Q: With both fibromyalgia and osteoarthritis, I have constant pain. Even with treatment, it never goes away completely. I’ve just been “dealing with it.” Is that OK?
A: Chronic pain is not a problem you should just put up with; in fact, you should make every effort to reduce it because an increasing number of studies are showing serious consequences of having chronic pain. It may cause damage to certain areas of the brain, just as chronic stress does. It also may lead to psychological problems, such as depression; social problems, such as isolation or decreased earnings potential; and functional problems, such as decreased activity or disability.
Overall, people do far better if they take an active role in aggressively managing their chronic pain-inducing condition(s). You should treat pain, as long as the treatments you use do not have side effects that exceed the benefits. Practicing relaxation techniques and sticking with a regular exercise plan may reduce pain in some of the same ways as pain medications. Massage and some supplements also may provide similar benefits, but these therapies have had less research documenting the benefits.
For moderate-to-severe knee osteoarthritis (OA), the supplement glucosamine may provide some relief, as may the right combination of analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs). The analgesic tramadol (Ultram), four antidepressant medications – amitriptyline (Endep), cyclobenzaprine (Cycloflex), duloxetine (Cymbalta) and fluoxetine (Prozac) – and two anti-seizure medications – gabapentin (Neurontin) and pregabalin (Lyrica) – have been studied in people with fibromyalgia.
In fact, Lyrica, developed to help ease pain, promote sleep and reduce fatigue, became the first drug approved by the FDA to treat fibromyalgia in 2007. Cymbalta and milnacipran HCl (Savella), both designed to help ease fibromyalgia pain, became the second and third drugs, respectively, approved by the FDA to treat the condition. Savella is also designed to help manage the fatigue associated with fibromyalgia.
Tell your doctor that the treatments you tried previously are not resolving your chronic pain, and then work with him to find the right combination of treatments for you. It may take some time, but the end result will be worth the effort.
Daniel Clauw, MD, Rheumatologist
It is important to remember that Ultram (Tramadol) contains acetaminophen (Tylenol)
and you should not exceed 4 grams (4000 mg) in a 24 hour period. Doing so can cause major kidney damage and failure. Each tablet contains 325 mg which means you should not take more than 12 tablets total in a 24 hour period. If exceeding 12 tablets per 24 hours stop doing so immediately!
Withdrawal symptoms may be experienced and can be quite unpleasant but a far better option than losing your kidneys. If you have a supportive spouse, friend, or family member ask them to stay with you during that trying period.
Once you have adjusted to 12 tablets in a 24 hour period THEN you can start tapering.
Usually when doing a home detox/taper it is recommended that you taper down slowly just one pill at a time and when you have adjusted successfully to that you can then taper down one more.
If you do not already have one and it is possible/available ask for a referral to a good Pain Management Specialist doctor/clinic for assistance with your detox symptoms as well as continued pain control --IF you believe you will be receptive to their recommendations that is. Otherwise you will just be wasting your money and time.
Before you start check with your doctor and see if will prescribe something for the anxiety and for the potential of nausea and vomiting. However, a slow taper as described above probably won't cause any severe anxiety or stomach upset. These should be quite mild -- if they even occur at all.
IF however you are exceeding 12 tablets in a 24 hour period you will need stop and cut back immediately to only 12 tabs -- and depending on just how much you are exceeding that amount-- it is possible you may experience moderate to severe anxiety and stomach upsets. In which case an anti-anxiety and anti-emetic could be quite helpful when taken as directed.
Also, you need to cleanse and be kind to your system. So, lay in a large supply of assorted fresh fruits and veggies and 100% real-- no added & low salt or sugar-- fruit juices and/or veggie juices. If you have a juicer you can of course make your own juices.
No meats-- EXCEPT optionally can make broiled fish (whole or fillets) three to four times a week. NOT fish sticks; not any breaded fish; not sardines; not any canned fish; not any salt cured, smoked, or pre-seasoned fish; and not any deli or restaurant prepared fish.
If you do not want/like fish then start taking fish oil capsules 3 to 4 times a day instead.
You should also take a good multi-vitamin that also contains B-vitamins, iron, calcium, Vitamin D, and assorted trace minerals.
Avoid caffeine as this can increase anxiety, jitters, and insomnia. Substitutes: decaf coffee, no caffeine herbal teas, decaf iced tea, decaf diet (no sugar) soda. Exception: one to three servings of a caffeine drink used medicinally for migraines (NOT for regular headaches).
Drink a minimum of 8 to 10 glasses of water daily. (Do not count juices toward this!)
Drink one to three cups of milk daily (or a milk substitute such as soy or rice milk if lactose intolerant).
Eat alternative protein sources such as beans, tofu,(low fat & cottage or white) cheeses, unsalted or low salt nuts, and peanut-butter or other nut butters.
A great home remedy for nausea which sounds really gross but in reality tastes WONDERFUL is to mix 6 ounces of whole or 2% cow's milk with a 12 ounce can of cold/refrigerated regular Seven Up or store brand equivalent, stir well, and drink. The consistency is smooth, thick, and frothy. And the effect on nausea is almost instantaneous.
Fresh fruits and veggies examples (to be eaten raw/uncooked):
yellow squash
green zucchini
celery sticks
baby carrots
grape or Roma tomatoes
large vine ripened tomatoes
dark green leafy lettuce
kale
purple cabbage
yams
snow peas
bean sprouts
bell peppers (green, orange, yellow, red)
apples (green, golden, and red)
peaches
oranges
tangerines
grapefruit (if not contraindicated by meds)
seedless grapes (red, black, green)
seedless watermelon
pears
plums
apricots
bing cherries
raspberries
strawberries
bananas
tangaloes
kiwi
cantelope
honey dew melon
pineapple
coconut
lemons
limes
Most veggies now available year
'round due to hot houses and
hydrophonics. However, fresh
fruit and berries are almost
always Seasonal. During the off
seasons may check out the frozen
and canned fruits and berries.
Plus, most fruit is available in
dehydrated & sundried forms (prunes,
raisins, banana chips, shredded
coconut, and so on.) Read labels
where available. Avoid dyes, preservatives, artificial flavorings, MSG, added salt and sugar.
Hopefully you will find this diet not only helps with your detox/tapering but also with your fibromyalgia.
You should try alternative pain control measures and not rely on pain medication alone. Based on how the other meds effected you and the obvious lack of pain control with your current medication you have a ways to go yet.
I hope the Ultram is not the only med you've been given. Have you also been given one of the three approved meds for fibro: Lyrica, Cymbalta, or Savella? Taken as directed they can offer some pain relief although not immediately...you have to give it time to build up. Additionally, gabapentin (Neurontin)? Ammitriptyline?
If narcotics is the only thing you've been given then you need to seriously look into finding a better doctor.
Please, someone, tell me how you fared with this medication. I tried detox, but was kicked out because they don't taper pain meds in detox. Any ideas, anyone on how to get on a lower dosage without a hospital taper, in which I'll start the same thing the minute I get out. The Ultram also helps to make you feel relaxed and calm. Has anyone else out there been addicted to Ultracet for pain, and how did you taper down?
Thanks,
Allanarae
Look up the Better Business Bureau in the phone book and call and ask them about referral services for Rheumatologists. This is the doc that will not only take you seriously, but be able to help you. I recently started taking Savella and I think this is the one that will eventually help me. I'm going off Lyrica (don't like the side effects) and Cymbalta just gave me insomnia and worry about my liver.
Check out Chiropractors who share space with Massage Therapists or Acupuncturists; if its done right it is NOT painful. I've had Migraines, lower leg seizures, and fibro for about 25 years now and believe me, its no fun. I'm 51 this Sept.
I hope this helps some of you. Hugs & prayers for all. JJ
If someone who is familiar with practitioners in Westchester County, NY, and know of someone good, please e-mail me at bodenheim@verizon.net.
I would love it also if th folks at the Arthritis Foundation, who read this, might make a referral.
Thanks and Godd Bless!
I cannot wait to just die and be done.
Besides the TENS, I use heat (cold therapy makes my muscles contract painfully), guided imagery CDs, stretching, a foot bike for aerobic exercise, pacing of activities, and a special wool mattress topper to reduce pain while sleeping.
I get a therapeutic massage weekly and would be much worse off without it.
I would love to be able to use pool therapy, but can't because of allergies, but I hear it is great.
I use Arthritis Strength Tylenol, magnesium maleate, and trazodone and sertraline for pain and sleep, and take a teaspoon of French's yellow mustard to prevent or stop muscle spasms. It works amazingly quickly.
In order to create this self-care strategy I have done a lot of reading of books and websites and talked to a lot of other people with fibromyalgia and arthritis. You might find a support group, either face-to-face or online, to be very helpful. We are all different, and different meds and strategies work differently for each of us. Best of luck!
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