Re: Question about pain relief, and a rant

[Guest guest]

Here is the big picture on drugs and arthritis. From the Latrobe website

http://www.latrobe.edu.au/podiatry/rheumatology/rheumatology_lecture_2.htm

Granted it's a podiatry site but it seems to match what I have been

finding out. Surely you would fit into the " relieve symptoms "

category

Annette

Pharmacological management

• As there is no cure for rheumatoid arthritis, the goal of

pharmacological management is to relieve symptoms, prevent joint

damage and put the disease into remission.

• NSAID's are commonly used early, but disease-modifying agents are

now being used earlier.

• More aggressive approaches are now being used than in the past –

combination of drugs is common approach as many of them are not as

effective if used as monotherapy.

• Delay of treatment --> poorer outcome

NSAID's:

• •do not appear change natural history of disease, but are widely

used as first line drug

• •control pain and inflammation --> better joint function

• •patient's vary in response

• •often only drug necessary in mild disease

Corticosteroids:

• • suppress inflammation and immune response

• •commonly used, especially as a continuous oral background therapy

• •can use with anti-osteoporotic therapy

• •intra-articular injections may help settle a flare

DMARD's:

• Pharmacological intervention with DMARD's before joint erosion and

permanent damage ? prevents and/or retards joint damage --> reduction

in symptoms.

• DMARD's are being used with increased frequency in combination and

in an earlier stage of the disease process.

Antimalarials:

• •Hydroxychloroquine is safe and effective in mild disease

• •have suppressive effect on disease – shown to be very effective

• •retinopathy is a common side effect ? need opthamology screens

every 6-12 months

Sulphasalazine:

• •anti-inflammatory and modulates immune response

• •common first choice drug – takes 6+ weeks for benefits to show

• •has been shown to reduce joint erosions

• •may be more effective in the seronegative spondyloarthropathies

Gold:

• •suppresses activity in a number of patients ? prevents disease progression

• •IM more effective than oral – usually weekly injections

• •mechanism of action unclear

• • associated with large number of side effects

D-Pencillamine:

• •degradation product of penicillin

• •shown to reduce inflammatory synovitis in 50%

• •Not used much due to high toxicity (in 60% and can trigger a number

of rare autoimmune diseases) and slow onset of action (often 6+ months

to get effects)

Leflunomide:

• •shown to be as effective at methotrexate and more effective than

sulfasalazine

• •suppresses disease activity and delays radiological progression

• •rapid onset compared to methotrexate and sulfasalazine

• •well tolerated (given orally)

Methotrexate (MTX):

• •cytotoxic – shown to clearly control the inflammatory response;

most common first line agent – considered 'gold-standard' disease

modifying agent

• • long term efficacy is well documented, but rarely leads to a

true/complete remission ? often used in combination

• •monotherapy with MTX is not often associated with sustained disease

remissions

• • only 50% of patients stay on it after 5 years due to toxicity

Anti-tumour necrosis factor (TNF) drugs:

• •biological agents shown to reduce disease activity and joint damage

• •the cytokine, TNF has a number of pro-inflammatory effects ? plays

a major role in inflammatory disease such as rheumatoid arthritis and

is a key element in its pathogenesis ? potential to block TNF

• •eg Etanercept (subcutaneous injection); Infliximab (given IV) ?

block activity of TNF-alpha

• •shown to have rapid improvement in joint pain and swelling – fast

onset (1-2 weeks)

• used either alone or with methotrexate

On 5/9/05, rightgirl@... <rightgirl@...> wrote:

> Hello, everyone...

>

> I was diagnosed with RA several years ago, in particular, a form that

> manifests itself in a rare, painful type of glaumcoma that affects one eye.

>

[Guest guest]

I'm only going to address the pain/addiction problem. Addiction means that your body begins to depend on the drug, independently of psychological dependence. Pain-killers are especially easy to develop an addiction to. But that's not the real problem; the real problem is that when you become addicted to any drug, you need more and more of it to get the same effect. If it's painkillers, you quickly get to the point where you can't tolerate any higher dosage or you'll overdose(and die), but it's not enough and it isn't stopping the pain. You build a tolerance to the drugs. Unfortunately, the more painkillers you take, the higher your tolerance goes, and it doesn't go back down for years after you've stopped. Doctors are leery about prescribing pain killers for that reason --- what do you take when you've developed a high tolerance to pain killers? Learning to manage pain with the least addictive drugs is really the only way to go right now. If you start on painkillers when you're relatively young, in ten or fifteen years you won't be able to find anything that affects you in any way when you're in pain.

That's how they work. Period. You can't control whether or not you build up a tolerance and once you do, there's nothing you can do about it. That's why some people are on two and three different pain killers. Their tolerance is so high that nothing works, and they're trying to find a combination that has some effect. Worse yet, the less pain you have, the less you are able to tolerate. If you've ever known anyone who was addicted, one of the most difficult things for them to deal with is the pain from things that a lot of people overlook -- headaches, aches and pains, etc. They aren't used to feeling that at all, and have to find other ways of dealing because otc drugs don't work and their tolerance is so high to opiates that they can't take enough to make a difference without putting themselves at risk.

----- Original Message ----- From: rightgirl@...

Rheumatoid Arthritis

Sent: Monday, May 09, 2005 6:18 PM

Subject: Question about pain relief, and a rant

Hello, everyone...I was diagnosed with RA several years ago, in particular, a form that manifests itself in a rare, painful type of glaumcoma that affects one eye. The glaucoma has been the worst symptom of RA for me until recently.I've always had joint pain that was particularly bad in the morning, but I dealt with it via nuprin and other OTC NSAIDs. The pain in the last few months has gotten a lot worse. I went back to the RA dr. who prescribed celebrex again (I had a bad experience w/celebrex the first time he prescribed it; his solution was to double the dose...!)The RA dr. said to call him if the celebrex doesn't work, and he'll prescribe "something else." I'm a little on the paranoid side about strokes (a possibility w/celebrex), so can anyone who has been in this position tell me what the next step might be when celebrex doesn't work?The other question I have is one I experienced with the opthamologist who is treating my glaucoma. As I said, it can be extremely painful (like someone drove a spike through your temple.) I see this dr. a lot to monitor my eye pressure. One day, I asked him if he could prescribe a pain reliever. I got this big lecture about how the pain would go away once the pressure was reduced; well, I've been going to him for over a year, trying every type of drop and pill possible to reduce the pressure, and still the pain comes back. I guess I was just in a really bad mood, the way you get when you're in pain, and I said, "So what's your solution? That meanwhile, while you play around with drugs and drops, I should suffer? When you could do something to stop this pain, you don't? What kind of doctor are you? Do you get off on watching people in pain?"I got a prescription for tramadol. Unfortunately, or maybe because of all the other freaking drugs he has me on, I broke out in a rash when I took it, so I had to discontinue it after one pill.The appointment with the RA dr. was a few days after this. I asked him what he does for pain relief. He told me to take Tylenol. I said, you went to medical school for that? He said he does not prescribe pain medications for RA patients, no matter how bad it is. He said you can learn to live with pain. I said, and why should you? He hissed, you could become ADDICTED! I said, and that's bad for what reason again? If the medicine relieves pain and gives you a life again, isn't there a way to manage taking it? I swear he broke out in a cold sweat.I had also mentioned to this dr. that the pain in my joints made sleeping difficult if not impossible. He slyly said, well, you know, there are sleeping pills.... I said, I don't want sleeping pills. I could sleep if this didn't hurt. He laughed and said, so there are some drugs you don't want!I could've slapped him.Maybe I'm just pissed off about being in pain so much, but I've been trying to do research about why pain killers are so bad, and the reasons I get are just BS. I wonder how many people are SUFFERING needlessly because drs. are afraid to write prescriptions for painkillers. And I wonder why there's some kind of onus put on people in pain, as if they had weak characters or something, for wanting relief from pain.I know many of you are in much worse shape than I re: RA, but I'm also sure you've been through the pain killer route. I guess I'm angry at the RA dr's snide attitude (i.e., he blew off my concerns about the stroke implications of celebrex, and seemed to think I was some kind of drug addict for having the nerve to even ask about pain relievers.) I do need to know what the next step up is from celebrex when celebrex doesn't work. But I'd also like to hear some opinions about pain relief and pain management. TIA for any help.Debby

No virus found in this incoming message.Checked by AVG Anti-Virus.Version: 7.0.308 / Virus Database: 266.11.7 - Release Date: 05/09/2005

No virus found in this outgoing message.

Checked by AVG Anti-Virus.

Version: 7.0.308 / Virus Database: 266.11.7 - Release Date: 05/09/2005

[Guest guest]

Hi Debby,

Yes, I have been there done that! My first Rheumatologist was some kind of

sadistic idiot. I would tell him how bad the pain was and he just kept trying

NSAID after NSAID. He never diagnosed me with RA either. A professional

colleague of mine who is a Rheumatologist in the pharmaceutical industry

told me that I was not getting proper care. He referred me to a wonderful

Doctor who pretty much looked at me and said I had RA! He put me on

Enbrel, but since that can take a couple of months to work, also gave me

Percoset. What a life saver it was!

Unfortunately he retired and now I have another Doc who is a bit paranoid

about narcotics. But I have a couple of other Docs who I see who have no

problem in prescribing them to me. I have taken narcotics for a year and a

half. I don't take them every day, indeed, I had a couple of good months

where I didn't take any! Is that addiction? I believe they can be used

responsibly and I think you should find a doctor who is more sympathetic.

You are a person, not an experiment and your pain is real!

Good luck,

In Rheumatoid Arthritis , rightgirl@a... wrote:

> Hello, everyone...

>

> I was diagnosed with RA several years ago, in particular, a form that

> manifests itself in a rare, painful type of glaumcoma that affects one eye.

The

> glaucoma has been the worst symptom of RA for me until recently.

>

> I've always had joint pain that was particularly bad in the morning, but I

> dealt with it via nuprin and other OTC NSAIDs. The pain in the last few

months

> has gotten a lot worse. I went back to the RA dr. who prescribed celebrex

again

> (I had a bad experience w/celebrex the first time he prescribed it; his

> solution was to double the dose...!)

>

> The RA dr. said to call him if the celebrex doesn't work, and he'll prescribe

> " something else. " I'm a little on the paranoid side about strokes (a

> possibility w/celebrex), so can anyone who has been in this position tell me

what the

> next step might be when celebrex doesn't work?

>

> The other question I have is one I experienced with the opthamologist who

is

> treating my glaucoma. As I said, it can be extremely painful (like someone

> drove a spike through your temple.) I see this dr. a lot to monitor my eye

> pressure. One day, I asked him if he could prescribe a pain reliever. I got

this big

> lecture about how the pain would go away once the pressure was reduced;

well,

> I've been going to him for over a year, trying every type of drop and pill

> possible to reduce the pressure, and still the pain comes back. I guess I was

> just in a really bad mood, the way you get when you're in pain, and I said,

" So

> what's your solution? That meanwhile, while you play around with drugs

and

> drops, I should suffer? When you could do something to stop this pain, you

don't?

> What kind of doctor are you? Do you get off on watching people in pain? "

>

> I got a prescription for tramadol. Unfortunately, or maybe because of all the

> other freaking drugs he has me on, I broke out in a rash when I took it, so I

> had to discontinue it after one pill.

>

> The appointment with the RA dr. was a few days after this. I asked him what

> he does for pain relief. He told me to take Tylenol. I said, you went to

> medical school for that? He said he does not prescribe pain medications for

RA

> patients, no matter how bad it is. He said you can learn to live with pain. I

said,

> and why should you? He hissed, you could become ADDICTED! I said, and

that's

> bad for what reason again? If the medicine relieves pain and gives you a

life

> again, isn't there a way to manage taking it?

>

> I swear he broke out in a cold sweat.

>

> I had also mentioned to this dr. that the pain in my joints made sleeping

> difficult if not impossible. He slyly said, well, you know, there are sleeping

> pills.... I said, I don't want sleeping pills. I could sleep if this didn't

> hurt. He laughed and said, so there are some drugs you don't want!

>

> I could've slapped him.

>

> Maybe I'm just pissed off about being in pain so much, but I've been trying

> to do research about why pain killers are so bad, and the reasons I get are

> just BS. I wonder how many people are SUFFERING needlessly because

drs. are

> afraid to write prescriptions for painkillers. And I wonder why there's some

kind

> of onus put on people in pain, as if they had weak characters or something,

for

> wanting relief from pain.

>

> I know many of you are in much worse shape than I re: RA, but I'm also sure

> you've been through the pain killer route. I guess I'm angry at the RA dr's

> snide attitude (i.e., he blew off my concerns about the stroke implications of

> celebrex, and seemed to think I was some kind of drug addict for having the

> nerve to even ask about pain relievers.)

>

> I do need to know what the next step up is from celebrex when celebrex

> doesn't work. But I'd also like to hear some opinions about pain relief and

pain

> management.

>

> TIA for any help.

>

> Debby

[Guest guest]

Debby, I believe I would get a second oppinion.........Joyce M

----- Original Message -----

From: <rightgirl@...>

<Rheumatoid Arthritis >

Sent: Monday, May 09, 2005 5:18 PM

Subject: Question about pain relief, and a rant

Hello, everyone...

I was diagnosed with RA several years ago, in particular, a form that

manifests itself in a rare, painful type of glaumcoma that affects one eye.

The

glaucoma has been the worst symptom of RA for me until recently.

I've always had joint pain that was particularly bad in the morning, but I

dealt with it via nuprin and other OTC NSAIDs. The pain in the last few

months

has gotten a lot worse. I went back to the RA dr. who prescribed celebrex

again

(I had a bad experience w/celebrex the first time he prescribed it; his

solution was to double the dose...!)

The RA dr. said to call him if the celebrex doesn't work, and he'll

prescribe

" something else. " I'm a little on the paranoid side about strokes (a

possibility w/celebrex), so can anyone who has been in this position tell me

what the

next step might be when celebrex doesn't work?

The other question I have is one I experienced with the opthamologist who is

treating my glaucoma. As I said, it can be extremely painful (like someone

drove a spike through your temple.) I see this dr. a lot to monitor my eye

pressure. One day, I asked him if he could prescribe a pain reliever. I got

this big

lecture about how the pain would go away once the pressure was reduced;

well,

I've been going to him for over a year, trying every type of drop and pill

possible to reduce the pressure, and still the pain comes back. I guess I

was

just in a really bad mood, the way you get when you're in pain, and I said,

" So

what's your solution? That meanwhile, while you play around with drugs and

drops, I should suffer? When you could do something to stop this pain, you

don't?

What kind of doctor are you? Do you get off on watching people in pain? "

I got a prescription for tramadol. Unfortunately, or maybe because of all

the

other freaking drugs he has me on, I broke out in a rash when I took it, so

I

had to discontinue it after one pill.

The appointment with the RA dr. was a few days after this. I asked him what

he does for pain relief. He told me to take Tylenol. I said, you went to

medical school for that? He said he does not prescribe pain medications for

RA

patients, no matter how bad it is. He said you can learn to live with pain.

I said,

and why should you? He hissed, you could become ADDICTED! I said, and

that's

bad for what reason again? If the medicine relieves pain and gives you a

life

again, isn't there a way to manage taking it?

I swear he broke out in a cold sweat.

I had also mentioned to this dr. that the pain in my joints made sleeping

difficult if not impossible. He slyly said, well, you know, there are

sleeping

pills.... I said, I don't want sleeping pills. I could sleep if this didn't

hurt. He laughed and said, so there are some drugs you don't want!

I could've slapped him.

Maybe I'm just pissed off about being in pain so much, but I've been trying

to do research about why pain killers are so bad, and the reasons I get are

just BS. I wonder how many people are SUFFERING needlessly because drs. are

afraid to write prescriptions for painkillers. And I wonder why there's some

kind

of onus put on people in pain, as if they had weak characters or something,

for

wanting relief from pain.

I know many of you are in much worse shape than I re: RA, but I'm also sure

you've been through the pain killer route. I guess I'm angry at the RA dr's

snide attitude (i.e., he blew off my concerns about the stroke implications

of

celebrex, and seemed to think I was some kind of drug addict for having the

nerve to even ask about pain relievers.)

I do need to know what the next step up is from celebrex when celebrex

doesn't work. But I'd also like to hear some opinions about pain relief and

pain

management.

TIA for any help.

Debby

[Guest guest]

Sounds like you need a more compassionate doctor! What a jerk!

> Hello, everyone...

>

> I was diagnosed with RA several years ago, in particular, a form

that

> manifests itself in a rare, painful type of glaumcoma that affects

one eye. The

> glaucoma has been the worst symptom of RA for me until recently.

>

> I've always had joint pain that was particularly bad in the

morning, but I

> dealt with it via nuprin and other OTC NSAIDs. The pain in the last

few months

> has gotten a lot worse. I went back to the RA dr. who prescribed

celebrex again

> (I had a bad experience w/celebrex the first time he prescribed it;

his

> solution was to double the dose...!)

>

> The RA dr. said to call him if the celebrex doesn't work, and he'll

prescribe

> " something else. " I'm a little on the paranoid side about strokes

(a

> possibility w/celebrex), so can anyone who has been in this

position tell me what the

> next step might be when celebrex doesn't work?

>

> The other question I have is one I experienced with the

opthamologist who is

> treating my glaucoma. As I said, it can be extremely painful (like

someone

> drove a spike through your temple.) I see this dr. a lot to monitor

my eye

> pressure. One day, I asked him if he could prescribe a pain

reliever. I got this big

> lecture about how the pain would go away once the pressure was

reduced; well,

> I've been going to him for over a year, trying every type of drop

and pill

> possible to reduce the pressure, and still the pain comes back. I

guess I was

> just in a really bad mood, the way you get when you're in pain, and

I said, " So

> what's your solution? That meanwhile, while you play around with

drugs and

> drops, I should suffer? When you could do something to stop this

pain, you don't?

> What kind of doctor are you? Do you get off on watching people in

pain? "

>

> I got a prescription for tramadol. Unfortunately, or maybe because

of all the

> other freaking drugs he has me on, I broke out in a rash when I

took it, so I

> had to discontinue it after one pill.

>

> The appointment with the RA dr. was a few days after this. I asked

him what

> he does for pain relief. He told me to take Tylenol. I said, you

went to

> medical school for that? He said he does not prescribe pain

medications for RA

> patients, no matter how bad it is. He said you can learn to live

with pain. I said,

> and why should you? He hissed, you could become ADDICTED! I said,

and that's

> bad for what reason again? If the medicine relieves pain and gives

you a life

> again, isn't there a way to manage taking it?

>

> I swear he broke out in a cold sweat.

>

> I had also mentioned to this dr. that the pain in my joints made

sleeping

> difficult if not impossible. He slyly said, well, you know, there

are sleeping

> pills.... I said, I don't want sleeping pills. I could sleep if

this didn't

> hurt. He laughed and said, so there are some drugs you don't want!

>

> I could've slapped him.

>

> Maybe I'm just pissed off about being in pain so much, but I've

been trying

> to do research about why pain killers are so bad, and the reasons I

get are

> just BS. I wonder how many people are SUFFERING needlessly because

drs. are

> afraid to write prescriptions for painkillers. And I wonder why

there's some kind

> of onus put on people in pain, as if they had weak characters or

something, for

> wanting relief from pain.

>

> I know many of you are in much worse shape than I re: RA, but I'm

also sure

> you've been through the pain killer route. I guess I'm angry at the

RA dr's

> snide attitude (i.e., he blew off my concerns about the stroke

implications of

> celebrex, and seemed to think I was some kind of drug addict for

having the

> nerve to even ask about pain relievers.)

>

> I do need to know what the next step up is from celebrex when

celebrex

> doesn't work. But I'd also like to hear some opinions about pain

relief and pain

> management.

>

> TIA for any help.

>

> Debby

[Guest guest]

OH I so Feel for you. I been through that town of " TOO BAD " So I

kept firing my Drs.til I found one who really listened and really

cared. I don't know about others but I take morphine,Dilaudid(which

is stronger and longer acting than morphine.ALso Flexeril and

Klonopin.Youo have everyright to be angry. These Drs have their

heads up their Butts. Find out if there is a painclinic at your

nearest hospital.They will be more than willing to help you with

pain. Make sure that the clinic is run by anesthesiologists. They

care and hate seeing people in pain...Keep us informed...Skye

> Hello, everyone...

>

> I was diagnosed with RA several years ago, in particular, a form

that

> manifests itself in a rare, painful type of glaumcoma that affects

one eye. The

> glaucoma has been the worst symptom of RA for me until recently.

>

> I've always had joint pain that was particularly bad in the

morning, but I

> dealt with it via nuprin and other OTC NSAIDs. The pain in the

last few months

> has gotten a lot worse. I went back to the RA dr. who prescribed

celebrex again

> (I had a bad experience w/celebrex the first time he prescribed

it; his

> solution was to double the dose...!)

>

> The RA dr. said to call him if the celebrex doesn't work, and

he'll prescribe

> " something else. " I'm a little on the paranoid side about strokes

(a

> possibility w/celebrex), so can anyone who has been in this

position tell me what the

> next step might be when celebrex doesn't work?

>

> The other question I have is one I experienced with the

opthamologist who is

> treating my glaucoma. As I said, it can be extremely painful (like

someone

> drove a spike through your temple.) I see this dr. a lot to

monitor my eye

> pressure. One day, I asked him if he could prescribe a pain

reliever. I got this big

> lecture about how the pain would go away once the pressure was

reduced; well,

> I've been going to him for over a year, trying every type of drop

and pill

> possible to reduce the pressure, and still the pain comes back. I

guess I was

> just in a really bad mood, the way you get when you're in pain,

and I said, " So

> what's your solution? That meanwhile, while you play around with

drugs and

> drops, I should suffer? When you could do something to stop this

pain, you don't?

> What kind of doctor are you? Do you get off on watching people in

pain? "

>

> I got a prescription for tramadol. Unfortunately, or maybe because

of all the

> other freaking drugs he has me on, I broke out in a rash when I

took it, so I

> had to discontinue it after one pill.

>

> The appointment with the RA dr. was a few days after this. I asked

him what

> he does for pain relief. He told me to take Tylenol. I said, you

went to

> medical school for that? He said he does not prescribe pain

medications for RA

> patients, no matter how bad it is. He said you can learn to live

with pain. I said,

> and why should you? He hissed, you could become ADDICTED! I said,

and that's

> bad for what reason again? If the medicine relieves pain and gives

you a life

> again, isn't there a way to manage taking it?

>

> I swear he broke out in a cold sweat.

>

> I had also mentioned to this dr. that the pain in my joints made

sleeping

> difficult if not impossible. He slyly said, well, you know, there

are sleeping

> pills.... I said, I don't want sleeping pills. I could sleep if

this didn't

> hurt. He laughed and said, so there are some drugs you don't want!

>

> I could've slapped him.

>

> Maybe I'm just pissed off about being in pain so much, but I've

been trying

> to do research about why pain killers are so bad, and the reasons

I get are

> just BS. I wonder how many people are SUFFERING needlessly because

drs. are

> afraid to write prescriptions for painkillers. And I wonder why

there's some kind

> of onus put on people in pain, as if they had weak characters or

something, for

> wanting relief from pain.

>

> I know many of you are in much worse shape than I re: RA, but I'm

also sure

> you've been through the pain killer route. I guess I'm angry at

the RA dr's

> snide attitude (i.e., he blew off my concerns about the stroke

implications of

> celebrex, and seemed to think I was some kind of drug addict for

having the

> nerve to even ask about pain relievers.)

>

> I do need to know what the next step up is from celebrex when

celebrex

> doesn't work. But I'd also like to hear some opinions about pain

relief and pain

> management.

>

> TIA for any help.

>

> Debby

[Guest guest]

Debbie ,

This dr needs to be mentioned to someone and you to move to another , this crapy diease causes too much pain alone not to metion the other things it brings secondary and the related pain from the stress , the pain is all too real I can asure you as I would surely rather be deceased than go through this crap daily for all these years ! and have to put up with a Dr with an attitude , no way the pain does piss you off and watch out world dont put your crap on me no more i guess dealing with this and no releife just brings out the not so nice side of me but you are entitled to better care sorry youer haveing to travel this path ,

johnJoyce McCrary <j.mccrary@...> wrote:

Debby, I believe I would get a second oppinion.........Joyce M----- Original Message ----- From: <rightgirl@...><Rheumatoid Arthritis >Sent: Monday, May 09, 2005 5:18 PMSubject: Question about pain relief, and a rantHello, everyone...I was diagnosed with RA several years ago, in particular, a form thatmanifests itself in a rare, painful type of glaumcoma that affects one eye. Theglaucoma has been the worst symptom of RA for me until recently.I've always had joint pain that was particularly bad in the morning, but Idealt with it via nuprin and other OTC NSAIDs. The pain in the last few monthshas gotten a lot worse. I went back to the RA dr. who prescribed celebrex again(I had a bad experience w/celebrex the first time he prescribed it;

hissolution was to double the dose...!)The RA dr. said to call him if the celebrex doesn't work, and he'll prescribe"something else." I'm a little on the paranoid side about strokes (apossibility w/celebrex), so can anyone who has been in this position tell me what thenext step might be when celebrex doesn't work?The other question I have is one I experienced with the opthamologist who istreating my glaucoma. As I said, it can be extremely painful (like someonedrove a spike through your temple.) I see this dr. a lot to monitor my eyepressure. One day, I asked him if he could prescribe a pain reliever. I got this biglecture about how the pain would go away once the pressure was reduced; well,I've been going to him for over a year, trying every type of drop and pillpossible to reduce the pressure, and still the pain comes back. I guess I wasjust in a really bad mood, the way you get when you're in pain,

and I said, "Sowhat's your solution? That meanwhile, while you play around with drugs anddrops, I should suffer? When you could do something to stop this pain, you don't?What kind of doctor are you? Do you get off on watching people in pain?"I got a prescription for tramadol. Unfortunately, or maybe because of all theother freaking drugs he has me on, I broke out in a rash when I took it, so Ihad to discontinue it after one pill.The appointment with the RA dr. was a few days after this. I asked him whathe does for pain relief. He told me to take Tylenol. I said, you went tomedical school for that? He said he does not prescribe pain medications for RApatients, no matter how bad it is. He said you can learn to live with pain. I said,and why should you? He hissed, you could become ADDICTED! I said, and that'sbad for what reason again? If the medicine relieves pain and gives you a

lifeagain, isn't there a way to manage taking it?I swear he broke out in a cold sweat.I had also mentioned to this dr. that the pain in my joints made sleepingdifficult if not impossible. He slyly said, well, you know, there are sleepingpills.... I said, I don't want sleeping pills. I could sleep if this didn'thurt. He laughed and said, so there are some drugs you don't want!I could've slapped him.Maybe I'm just pissed off about being in pain so much, but I've been tryingto do research about why pain killers are so bad, and the reasons I get arejust BS. I wonder how many people are SUFFERING needlessly because drs. areafraid to write prescriptions for painkillers. And I wonder why there's some kindof onus put on people in pain, as if they had weak characters or something, forwanting relief from pain.I know many of you are in much worse shape than I re: RA, but I'm also sureyou've been

through the pain killer route. I guess I'm angry at the RA dr'ssnide attitude (i.e., he blew off my concerns about the stroke implications ofcelebrex, and seemed to think I was some kind of drug addict for having thenerve to even ask about pain relievers.)I do need to know what the next step up is from celebrex when celebrexdoesn't work. But I'd also like to hear some opinions about pain relief and painmanagement.TIA for any help.Debby