Pain relief opioids
I am currently a responder to Cosentyx injections ,150mg every 2 weeks , but the effects of this biologic wear off approx 5 days before my next dose , so the joint swelling, redness, stiffness and PAIN slowly return during those 5 days , Tramadol 50mg 3 times/day helps , but my prescriber GP, not the rheumatologist wants to stop it because “it does not work for chronic pain which is in the brain “, agreed, since I also do PRT (Pain Reprocessing Therapy for chronic pain ), however , my rheumatologist informed me this few days of symptom return due to “biologic wear off” do represent acute inflammatory pain all over again and opioids like Tramadol are indicated in these cases .
Have any of you found relief with all possible modalities (TENS, physiotherapy , psychological therapy , massage , excercise , biológics, dmards, nsaids and opioids ?
I have and without all these meds I would not be able to take care of myself at all .
What has been your experience ?
It seems to me rheumatologist understands PSA is very painful , but my GP in charge of my Tramadol prescription does not , she thinks the biologic can do 100% of the pain relief and does not understand that the current state I am in has been deemed as my best possible outcome or MDA - minimal disease activity , my disease is still active .
As someone trained in addiction counseling, as well as a recovering addict myself, I would tend to lean toward what your GP is advising. Even though the opioids are short term, repeated use over short periods can lead to abuse/addiction. Additionally, it is the inflammation needing to be addressed, regardless of pain levels. My rheumy used to prescribe 10mg Prednisone to take on days like that. You can have relatively little pain, and inflammation from PsA can still be creating havoc on your various systems. And, it seems that the effects of the Cosentyx are actually wearing off far more than five days prior to your next injection, and its only over those final five days that you once again become symptomatic. I had this same issue with Cosentyx after being on it for six months,exactly as you describe, but I continued on for about another six months before my rheumatologist finally declared it was no longer working. As you stated, no biologic is 100% effective. It only needs to improve your symptoms by 20% to get FDA approval. However, some biologics bring a better outcome than others. For me, Taltz never worked, and Cosentyx worked so-so for less than a year (both are IL-17 inhibitors), but Skyrizi, an IL-23 inhibitor, is working a lot better than anything i've been on to date. Personally, I would be looking to get onto a different biologic rather than continue on the Tramadol.
Lourdes, I have a GP that I like and a rheumatologist that is outstanding. Since pain is part of what we live with daily, is pain management something that you discuss with your rheumatologist? I see my rheumatologist more often than my GP.
PsA is so darn complicated. My GP tends to follow the directives of my rheumatologist. It sounds like you have a good rheumatologist so perhaps discuss how you are feeling about pain management decisions with him/her.
Wishing you well!
