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I have had gout (ankle/toe/knee) mostly on the left side but occasionally on the right for 2 plus years now. I am now a nondrinking, vegetarian (90%). Is it standard of care to prescribe narcotic pain medication for major flair ups ?
I take allopurinol (colchicine when an attack starts) but the pain is agonizing I have taken prednisolone 5 times (40mg 5 days) in the last year. But I always have to ask for pain meds. So, why is this not the standard of care -first treat the pain (relief) then take care of inflammation/uric acid levels etc???
Does anyone actually have their doctor say first we get the pain under control? I'm just curious why I (on a very few occasions) have had to say “jeez man I am in agony here, can you give me something till the rest of it gets to working”…I hate to even go to the Doc but I hate even more to have to ask for obvious relief. Curious if anyone else has this problem.
Rant Over
I find that colchicine at the start of an attack always aborts it, with any luck after the fourth pill. During a raging attack it may take 10 pills (one an hour.)
I think its a better method than pumping in a narcotic…and relieves pain more quickly.
Are you sure you are taking enough colchicine?
Maybe I am waiting to long into the process. Do you take the colchicine at the very moment you feel any discomfort – even slight?
I have had at a minimum of 10 plus the last year….5 I have used the steroid for.
I generally have taken one a day…then one an hour AFTER the process gets along fairly well. Maybe I need to pull the trigger on the colchicine sooner….will give it a shot “next time”.
I am in the same situation. Occassionally, i really need something more for pain, once a year or so. Unfortunately, I can't take colchicine, I am allergic to it. Up until I had the allergic reaction to colchicine it worked great in quickly getting rid of my gout. But now I take the typical endocyn doses when I have a flare ups, and sometimes it takes weeks or more for it to get better. I got a Narcotic for it, and it helped to some degree, and a little more at night. However, I still think for most pain and a few Ibuprofen help with gout just as well, but the occassional major attack needs a little more. Next bad attack I have – hopefully in the distant future – I will request a narcotic with Ibuprofen in it, instead of tylenol.
Sorry about the last post looking funny – I started off quoting one of the others, and deleted the quote.
Hot Foot,
No, I don't take colchine for EVERY twinge because I know well the likelihood of the joint pains of aging especially with daily workouts at the gym (when I'm being GOOD.)
But if I feel that CERTAIN twinge in my right toe in the morning on awakening I take two colchicine. If I still feel it an hour later I take two more. Usually the first two stop it, ALWAYS the second two…I'm glad for that becasue by pill 6 I get a diahrrhea like Niagara.
Probaly some of the other aches and pains are uric acid related but I don't use colchicine for them becasue they aren't disabling and Aleve works for well.
Frigging agony as I type….took colchicine yesterday for 10 hours. Never got sick but had a reduction in pain combined w/ Motrin….back with a vengence today. Friday night and starting colchicine again 2 hours ago……damn it man, one of the worst attacks to date and no family doc.
I seem to be having way more recurrances than nomal……….seeing specialist ASAP. Long nite ahead…..and I think I have had way too many anti-inflammator meds stomach pain….long nite ahead… Sh** gotta luv it leg elevated on desk an nothing to do but hurt.
Fun
Hot Foot said:
I have had gout (ankle/toe/knee) mostly on the left side but occasionally on the right for 2 plus years now. I am now a non drinking, vegetarian (90%). Is it standard of care to prescribe narcotic pain medication for major flair ups ?
I take allopurinol (colchesine when attach starts) but the pain is agonizing I have taken predizolone 5 times (40mg 5 days) in the last year….but I always have to ask for pain meds…why is this not the standard of care -first treat the pain (relief) then take care of inflammation/uric acid levels etc…..???
Does anyone actually have their doctor say first we get the pain under control ? I'm just curious why I (on a very few occasions) have had to say “jeez man I am in agony here, can you give me something till the rest of it gets to working”…I hate to even go to the Doc but I hate even more to have to ask for obvious relief. Curious if anyone else has this problem.
Rant Over
Kevin,
It's a SHAME about your developing an allergy to the colchicine. How does it manifest, a rash, hives, or angioedema (swollen lips, eyelids, tongue?) The diarrheah is very normal and I don;t give it a second thought. I LOVE how quickly colchicine acts and would hate more than anything to get allergic to is.
hot foot,
I'd never mix colchicine with any NSAIDS, especilally ibuprofen (Motren) which chews up my stomach real bad all by itself. Not to prescribe but if I were in your boat, Id do another day of colchicine, just colchicine and I'd go to the maximum 16 pills…2 to start and one an hour for the next 15 hours, or even a COUPLE more (I know that 22 didn't kill me 🙂 :). Maybe it's just me, but I find that diarrhea and pain relief go hand in hand (or toe and ass or whatever!) : > ) What I'd also do if the pain stopped is to take perhaps 4 colchicine a day, maybe every 6 hours for several days afterwards to prevent recurrence.
I sympathize with your pain!
I assume you are on daily allopurinol?
I really hate it about my allergy to Colchicine too. My first few attacks it was quick and a tremendous relief (aside from the usual side effects). My reaction started with a hives (thought I had poison ivy) and took some anit-histamine, which only made me take a nap. When I awoke, my hands were so swollen I could not make a fist, my eyelids, lips and tongue were swollen as well. Went to the ER and had to get a shot. I have had several bouts of gout since, and they are not quick to get rid of. On a few occassions it will take up to two months, with a week or more of the peak of the attack. During some of these, i have been tempted to get a few doses of the colchicine (as it did work) and just go get a shot once the allergy symptoms come up. I know this would not be medically advised, but after 4, 6 or even eight weeks of pain, your mind starts to wonder.
Kevin,
I wouldn't risk another colchicine exposure. Allergies only get worse and worse with repeated insults. Once you've reached the hive/swelling stage, you are risking not reaching the hospital the next time. Most immediate threat is throat closure and suffocation.
Are you taking daily allopurinol to control your serum uric acid?
PS…Tylenol is a waste. I think you might get more pain relief with ALEVE <naproxyn> and a narcotic (like codeine?) and if you can;t get a combo pill just het the RX for the narcotic and buy your naproxyn OTC!
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