If you have moderate or severe osteoarthritis, how do you treat the pain? I have spinal arthritis (lumbar region) and have had both spinal stenosis surgery and, a few weeks later, an epidural, but of course I still have arthritis and especially in the untreated spots like the sacroiliac, I still have quite a bit of pain. I fell like I’m getting stabbed with a railroad spike.
Acetaminophen and NSAIDS shouldn’t be taken long term, so they’re not an option for chronic pain (and don’t seem to help much). Opioids are, of course, addictive. Have you found (or been prescribed) anything that works and is generally considered safe to take long-term?
For the record, I start PT this week, and though I’m already doing exercises recommended for lumbar arthritis, I’m hopeful it’ll help. I push through the pain and work out 6 days a week and either use the treadmill or walk, usually 5-6 miles per day. Hot baths do not help. Ice packs do, but only if I’m lying down. I can’t do that all day.
I’m interested in whatever has worked for others. I’m not keen on on chiropractors, but I could be convinced by clinical evidence that they help arthritic backs.
Prescribed gabapentin worked well for me for several years, until I finally had my back surgery. After the initial period of adjustment to the pills (they made me feel dizzy for a couple weeks) I had no discernable side effects.
PT worked the best for me. I was diagnosed with osteoarthritis in both knees over 10 years ago. I do leg strengthening exercises to toughen up all my leg muscles and ligaments (like the sideways walk with the rubber band around the ankles), and have not progressed to anything stronger than occasional NSAIDs a couple times a week.
Thanks so much for all the comments. The therapist at PT said I’m already doing much of what he’d recommend in terms of exercises. I’ll find out more Friday.
I tried it several years ago for lupus arthritis in my hands (now almost gone due to remission), and it didn’t seem to do anything. I haven’t tried it for the back pain, but the rheumatologist who Rx’d it for the hand pain said I shouldn’t take it long-term due to stomach issues and, IIRC, heart attack risk(?).
That was interesting. The first one reminded me of when a friend was in the hospital with just-diagnosed Stage 4 Hodgkin’s. She was in a lot of pain and so scared that she wasn’t sleeping, as in at all, but the doc refused to give her anything but Tylenol and melatonin. By the time a bed became available in oncology, she was delusional from lack of sleep. Bless the oncology ward docs and nurses. They medicated her, and she felt better–and slept. She was hospitalized for 2 weeks and didn’t get addicted.
Maybe this is a topic for another thread, but I loathe opioids because they make me sick to my stomach and give me nightmares, plus I hate that groggy feeling. Are those of us who suffer from side effects less likely to get addicted? With time, the side effects might dissipate, but you’d have to twist my arm (hard) to get me to take them that long.
I found the letter about opioids sensitizing us to pain interesting. The one that said
Rigor is required for social and economic survival in America; yet, without opioids, many chronic pain patients will spend decades of unwanted survival as isolated, bedridden wretches.
was as depressing as watching They Shoot Horses, Don’t They?
PT worked much better for me when I blew out my knee. The PT not only taught me exercises but also did some hands on manipulations and diathermy, as well as taught me how to use cold packs as needed and how to best use OTC pain relief.
Good thing as it was clear that my doctor wasn’t going to prescribe anything helpful~too scared, shivering in their boots about opioid misuse. Did not seem to penetrate that this was the only time in 15+ years in their care that I had ever asked for pain meds and perhaps I wasn’t a hopeless drug seeker about to drag their career down with me.
I’ve taken opioids many times (I ride dirt bikes, ski, MTB, am arthritic and break things). At small doses they’re pleasant in a foggy way. At high doses (got my shoulder scoped and it was 2 oxycodone every 6 hours) it was very unpleasant–puking, couldn’t sleep. I think if you genetically “code” for opiate addiction it’s pretty quick. For me, I’ve never got to the end of a bottle and thought: “got to get me more of THAT stuff!”.
Hate how pain meds and benzos have gotten so stigmatized, however. If you are actually a drug seeker, they should be trying to help you vs. calling the cops. I’m getting shoulder replacement this fall due to OA and I’ll have to run that gauntlet I’m sure.
Only if you take around 2400 mg a day in divided doses, 3-4 times a day, for at least a few weeks. And at that frequency and duration it (and other NSAIDs) can play havoc on the stomach lining and stress out the kidneys and decrease their efficiency. They also add cardiac risk when used chronically. Even the Cox II NSAIDs like the much vaunted celebrex has all these problems associated with it.
Any NSAID needs to be taken regularly for a few weeks before it really fights inflammation. Otherwise they just reduce pain and fever.
And osteoarthritis is not an inflammatory arthritis anyway. Usually tylenol/acetaminophen gives equal relief as advil/ibuprofen (for the average patient, individual mileage varies greatly).
For my patients with OA, I generally emphasize exercise, stretching, meditation, distracting activities involving hobbies/etc. I prescribe a lot of acetaminophen, sometimes alternating it with NSAIDs like ibuprofen or meloxicam or naproxen. I’ll add topical voltaren gel, TENS units, physical therapy for exacerbations. PT is especially helpful in teaching proper posture and body mechanics. Sometimes bracing helps for particularly problematic joints. Orthotics for OA in the feet and ankles can help too.