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Medical Forum / Diseases and Disorders / Lupus / March 2006

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Pain Medication

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Nutty - 27 Mar 2006 23:18 GMT
Hi everyone,

I am struggling with the pain from pleuritis and pericarditis.  I am
currently taking predisone (20 mg) and
plaquenil (400 mg) as well as hydromorphone for pain.

Since the inflammation has been so bad in my chest and lung, my nurse
(I'm on home care) has suggested that I be re-evaluated by the family
doctor.  My rheumatologist didn't want to increase my predisone;
however, the nurse suggested that there are better pain medications to
deal with the pain.  Does anyone have any suggestions for this type of
inflammation?  I hope to see my family doctor tomorrow.

Thanks.

Nutty
J - 28 Mar 2006 02:13 GMT
> I am struggling with the pain from pleuritis and pericarditis.  I am
> currently taking predisone (20 mg) and
[quoted text clipped - 6 lines]
> deal with the pain.  Does anyone have any suggestions for this type of
> inflammation?  I hope to see my family doctor tomorrow.

Hello Nutty, Hydromophone is not an anti-inflammatory.
Here's what this articles says.
http://www.emedicine.com/PMR/topic135.htm
Heart function and circulation can be affected in patients with SLE.

   * Pericarditis (common)
         o Chest pain occurs and can be intermittent. This pain is often
mild, but it can be severe. The chest pain can be sharp and retrosternal.
         o Diagnosis of pericarditis is through the presence of a
pericardial rub, electrocardiogram (ECG), and echocardiogram (ECHO).
         o Pericarditis is treated with NSAIDs and prednisone.

   * Myocarditis (less common)
         o Shortness of breath may be reported on exertion and while the
patient is lying supine.
        o Orthopnea is noted and is aggravated when the patient is lying
flat.
         o Cardiac arrhythmias may be present.
         o Peripheral edema also may be associated with myocarditis.
         o Diagnosis is with increased cardiac CK, ECG, and ECHO studies.

         o Treatment of myocarditis is with steroids.
_____________________________________________-
Here's a list of NSAID's
ibuprofen (Advil®, Medipren®, Motrin®, Nuprin®, Rufen®), indomethacin
(Indocin®), and naproxen (Aleve®, Anaprox®, Naprosyn®).
Valdecoxib/Bextra, Mobic/ Meloxicam  , tromethamine (Toradol
There's many more anti-inflammatories.
I was thinking if you combined one with food and the steroid....
However, I really feel that a heart specialist and pain specialist and
rheumatologist should put their heads together and decide on a treatment
plan for you (and continue to monitor you).
J
Marvie's Wife - 28 Mar 2006 03:10 GMT
>> I am struggling with the pain from pleuritis and pericarditis.  I am
>> currently taking predisone (20 mg) and
[quoted text clipped - 40 lines]
> plan for you (and continue to monitor you).
> J

Thanks J,

I forgot to mention that I can't take NSAID'S because I'm on coumadin
for blood clots.  That's why I take the prednisone and regular pain
medication.

I didn't know about the connection of heart problems with hydromorphone.
   Thanks for the link.

Nutty.
blades49456 - 28 Mar 2006 20:29 GMT
You might want to get the inflammation cleared up rather than just treat
the pain.  Talk to your physicians about getting the inflammation down.
--
Bruce

>>I am struggling with the pain from pleuritis and pericarditis.  I am
>>currently taking predisone (20 mg) and
[quoted text clipped - 40 lines]
> plan for you (and continue to monitor you).
> J
Nutty - 28 Mar 2006 23:15 GMT
> You might want to get the inflammation cleared up rather than just treat
> the pain.  Talk to your physicians about getting the inflammation down.
Thanks Bruce,

That's what I'm hoping to do.  My family doctor increased my pain meds a
bit, but wanted me to go back to the rheumatologist.  Luckily, I got an
appointment tomorrow.  Hopefully, she will do something to treat the
inflammation.

Nutty
J - 29 Mar 2006 19:49 GMT
> > You might want to get the inflammation cleared up rather than just treat
> > the pain.  Talk to your physicians about getting the inflammation down.
[quoted text clipped - 9 lines]
>
> Nutty

If NSAid's cause you blood thinning, why can't you take less coumadin (lower
dose) combined with NSAID's?  I realize there's a limit to how NSAID we can
take, but if she's limited your steroid, seems like adding NSAID is only
solution for (extra help for) inflammation.
Good luck, sorry you're bouncing back and forth between doctors.
Maybe we could call you "Bouncey" instead of "Nutty" <g>
J
Marvie's Wife - 31 Mar 2006 17:33 GMT
>>> You might want to get the inflammation cleared up rather than just treat
>>> the pain.  Talk to your physicians about getting the inflammation down.
[quoted text clipped - 17 lines]
> Maybe we could call you "Bouncey" instead of "Nutty" <g>
> J

That's funny J lol.  "Bouncey" seems to be fitting at this time,
although this condition is driving me "Nutty" as well.  When I got the
nick name "Nutty" though, it had a positive connotation.  I was "crazy",
but in a fun way.

Anyway, in the end, the rheumatologist did increase my prednisone to 30
mg (up from 20 mg), so I'll see what happens.  She hopes that the
plaquenil will kick in after 6 weeks, which would help.  I've read that
it could take up to 6 months though.  Keeping my fingers crossed.

Nutty (who is being bounced around)
 
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