited 30. Nov -1, 00:00
    I can most definitely tell the difference and it seems to have been on a cycle for a few years now, with a flare its the sort of pain that you can't move beyond, a nerve ending pain that travels through your limb, OA usually produces a sharp burning pain plus aching most of the time. There are a few other levels but that describes it.
  • louisarm
    louisarm Member Posts: 52
    edited 30. Nov -1, 00:00
    Hi DD,

    Please don't think that this thread had been 'hijacked' it's really enlightening to have all this debate.

    My husband (bless him) keeps saying that his knees are hurting too. I know he is trying to help but it is frustrating to try and explain that arthritis pain is different. But to be fair until I experienced it I was ignorant too.

    To all who have replied on this thread, thank you for your input.

    Louisa

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