Adding an NSAID to my regimen...

[Doug2113]

I'm not sure if this would better go here or in OD (but I'm always posting here so I figured why not), and I know we're not allowed to ask questions like "What should I take to get fucked up?", but this question is nothing like that.

I'm thinking of asking my doctor to add an NSAID to my chronic pain regimen, and I was wondering if I could possibly get suggestions of ones that work best/have the least amount of GI side effects (i.e. abdominal pains, ulcers, stomach bleeding, etc.).

I currently take:
100mg Tramadol 4x daily
10mg Flexeril 3x daily
600mg Gabapentin 3x daily

And an assortment of OTC pain relievers usually involving 2 Aleve (each containing 220mg Naproxen Na), 4-8 Excedrin (throughout the day, not at once; each contains 250mg Acetaminophen, 250mg Aspirin, and 65mg Caffeine), and 6-8 Ibuprofen (spread throughout the day; each dose being 6-800mg).

I know I need to speak with my doctor about this, but was just wondering if anyone here had experience with ones that worked well/didn't cause many issues.

Any advise is appreciated, and feel free to move/close this thread if it doesn't fit the criterion or somehow violates the BLUA/BDD Guidelines, moderators. (I'm not asking how to get fucked up, so I thought this might be one of those grey area questions)

 

[Tripman]

This question is perfectly legitimate and allowable Doug.

Often patients will experience a different response to different medications. This could be why some medications have helped your symptoms while others do not have a significant effect. This is not unusual, and it is difficult to predict which medications will most benefit a given individual. The best way to determine which NSAID is best for you is to try different options. Often a physician will recommend one NSAID, and if adequate relief of symptoms is not obtained within several weeks of treatment, another NSAID can be tried.

I would consider some of the newer, prescription medications, such as Celebrex, because these may be taken as once-a-day doses rather than three or four times daily. In addition the COX-2 inhibitors are thought to have fewer side-effects on the stomach. Because of the possible decreased risk of stomach problems, may doctors will recommend the COX-2 inhibitors for patients who may have risk factors for bleeding or stomach ulcers.

 

[Oxide]

I only have any experience with celebrex and meloxicam, and they are both supposed pretty rough on the stomach. I'm pretty sure all of the NSAIDs are going to have some stomach related risks though.

Look a little into celebrex and meloxicam, and mention them to your doctor. He also might have suggestions of his own.

 

[Doug2113]

I've tried Celebrex and Mobic before, but they were Rx'ed by themselves before I was on the plethora of medication I'm on now (which STILL isn't cutting it, lmfao), so I'm sure you could see how I'm not sure how these work. If only there was a way to mathematically monitor your pain levels and how medications was working on them. That would make things SO much easier lol.

 

[Tripman]

Celebrex is meant to be less rough on the stomach

 

[Doug2113]

I've read this too actually (COX-2 being easier on stomach). And another question if this one is okay lol. Does anyone have suggestions on better muscle relaxants than Flexeril. I've read that these are about the least effective ones. I'm pretty sure someone's going to end up saying "Soma" (Carisoprodol), but that's actually a C-IV drug in my state, so that's not actually something I should suggest to my doctor I think lol.

 

[Tripman]

Valium and as you said Soma are really the only two muscle relaxants I can think of, I'll leave this one up to someone else.

 

[Alex000]

Soma is much better than Flexeril.

 

[Doug2113]

...Told ya lol...I know Soma is better. But am I going to go into my doctors office and say, hey, gimme some 350mg Somas QID? No lol...I like not having red-flags in my records...at least...I think I don't have any red flags...

Is there a way you can find that kind of stuff out?

 

[Oxide]

Is there a way you can find that kind of stuff out?

No.

As far as muscle relaxants go, of course carisoprodol is going to be preferable. Baclofen is another option though, I was prescribed this by a pain management doctor in conjunction with 180 tramadol a month instead of carisoprodol as my state health insurance wouldn't cover the Soma. Baclofen wasn't the best, but it was better than flexeril, at least in my experience. Your mileage may vay.

 

[painenduser]

Doug,

You answered your own question when you said COX-2 inhibitors are best for people with history of ulcers or stomach issue associated with NSAIDS.

Information below found here:
Information on NSAID's Specifically Selective NSAIDs or COX-2 Inhibitor's

Selective NSAIDs — Selective NSAIDs (also called COX-2 inhibitors) are as effective in relieving pain and inflammation as nonselective NSAIDs and are less likely to cause gastrointestinal injury. Celecoxib (Celebrex®) is the only selective NSAID currently available in the United States.

Selective NSAIDs are sometimes recommended for people who have had a peptic ulcer, gastrointestinal bleeding, or gastrointestinal upset when taking nonselective NSAIDs. Selective NSAIDs have less potential to cause ulcers or gastrointestinal bleeding, but they do not prevent ulcers that develop for other reasons.

Precautions with selective NSAIDs — Rofecoxib (Vioxx®) and valdecoxib (Bextra®) were taken off the market in 2004 when it was discovered that people who took these medications had a slightly increased risk of heart attack and stroke.

People with known coronary artery disease (eg, past history of heart attack, angina (chest pain due to narrowed heart arteries), history of a stroke, or narrowed arteries to the brain) and people who are at a higher than average risk for these conditions should avoid using COX-2 inhibitors and some nonselective NSAIDs until more information is available, and should consult their clinician before any such use.

NSAIDs are generally not recommended for people with kidney disease, heart failure, cirrhosis, or people who take diuretics. Some patients who are allergic to aspirin may be able to take selective NSAIDs safely, although this should be discussed in advance with a healthcare provider.

Dose of NSAIDs — Lower doses of NSAIDs, as recommended for use with nonprescription NSAIDs, are adequate to relieve pain in most people. To fully treat inflammation, a higher dose of the NSAID must be taken on a regular basis for several weeks before the full antiinflammatory benefit is realized.

If the initial dose of NSAIDs does not improve symptoms, a clinician may recommend increasing the dose gradually or switching to another NSAID. People taking one NSAID should not take a second NSAID at the same time.

Apparently there are few on the market anymore as this is what I found:
List of COX-2 Inhibitors found here

• Celebrex (Celecoxib)
• Mobic (meloxicam) - this one came from a different source
• Vioxx (Rofecoxib)(No longer on market as of September 2004)
• Bextra (Valdecoxib)(No longer on market as of April 2005)

There are also other COX-2 Inhibitors being developed, including:

• Prexige (Lumiracoxib)
• Arcoxia (Etoricoxib)

I would make sure you talk with your Dr about your concerns here. Hopefully he will be fair and listen to you and get you feeling better.
Hope this helps bud, and good luck to you! Let me know if there is anything further I can help with.

 

[Oxide]

For the time being, I'm going to close this thread as it appears to have been answered.

If anyone has any questions or would like me to re-open this thread, send me a PM.