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Rheumatoid Arthritis

Painkillers and rheumatoid arthritis

A variety of drugs are prescribed for people with rheumatoid arthritis and some of the first are likely to be analgesics (painkillers) together with anti-inflammatory drugs to reduce the swelling and inflammation in the joints. Painkillers help to relieve the pain but do not affect its cause, so other types of drug are prescribed as well. Many different types and strengths of painkillers exist; some need a prescription whilst others can be bought over the counter from a pharmacy.

Participants often found that particular ones worked better than others for them. People reported taking painkillers at different times of the day. This depended on their pain levels so they took them either at regular intervals through the day, just once a day, or as and when they felt they needed them, perhaps occasionally during a flare up.

One woman's pain was so bad that she would count the hours between doses. Other people took them first thing in the morning to help get over their early morning stiffness. Two people said that if they knew they were going to do something strenuous at work or were going to be on their feet all day they would take painkillers beforehand to counteract the pain before it started.

 

Describes intense pain - counted the hours between taking the pain killers.

Describes intense pain - counted the hours between taking the pain killers.

Age at interview: 53
Sex: Female
Age at diagnosis: 30
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I was taken into hospital for a period as an inpatient and the pain was just extraordinary, it was like burning, it was just so intense and it was the kind of sleep [pain] I couldn't sleep through. I couldn't, I really couldn't ignore it didn't seem to be susceptible to the drugs that they were giving me. They were, they tried anti-inflammatories, non-steroidal anti-inflammatory drugs which well, they appeared to suppress it slightly. Paracetamol appeared to reduce the pain slightly but, but I mean all these drugs only last for a few hours and then you're back to square one. And having, having to count the hours and you know remembering how long ago you last took the dose and watch the clock and still not being on top of the pain.

 

Has learnt to take painkillers before doing something strenuous to counteract the pain before it...

Has learnt to take painkillers before doing something strenuous to counteract the pain before it...

Age at interview: 42
Sex: Male
Age at diagnosis: 17
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'Cos as I say, I just have to be careful, try and plan my days out as to what I do and if I know I've got a particular type of work like that then I perhaps dose myself up on a few painkillers just to get me over that, that sort of initial hurdle really.  

But do you then feel the affects sort of the next day or?

Not normally no, no. It's the painkillers normally sort of, if I know that I'm gonna do that, I sort of perhaps take them perhaps for a day if I know I've got something really sort of straining to do. But I don't really feel anything else after that. The painkillers wear off and you're fine. But you know if you don't take them, you are gonna seem to suffer. Obviously with the strain of whatever else really.  

I also sort of have now got to that stage where I know what's going to aggravate it as well. So I'm able to take precautions that way so I'm going to do something that's to me is aggressive to the joints I can take a few more painkillers or something like that and get myself sort of dosed up and I'm able to sort of cope with sort of most situations quite sensibly and helpful to myself sort of thing. And so that's, that's some benefit at least. At least I do understand, understand it a lot more sort of thing. I mean obviously than you did in the, the first case.

Some people needed painkillers to ease the pain to help them get to sleep at night. One woman tried to do without them but sometimes needed them if the pain was bad. Another said that although she did take them to help her sleep, they didn't last the whole night so she would wake up in the early hours in pain.

 

Avoids taking painkillers if possible but needs them sometimes to help her sleep.

Avoids taking painkillers if possible but needs them sometimes to help her sleep.

Age at interview: 57
Sex: Female
Age at diagnosis: 39
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I don't like it but it's a case of having to. I mean I've never been a one for drugs, you know even a headache tablet, I wouldn't take. But I realise now I have to, like I take painkillers cocodamol whatever you call them, you know I have to take them. I try not taking them every night, it's only if I can't sleep, then I will come down and take a couple. But on the whole I try not to.  

So it's generally at night that you take them?

Yeah, yeah 'cos in the morning, I get up and a couple of hours, it'll take for me to get back on, you know, on track as I call it [laugh]. And then I'm all right till maybe the evening.

Many people regulated the dose of painkillers they took themselves and they would consult their GP only if they felt they needed stronger ones to control the level of pain. One man described taking them when required but also how he had found other ways to cope with the pain.

 

Uses painkillers together with exercise and distraction to overcome pain. Has come to terms with...

Uses painkillers together with exercise and distraction to overcome pain. Has come to terms with...

Age at interview: 46
Sex: Male
Age at diagnosis: 38
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I take Tylex painkillers when I need them as well.

And do you find you have to take many of those?

It varies, it's up to six, six a day sometimes if it's bad, but obviously when you're not working like right, I always tend to, well I've tended to find now I can, I can manage it a lot better I can do things, exercise certain things, I've got exercise sheets where I can try and sort of exercise the pain out of it more than, than take pills and things like that, so I've done that more sort like, like swimming as well like right, which is pretty good a couple of times a week.  

Use me mind a bit more like getting out of it, getting round it that way basically as opposed to just swallowing tablets all the time, but when it does get bad like right, out come the tablets and away they go like and they are pretty good yeah.

And how do you feel about taking them long term?

A lot better now than what I did do, I had a real problem with tablets years ago, I didn't think, you know, like I said like a person who'd never taken in their life, I thought 'God I'm taking all these pills' and what have you and I have a cupboard, well a box full of pills and there was pills for this that and the other and you know it was a bit of an eye opener and it was a bit frightening really. But as of late, sort of the last year I've come to terms with it a lot better, and as the illness has sort of, as I say the last few months sort of died down a bit, I'm taking less tablets so it's working quite well. I don't feel bad about it at all really.

Several people described avoiding taking too many tablets and how they had tried to reduce the dose they took and this was because they didn't want to become dependent on them or because they were unsure if they really needed them. One woman didn't like taking co-proxamol but felt she was addicted to it.

 

Has tried to reduce the strength of painkillers.

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Has tried to reduce the strength of painkillers.

Age at interview: 37
Sex: Female
Age at diagnosis: 19
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What I've tried to do is come off the Tramadol and go back down to Paracetamol, but what I found was I got below, when I got to four tablets a day instead of the eight that I've been taking, the nervy pain came back, like really bad, so I've had to sort of give up that, but that again is something that I won't just give up on. I'll try again in a couple of months and see if things settle down, 'cos it was explained that everything doesn't settle back down to normal from a knee replacement up to about eighteen months.

So while I feel fine and better than I've felt for years and like the clock's been turned back, there's still certain things that haven't settled back to where they should be, so you know I'll just keep trying with the painkillers, because I do, I do want to get back down to sort of a weaker one and one that's less dependant really. 'Cos in the Tramadol there is a warning to say don't take them for too long. So I think I do get addicted slightly.

 

Tries to go without painkillers to test if she needs them for a particular activity but takes...

Tries to go without painkillers to test if she needs them for a particular activity but takes...

Age at interview: 27
Sex: Female
Age at diagnosis: 27
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I'm perhaps a little more careful and I've got extra pain killing tablets that I can take if I'm having a really bad day. So if I know that I'm gonna to be doing a lot on my feet or something, I either kind of take some to pre-empt not getting in pain 'cos if you're in pain, you get tired more quickly or I just take them with me. If I, if I've done something before and was OK and I took the painkillers before, I sometimes as long as it's not silly to, I try to do without them. I still take them with me just because if I always take them I'm never gonna know whether I can do stuff without them. So I mean I'm not, I try not to be silly about it and I you know, if I'm in pain I'm obviously gonna take them. But I don't take them unless I am in pain if you can see what I'm saying [laughs]. 

Yeah I think I know what you mean, yeah.

Kind of you don't know whether you need them unless you don't take them sometimes, you know, 'cos they're the extra, they're the extra ones on top of the, the Diclofenac that I take so I kind of I shouldn't be taking them every day anyway so. I just take them when I need them [laughs].

Although people tried to keep the amount of painkillers to a minimum and take them as and when needed, one participant talked about an education course she had been on and learnt from a nurse that, if required, it is probably better to take them more regularly. Another woman described how she didn't drink alcohol whilst taking some painkillers.

 

An education course taught her to take painkillers at regular intervals.

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An education course taught her to take painkillers at regular intervals.

Age at interview: 37
Sex: Female
Age at diagnosis: 19
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They covered all sorts of things, like drugs, what drugs sort of are common for rheumatoid arthritis and things. Sort of treatment, they had a weekly, one week session with a chiropodist, another one with a physio, another one with a ward sister and they just sort of educated you to the back ground of what goes on with all the different aspects of your treatment and that was only, I think about four years ago and you think that you know everything, but there's always something else to learn and I found it really beneficial when the ward sister came in 'cos she, she explained how painkillers work a lot more, well in more detail than anybody ever had. I always took painkillers as and when and she explained that if you took them regularly, so she would explain that say if you took only four a day, you took them twice a day, break them down into one tablet and take them four times a day because she said it's much easier to prevent the pain, than to treat it when it's there.

And I have found that to be right. I do find that there is still a lot of stiffness and pain in my neck and that's the main thing that I'm taking painkillers for, but as I've discovered, if I just take them as and when then the pain comes back in my knee so that, that preventative measure that was explained on that course, it does work, it definitely does. You know and that was a major thing, you know to me, that I learnt and you know it was that many years in. You know I'd already gone about fourteen years not knowing that.

One woman accidentally took too many painkillers whilst on holiday.

 

Mistakenly overdosed on painkillers on holiday by taking them too frequently.

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Mistakenly overdosed on painkillers on holiday by taking them too frequently.

Age at interview: 49
Sex: Female
Age at diagnosis: 36
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So he started me on Voltarol I can, actually I can always remember as well, just before I went, I went on holiday with some friends to Madeira and I was hobbling about a bit there but on one day we went for a walk, it was, it was quite flat terrain, by mid-day and I was then dosing myself with aspirins and you forget, on holiday you have a late breakfast and have an early lunch 'cos, you know, we were just going out for, so I'd had three aspirins at breakfast and three aspirins not long afterwards [laughs] and I suddenly went as high as a kite and felt absolutely wonderful. And all, all me pains went, you know. But I thought, 'I can't really do that forever.' 

Although many people had no side effects from painkillers, some did. They included 'fuzzy head', hallucinations, skin rash (aspirin), sickness, and sweating.

Last reviewed August 2016.

 

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