To be annoyed doctors won't prescribe anything for fibromyalgia and arthritic pains?

[KingKhazi]

I have fibromyalgia and "mild" arthritis in both hips. I'm 36. I recently went to the doctors for some sort of painkillers as OTC stuff isn't helping any more.
I was told they won't prescribe anything stronger for my arthritis as its only going to get worse and they don't think I need anything stronger yet.
Also won't for fibro as its not real pain. It's my nerve endings being hyperactive. I do understand fibro and know its my brain telling me its painful when it isn't.

I was prescribed yoga and meditation . Yes I'm sure they would help but not when I'm in so much pain I'm crawling up the stairs and struggling to drive. It's my hips more than the fibro that I want pain relief for.

What OTC stuff do you use?

I know it’s a wait but can you ask to be referred to a rheumatologist or perhaps pay to see one privately? They could create a treatment plan (long term pain management and then again for flare ups) which I’m sure a GP may feel comfortable sticking to. It’s not acceptable to not be given analgesia but I do feel for GPs if they are just handing out strong painkillers patients can and do get addicted which causes another set of problems.

So have you tried the meditation/yoga? A lot of our painkillers can have health risks when used long term. However this could be sexism and ageism on the GPs part. Did you go through an arthritis clinic? Is that who pain scored you?

Yep get a referral. And put a complaint in to the practice manager. Even if your symptoms do get worse it doesn’t mean you need to suffer until then!

Honestly I wonder what some drs are on. I have to be very assertive and basically say I’m not leaving until I have a prescription.

I would be looking at any self help strategies I could such as exercise, weight management, diet, mental health techniques as you have long term health conditions at a relatively young age. Ask your GP for a referral to a muscular skeletal therapist for help with the hips in particular. The one at my GP practice is amazing!
Developing healthy habits now will pay dividends in the future.

Sounds reasonable to try yoga and meditation first.
If you take regular paracetamol ibuprofen ( could be gel) plus low dose codeine you are taking quite a lot already.

And I'm sure some doctors wonder what patients are on!! You obviously think you know more than a trained medical professional - a prescription is not always needed, but no doubt you know best.

Where did you do your medical and speciality training?
Bet your GP cannot roll their eyes further back when you turn up demanding an prescription!

What type of analgesia would you like to have prescribed? What are the ling term health risks of this type of analgesia?

Ask for referral to a pain management clinic. They have a far better understanding of how to treat pain than your GP.

You need to see the specialist who diagnosed you with fibromyalgia/arthritis. They are experienced in management of long term pain, and they might be able to prescribe either medication or physiotherapy or another treatment to control the pain without just going to stronger painkillers. A GP will be happy to follow their recommendations but rightly reluctant to hand out strong painkillers to a young person whose condition may need another 50 years of management.

Yes, or a pain management clinic.

If you have fibromyalgia you should be under a rheumatologist- have you ever seen one? Ask for a referral or contact them if you’ve seen them before. For nerve / chronic pain like fibromyalgia you should be offered things like amitriptyline. I have lupus and long term bladder issues (nerve pain) and I take amitriptyline and Tramadol.

They're probably trying to prevent addiction issues such as have devastated parts of the US. But hopefully can suggest alternatives.

There’s serious implications for long term painkiller use-I think you need to try lifestyle changes as they’ve suggested like yoga, other gentle exercise, diet changes, support for your mental health etc.

Well medications for pain relief also only work on the brain like blocking signals, such as NSAIDs. So if it was a doctor who said that you should report, or tell them you will if they don't prescribe you what you want.

They will give cocodamol or codiene for these pains. My mum has it so did my mum in law. You could also get an NSAID like Naproxen that's a strong painkiller.

Or pregabalin to relax muscles.

You need to gain an appointment, then tell the doctor what to prescribe you. They are there to serve you, signpost you and prescribe for you, that's a GP's function.

If you have fibro pain and it is thought to be nerve problems then the recommended meds are those which essentially turn down the inputs from the nerves.

I am on duloxetine for this reason (I also have chronic pain, in my case from an accident) but amytriptyline and pregabalin are also used.

I am not sure if a GP can prescribe these, as for me they were prescribed by my consultant.

See section 1.2 of the NICE guidelines for managing chronic pain, in particular section 1.2.7

www.nice.org.uk/guidance/ng193/chapter/Recommendations#assessing-all-types-of-chronic-pain-chronic-primary-pain-chronic-secondary-pain-or-both

The NICE guidelines are research based and best practice (ie what doctors should be doing) for chronic pain.

I suggest you go back to your GP with the guidelines and ask him or her to stick to them.

At your age your quality of life shouldn't be suffering because of life long pain. I have a chronic pain condition and i am 32 which I've had since 23. I wasn't given anything for the first few years because my age made them hesitant and it completely ruined me mentally and physically. With the amount of help that is available for pain now a days, noone should have to suffer. Medication may not be the choice of treatment for you but there are so many other options available now for pain relief to enable you to still have a reasonable quality of life. Personally I'd be asking for a referral to your local pain clinic. Treatment and support for chronic pain is what they are there for and are better equipped to deal with this than your local GP.

I wonder if something like a TENS machine might help? It would be worth a try.

Don’t start taking cocodamol regularly, it’s addictive and doesn’t work for chronic pain, ask for a referral to the pain management service and try lifestyle changes.

I couldn't function without codeine taking the edge off my arthritis pain.

No bloody way yoga or meditation would work.

You need to ask for a referral to pain management services. They will start with the least invasive/addictive and work their way up. Pain management services can recommend strong opiates if they think you need them, but they’ll want to try other things first. Before that, do you take your OTC painkillers religiously round the clock? You need to be taking them regularly, even if you think you don’t need them, as pain is much easier to manage ahead of it becoming too much. Also, have you tried nsaids like naproxen? They can really help.

It's the new nice guidelines for chronic pain. I'm guessing the people voting YABU aren't living with chronic pain.

I'm "lucky" to have other conditions that fall outside the guidance and medication prescribed by consultants, but I still had to fight to keep my medication with the GP surgery pharmacist at my last review.

There was an interesting documentary on pain medication a while back. Basically in many cases the medication doesn't help because it's the brain telling you that there is pain but there isn't anything to actually relieve. That doesn't help you short term, you can feel it real or otherwise, but the suggestion of meditation, yoga, cold water swimming is meant to be helpful is from medical evidence that these work. I have fibromyalgia, I get it, but I try not to take pain meds except in exceptional circumstances, then I take paracetamol with codeine

It sounds tough but I can also see where your GP is coming from.

My MIL has the same conditions as you and her GP certainly hasn’t said no to strong painkillers - although I’m sure she has been very pushy so don’t know if that has made a difference - and she lives on them, also drinking quite a lot of alcohol with them every evening, going to bed late and then lying in bed for half the next day, hasn’t worked or for years and rarely leaves the house..

And looking at it from the outside - and she really is an unhappy and angry woman - it’s very hard to unpick what is physical and what is mental health, and the painkiller use plays a massive part in that.

I have no idea how she can tell what is going on with pain and her health, with a mix of such strong painkillers and hangovers involved, plus she is overweight and that is a consequence of not going out or moving, but she can’t go out because she is in pain but the extra weight makes her joints worse so the pain is worse… and so on. So she just seems trapped.

She was like that in her early 50’s when I met her. It looks very much like addiction and her the amount of pain relief she takes seems unchecked and it is as if it just can’t be questioned, or lifestyle changes considered, because she does have arthritis and fibromyalgia and says that is the cause of everything.

If she had a GP who had encouraged her to try other things and not let her head down that road, rather than just repeatedly giving out the prescriptions for the strong stuff, perhaps she would be in a better state mentally now.