Pain relief in rheumatic disease 3.65/5 (20)

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Pain relief against rheumatic disease

Painkillers, pain relieving and non-drug pain treatment in rheumatic disease

All autoimmune rheumatic diseases cause pain. Painkillers are used by many to achieve a better quality of life, while others choose to refrain from using painkillers almost consistently. There are no general features that answer what is the proper use of painkillers for the individual, but some guidelines may be helpful. When it comes to the use of addictive drugs Norwegian Norwegian Directorate of Health guidelines. Useful patient information about many of the preparations is available in Norwegian here (NMA).

Paracetamol, Paracet, Pinex

  • Paracetamol compositions (Pinex, Pamol, Panodil, Acetaminophen (U.S.) and more) are not addictive and usually well tolerated. Effect on pain caused by rheumatic inflammation, but little effect on chronic pain syndromes like Fibromyalgia. Paracetamol should not be used in severe liver disease. Can be bought without a prescription. In case of chronic rheumatic disease, one may get "blue prescription" (refund point -71 or on specific diagnoses)

NSAIDs, NSAIDs, Nonsteroidal Antifogistics

  • NSAIDs (Non-Steroid Anti-Rheumatic Drugs, Non-steroidal anti-rheumatic drugs). Examples are Ibux, Diclofenac, Voltaren and more). Not addictive. May work slightly better than Paracetamol, but generally has a higher risk of side effects. Low-dose NSAIDs can be purchased without a prescription. Gastric ulcer, increased blood pressure and worsening of heart or kidney failure occur, especially in the elderly and with continuous use. Etoricoxib (Arcoxia), celecoxib (Celebra) and diclofenac (Voltaren, among others) may increase the risk of cardiovascular effects and should not be used in known cardiovascular disease. NSAIDs can be combined with Paracetamol, but one must be aware that they do not always go together with other drugs. Blood-thinning drugs such as Marevan and platelet inhibitors such as acetylsalicylic acid (ASA, Albyl-E) and others may increase the risk of bleeding. The Norwegian "Norwegian Medicines Agency" also calls for caution when using ACE inhibitors and angiotensin receptor blockers (most often used for high blood pressure). When NSAIDs are to be used with other drugs, it is recommended to check if the drugs fit together via Use of NSAIDs will over time increase the risk of acute myocardial infarction, which should also limit consumption. The lowest dose of analgesic dose is recommended.

 Addictive analgesic

Addictive pain medications (Pinex Forte, Paralgin Forte, Nobligan, Oxycontin, Oxynorm, Tramadol, Durogesic patch, Norspan patch, Dolcontin, etc.) are rarely used for long periods of chronic rheumatic diseases. The reason is that the drugs do not affect the disease activity and have side effects that always occur over time in addition to a large amount of potential side effects. However, short-term use of special indications is safe when precautions are taken. The Norwegian Directorate of Health recommends:

  • Prescription should be done through a GP who keeps an overview of the consumption
    • At startup in hospitals, the indication and duration of treatment should be clearly agreed. The doctor should be involved
    • Use over more than two to four weeks of time is not recommended
    • Risk of tolerance development (loss of effect over time), withdrawal and addiction is present
    • Do not use with benzodiazepines ("sedatives") or with z-hypnotics (sleep medicines). Please read more here: (National Expertise Center for Sleep Disorders)
    • In elderly, the dose should be low and short-acting drugs should be preferred
    • Generally, one should not drive a car after a drug intake

Chronic pain in rheumatic diseases can be treated without medication

  • Information about how pain occurs can make it easier to endure pain and to mobilize countermeasures
  • Regular sleep and low alcohol consumption give more profit to cope with pain
  • Physical activity mobilizes endorphins that are "the body's own morphine"
  • Relaxation, massage and meditation can derive the pain
  • Psychomotor Physiotherapy
  • Hot water, rice bags, injection of sterile water, acupuncture, TENS (Transcutaneous electrical nerve stimulation)
  • Depression may be a consequence of chronic pain and may enhance the symptoms
    • Treatment / Measures against depression Is useful to anyone
  • Some benefit from treatment stays with mobilization, physical activity and warm climate treatment. For Arthritis (RA), Ankylosing spondylitis og Psoriatic arthritis there are treatment options that are partly covered by state funds in Norway (information here )


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