Gel painkillers

[ladyalex]

What have people found most effective ?

It's for an elderly lady with very bad arthritis in her knee.It's giving her gyp at the moment . She cannot face the idea of an operation to replace her knee which has been offered.
She's already on methotrexate , so cannot take oral ibuprofen. Anything with codeine in it makes her very sick , as does tramodol. Any ideas would be welcome.
GP is happy for her to use ibuprofen gel on her knee, wondered if there was anythig better.
Thanks.

[boxtops]

I used it on my shoulder when Ibuprofen tablets were making me ill - but that was only moderate pain, not severe.

[Sqad]

\\\She's already on methotrexate , so cannot take oral ibuprofen. \\\

I disagree.

I am not keen on analgesic gels.....just a personal view you understand.

[ladyalex]

Thanks, boxtops. I'll get some for her and ask at the pharmacy.

Just wondered if anyone else had personal experiences/recommendations.

[Euphemia]

My OH has a similar problem with bad arthritis in his knee. He was prescribed paracetamol.

[ladyalex]

Thanks, sqad.
Her rheumatologist insisted that she could not have ibuprofen any more when she started on the methotrexate.
She was very anaemic at the time and I *think* the feeling then was that she was having stomach bleeds caused by the ibuprofen which was contributing to her anaemia.
She currently takes omeprazole and folic acid as well as her methotrexate, ferrous sulphate, Adcal-D and thyroxine. The only painkiller she uses is paracetamol at the maximum dose.
I'm not keen on the analgesic gels either as I've never found them to help me a bit!

[ladyalex]

Thanks, Euphemia, We've already got the paracetamol.

[Sqad]

ladyalex.....that is a good enough reason.....thanks.

[ladyalex]

OK sqad.
Any other ideas about painkillers ?
There is an awful feeling of running out of options here....

[droopdrawers]

Ask if she can use Voltarol Suppositories. I have multiple Arthritis problems and find they suite me better than anything else. I am not allowed them all the time tho.
Do try and persuade your friend she will be virtually pain free is she agrees to have a replacement. I've got 5 new joints and recommend it 110%.

[Sqad]

ladyalex

\\\It's for an elderly lady with very bad arthritis in her knee.It's giving her gyp at the moment\\\

That is the bottom line here.

Ibuprofen,Tramadol, codeine containing compounds all are a "no no" for the reasons given.

If Gels do not do the trick then an old lady cannot be left in pain and a chance has to be taken with Nsaids. This is a decision to be taken by the Dr....difficult.

Let's hope that Ibuprofen Gel works.

[Sqad]

Just seen droopdrawers post.... excellent suggestion.

[ladyalex]

Thanks, sqad. We'll give the gels a go and report back. (And get on to the GP if they don't.)

Droopdrawers, thanks too. She has had both hips and her other knee replaced, so she is well aware of the benefits of the op. Trouble is, she's 92 and lives alone with a minimum of help from a daily carer. She doesn't want to go into hospital for what would be a fairly prolonged stay at her age and stage of frailty, hence the 'cannot face the idea of an op.'
It's not the op that's the problem, it's the rehab afterwards that bothers her. Needless to say, the arthritis affects her hands, fingers and elbows too. It's not so painful in her hands etc, but it means that she has very little power or grip, so walking aids etc are difficult for her.
All this and she also has an iron will so will not be persuaded to do anything she doesn't want to do. (Good for her, I say, really...when I'm not trying to 'deal' with her, that is :-))

[ladyalex]

I'll certainly bear the Voltarol Suppositories in mind, but I foresee that there will be a difficulty in actually being able to use them.
As I said, she lives alone, is frail, has very little power or , perhaps more importantly dexterity in her hands/fingers.

[Mamyalynne]

Hello Milady - I have found some relief using Algesal Cream , but with this ladies history you would need to check for contraindications,

She sounds a very determined Lady indeed.

[Eve]

I have found voltarol gel the best in the past of the over the counter gels but still doesn't make a big difference to my arthritis. May well be stronger ones on prescription though.

Have they discussed other pain measures with her? I was put on medication for pain relief, essentially a low dose antidepressant - amitriptilyne (sp?). I am potentially going on methotrexate in combination therapy but don't know much about it now, potential contraindications etc...

A pharmacist suggested asking my GP about naproxen to me when I was asking about Voltarol diclofenac tablets as I'm not supposed to take ibuprofen etc.. as I have a delicate stomach and past history of ulcers. I have no idea again though of possible contraindications and having googled I can see it can affect your stomach as well.

Are there specialist nurses at her rhumatology clinic she could make an appointment to have a chat with? The ones at my centre are fantastic, so knowledgable and have some brilliant advice and may well have more time to talk than a consultant at an appointment. Probably far easier to get a quicker appointment and more regular and accesible support too.

Has she tried heat/cold therapies?

[ladyalex]

Thanks Mamya, I'll have a look at Algesal cream...and ask the pharmacist about contra-indications.
She is indeed a very determined lady and always has been. She will only do what she wants to do, in spite of any advice to the contrary. However, as she's got to 92 and is still living in her own house, I think she must be doing something right, so hesitate to argue with her too much. (That and fearing for my life if I do :-))
Thanks to you too, Jenna. I'll look at Voltarol gel.

[rowanwitch]

Not unreasonable to ask for a referral to a specialist pain management clinic, as there may be options they are willing to try with close monitoring. As she is covered by the omeprazole they may be willing to add in a low dose of an anti inflamatory but sometimes other options like supports and splints can help as well by reducing the compression at the joint surface

[ladyalex]

Thank you , rowanwitch.
I'm sure more could be done for this old lady, but , as always, there is never just one issue. Splints and supports might well be very helpful , but she cannot put them on or get them off herself because of her reduced dexterity and lack of manual strength. I'm not sure whether Carers (local authority) would do the putting on and taking off for her; they will certainly not touch medication of any kind other than to prompt taking it from a Nomad, so suspect they would be unable to help with splinting for fear they damaged her further.
We also have the lady herself who refuses help if she possibly can. She is housebound and very very unwilling to go to any hospital or clinic. Her GP is very good, visiting her when necessary, as are the District Nurses who call to take blood periodically.
I have offered to arrange a wheelchair loan from the Red Cross to take her to hospital etc etc, but she refuses to go. I think it is all just too much effort for her. And she is doubtful as to the outcome of any consultation...'all that bother for nothing'.
To say that she is frustrating to deal with is a huge understatement .

[rowanwitch]

domicillary services should include access to physios and a pain team... carers won't put on supports but the district nursing team will and it would only be a cople of short visits from a health care assistant each day...

She may be able to have other aids to make her life easier too... if she doesn't have them already... after all tough old ladies often defy the odds and live lot longer than 92 so of course it is worth the trouble

[ladyalex]

Thanks, rowanwitch. I wasn't aware of the existence of 'healthcare assistants' as opposed to 'carers'.
Would such people be employed by the local authority, or the NHS ? (We're in Scotland, if that makes a difference.)
She does have some aids, by the way and has been offered more which she has refused . The best way of getting her to accept the aids was discovered by the Community OT who just put the turners on the taps and left. She couldn't get them off and discovered that they did help.