Does prednisolone, mesalazine, or pantoprazole reduce pain?

[Lily24]

Hi all,

I'm new to this disease. Been suffering with stomach pains for years. Pain started in 2005 and went for scopes and doctors did not diagnose a symptom and I was taking steroids ( prednisolone ) and mezalazine for about a year and stopped it. Then this year, last month, i was really anemic and was admitted and i went for all the tests again. This time I was diagnosed as Chron's disease. There are ulcers in my small intestines which the doc said is the one that causes pain. Right now i'm taking Prednisolone ( 20mg ), iron tablets, mezalazine ( 3g per day ), and pantoprazole ( each time i take the steroids ). Are these medicines suppose to ease the pain or how? I've been taking it for about 2 weeks and I stil have pains in my stomach, back aches, and body sores. Night sleep are not constant due to pain and the stomach pain comes and goes. Do anyone else have the same pain like me? Do anyone know what causes the stomach pain? I also feel very drowsy at times, and sometimes sweat when i have the pain eventhore the weather is cool. Is it due to not enough food in stomach? The pain also comes when my first food goes in the stomach. Hope someone can please help me. Thank you.

 

[BWS1982]

I'd talk to the docs about the lack of response, but that dose of pred is a little lower for a starting dose...as far as the pain, you should have seen a change by now from the pred, it should only be around a week from what I've read for a change. I'd say if it hurts when you eat it's the gastric juices and perhaps an ulcer being irritated? As far as I would guess (remember it's a guess, I'm no dr.) the other pills you're on need to build in your system longer than 2 weeks, but I could be wrong. You should have felt a change from pred by now though...

Welcome, I'd speak to the doc again and let him know an update.

 

[Lily24]

About Prednisolone

Hi,

The doctor actually prescribed for 30mg per day but when I take 30 mg, which i break to 10 mg after breakfast, lunch and dinner, I usually have very bad ache in my back and my stomach pain worsens. Doctor gave me pantoprazole to take it with but it still doesn't work. That is why I take only 20 mg per day. Can I take the prednisolone during half way of my meals? When is the best time to take these medicines? Do i take the pantoprazole first after food and then take the prednisolone, or do you have any idea of the procedures? Thanks for the help.

 

[Guest]

hi lily, and welcome to the forum.

i would also say talk to your consultant again, i'd would imagine the meds should have had time to show some relief by now, so maybe they need to re-look at the meds/dosage.

the sweats are a common factor in crohns, and i dont think they are related to food intake.

keep us posted, and i hope you get on the right track soon!

 

[Kev]

Hi Lily... Welcome to the forum. sorry to hear of your troubles. couple of points i'd make is... welll, first off, none of us here are doctors; we can't take the place of talking with your doctor first hand. Just fellow sufferers who share experiences to try to help one another out. OK, got that out of the way. I 2nd the thought that your pred is low... my 1st time on it, I was only on 20 mg, and really saw zero of a major improvement till my docs increased me to 40 mg/day.
Other thing I vaguely recall (could be wrong, haven't been on pred for 1/2 yr.) was I think I took my pred 1st thing in the AM... before 9 AM I believe, and on a full stomach. Best thing to do is check with the drug makers website to see if they post a 'best practices' info... or any info on dealing with side effects. Pred is great for treating this IBD, but it can come with short term/long term effects that aren't so good. You may need to switch to other forms of steroids if you find that the pred just doesn't agree with you. Another thought that crossed my mind was the 'iron tablets'... that's for coping/dealing with your anemia. I know of number of folks who had problems stemming from simple iron pills. It can be nasty.. can cause severe stomach aches, cramps, nausea, ulcers, etc.. You might need to switch to B12 injections or other methods, if the pills are the culprits causing your stomach issues. As for foods, and possibly associated pains, ARE you watching/noting what you are eating? Start a daily diary, keep track of everything that goes in... foods, meds, beverages, etc.. and when/how
AND then track/note how your body responds/reacts for the next 1 - 2 days. It will help you determine/pinpoint possible trigger or trouble foods, or methods or times, associations, etc., of ANYTHING you injest to the pains, cramps, etc.. I went thru this for months before I was able to custom tailor my daily regimen to get the least problems, best results I could, for any given day. Keep in mind that, even once you have this pattern just right for you, you may experience a bad day (or two, ... ) where nothing you do 'right' works on any particular day.
It's one of the down sides of this disease.. where you can do everything right and the day goes wrong anyway. BUT, if you watch/learn from your disease, you can get to a stage where you can manage/predict it (for the most part).

all the best. keep posting. hope things turn around for you. and again, welcome

 

[elp888]

medication

Hi Lily,

Sorry to hear you're not feeling well!

As for medication: i'm based in The Netherlands and at my hospital a professor (and others) recently published an article in The Lancet (February 23, 2008 issue) on the results of a study suggesting that Crohn's is better treated with a combination of corticosteroids (Prednison) and immunosuppressant (Azathioprine). A higher percentage of patients was in remission and less surgery. This, as opposed to just treating patients the 'old fashioned' corticosteroids way.
Perhaps this would be a more effective approach for you, maybe your doctor has heard of this study?

I'm now on this combination of drugs, but it's still too early (it takes about 6 weeks for Azathioprine to start working) for to notice any difference.

Good luck!

PS.
for those who are interested, i've copy/pasted a summary of the article below:

Early combined immunosuppression or conventional management in patients with newly diagnosed Crohn's disease: an open randomised trial

Background

Most patients who have active Crohn's disease are treated initially with corticosteroids. Although this approach usually controls symptoms, many patients become resistant to or dependent on corticosteroids, and long exposure is associated with an increased risk of mortality. We aimed to compare the effectiveness of early use of combined immunosuppression with conventional management in patients with active Crohn's disease who had not previously received glucocorticoids, antimetabolites, or infliximab.

Methods

We did a 2-year open-label randomised trial at 18 centres in Belgium, Holland, and Germany between May, 2001, and January, 2004. We randomly assigned 133 patients to either early combined immunosuppression or conventional treatment. The 67 patients assigned to combined immunosuppression received three infusions of infliximab (5 mg/kg of bodyweight) at weeks 0, 2, and 6, with azathioprine. We gave additional treatment with infliximab and, if necessary, corticosteroids, to control disease activity. 66 patients assigned to conventional management received corticosteroids, followed, in sequence, by azathioprine and infliximab. The primary outcome measures were remission without corticosteroids and without bowel resection at weeks 26 and 52. Analysis was by modified intention to treat. This trial was registered with ClinicalTrials.gov, number NCT00554710.

Findings

Four patients (two in each group) did not receive treatment as per protocol. At week 26, 39 (60·0%) of 65 patients in the combined immunosuppression group were in remission without corticosteroids and without surgical resection, compared with 23 (35·9%) of 64 controls, for an absolute difference of 24·1% (95% CI 7·3–40·8, p=0·0062). Corresponding rates at week 52 were 40/65 (61·5%) and 27/64 (42·2%) (absolute difference 19·3%, 95% CI 2·4–36·3, p=0·0278). 20 of the 65 patients (30·8%) in the early combined immunosuppression group had serious adverse events, compared with 19 of 64 (25·3%) controls (p=1·0).

Interpretation

Combined immunosuppression was more effective than conventional management for induction of remission and reduction of corticosteroid use in patients who had been recently diagnosed with Crohn's disease. Initiation of more intensive treatment early in the course of the disease could result in better outcomes.

 

[Lily24]

Hi all,

Thanks for the supports. Feel a bit ok as I was really down. I would want to know, how will I know whether I'm getting better or worse by taking prednisolone? What are the symptoms of getting better? Can I take pantoprazole before taking the pred? Thank you.

 

[Sojourn]

Welcome. It should be very obvious to you if the Prednisone is working, i.e., lessening pain, good bm's, etc. When I first got on Prednisone, after being diagnosed, I thought I was healed. When I had to stop staking it, and all my symptoms returned, I realized what a *#%* this disease is.

Interesting study elp888.

I'm not familiar with pantoprazole. From what I understand, doctors are more able to prescribe Remicade or Humira, after diagnosis than before. I would suggest asking your doctor about this.

When I was diagnosed, a few years ago, the doctor said all other remedies had to be exhausted before starting biologics.

 

[michels1]

Hi Lily, welcome. Sorry that you have become one of us.. Good luck with the prednisone. I was not able to stay on it for very long because it made me worse. It can be either a great drug or a horrible one. I would definitely check with the dr. about your progress though. good luck

 

[Lily24]

In pain...

Hi,

I have seen some improvements in myself like better bm's, and weight increasing and so on but the pain of my stomach is not reduced. The pain is in the center in between the stomach and the chest. I'm having it everyday and its really bad. Is this one of the side effects of prednisolone or Pentasa? Usually they say its gastric pain but the pain is killing me. Every evenings i have this pain eventhore i eat something and usually it eases only after vomitting out some bile, or colourless water which i think should be the acidic. Then, i have to take Antacid to cool my stomach down before i eat something. Have anyone have any idea about how am I to reduce this? As for Crohn's, where do you usually get or feel the pain?

 

[BWS1982]

Well, my pain is almost isolated to the lower bowel/rectum or lower, but I get slight cramping if I'm not doing well. Yours sounds like it's possibly an ulcer or something along those lines, again, your medical professional or even a well trained pharmacist should be sought out.

 

[Kev]

Well, some folks can't tolerate ASA in the stomach... How are you taking your pentasa? Forget that question.. go to the pentasa website and see just how they say is the best method to take it; or if there are any methods to deal/cope with these issues (it may be a common side effect they post about on there, and they may have strategies spelled out to deal or minimize them). That is what I did. Important note.. I was on another brand of 5ASA, Salofalk... NOT Pentasa.

 

[Lily24]

Thanks, I'm also taking the same brand as you, 500mg Salofalk Mesalazine. 2 tablets, 3 times a day. How do you take it usually? Do anyone of you take any gastric tablets like 'omeprazole' or 'pantoprazole' before taking Prednisolone or Mesalazine? Another problem I have is, I can't consume any tablets before food as I'l have vommiting. Therefore, even the gastric tablets I have to take after food. Any help on this matter?

 

[Kev]

Welll, I didn't have any gastric distress taking the Salofalk, but I did (still do) feel a lot of cramping/pain when I take them. Not as much as I originally went thru. The first advice I was given, and it was also on the printout that came with the meds., was to take them with food. Doing that caused major cramping (good or bad I do not know) AND at the end of the day I'd wind up with migraine headaches. then I spoke with a doc at a GI clinic. He suggested that I because of my size, COULD try taking them in 3 sets, 3 + 3 + 2. I did that, and my side effects decreased... but were still pretty intense, esp. the headaches.
Then I went to the Dr Falk website. It suggested a different approach. I still had to take it with food (I dunno if this is to protect the stomach or the pill) but it suggested I eat first, wait 1 hour, then take the pills. This reduced my pains when taking them AND virtually eliminated those nasty migraine headaches.

As for pred., I seem to recall taking my pred 1st thing in the morning, before 9

Hmmm, I seem to recall another thread on here someplace where someone had posted a thingy about not taking pred @ same time as AZA (or was it Metho?)

 

[Keara07]

Hi Lily - welcome ( but also sorry to see you are on as it means you are part of this crazy world of CD)....

As Kev notes, we are not docs but can offer what litle advice based on personal experiences.

I have had a rough 4 months - just ended with ER surgery - and your story is similar. I was put on prednisone back in Jan but 50 mgs, then 40, then 50, then 40...now only tapering. My symptoms did NOT improve much and well, who knew but my *inflammation* was a bad stricture turning into a 180 degree obstruction and a bowel balloon the size of a grapefruit which almost ruptured....so check back with the docs...I am NOT trying to scare you but I wouldn't want anyone to delay and go through what I did, EVER! Get more tests - CTs whatever if the pain sticks around. I had pain in my center abs too but I also never used pantoprazole - but I was on 5-ASA pentasa brand.

I am now a believer in calling the docs for sure, for sure.

Good luck and I really hope you feel better very soon! Take care.

 

[Lily24]

Hi,

Thanks..Yesterday, I was quite alright in the morning but suddenly during the lunch time, I got a severe pain in my left side up to the abdomen. And the pain would not let me eat anything. It was so painful that I had it the whole day. I just rub some oilment and had a little of bloody motions. The pain lasted the whole day and I didn't manage to even take my medicines at night. Eating rice was a bad idea as each food that goes in causes more pain. Is this what that is called FLare-Ups?? Have anyone felt like this before? How to reduce the pain? How to reduce the pain when it comes during eating? The pain is really terrible. I still do have it and I don't know how to reduce it down. Please help.

 

[BWS1982]

Do you see a GI doc at all? I don't personally have any stomach issues, mine are all further down the line, I'd check with a dr. or if you don't have one, acquire one and seek an opinion. What you speak of would worry me, and I wouldn't resort to solely an internet forum, because even solving the pain may not solve the source of it. Best of luck.

 

[dizzyd]

Have your docs done a catscan or ultra sound. I had the same type of pain. Mine would wake me in the middle of the night and many times I wouldn't get any
relief until I threw up (then I was able to have a bowel movement.) My pain was caused by a narrowing of the bowel and a fistula that went from one section of bowel into another section lower down. It was that narrowing that caused all that pain...no food could get by. I was like you and kept trying to find a food I could eat when I probalby should have been sticking to liquids. Hope you feel better soon. When is your next appointment?

 

[Lily24]

Pain..

Hi,

Thanks for the info. Well, my next appointment is next week. Am waiting for it to ask the doctor lots of questions and also regarding this pain matters. How long did the pain stayed with you? Are you feeling better now? What kind of medication are you taking?

 

[dizzyd]

I had to have surgery to remove the diseased section. (18 inches small bowel and 6 inches). I have been in remission since (4 yrs and counting) and I am not taking any meds. (even though it was highly recommended in my case). Write down all your questions for the doctor so you don't forget and if possible I found it helpful to have my hubby come with me. He made sure I didn't make lite of my condition or forget to tell him anything...I was kinda shy of docs. It also helps to have an extra set of ears as the doctor tends to give out alot of info and it was sometimes hard to comprehend everything at once. Good Luck

 

[Lily24]

Alright. Will update you guys next week after seeing my doctor and what he says next.

 

[Lily24]

Latest doc visit

Hi all,

I just had my first check up after taking one month of medication. The doctor said the pain i was having is due to the inflammatory of the small intestine that when the food goes through it, it becomes painful. I'm still having the pain daily and nearly all the time. Have anyone gone through this?

He also added a new medicine to be taken. Called Azathioprine ( Imuran 50 mg ) - 1 tablet daily. My prednisolone is 20mg daily, Pentasa 3g daily, iron tablets 3 per day, controloc ( Pantoprazole ) for gastric pains. Anyone with experience of taking Azathioprine? What is the side effects that was on you guys? How long will it take to know the changes? What kind of changes can be seen? When is the best time to take the Azathioprine?

Doc said, Azathioprine is to be taken while he reduces the steroids. Sorry for the many questions cause I'm quite scared to take all these drugs. Hope you guys can help me thru it. Thanks.

 

[Kev]

Hey Lily... Yes, I went thru the daily, constant pain. It wasn't fun. You have my... heck, all of our sympathies. Just keep thinking that there are better days ahead.

As for the AZA, Imuran... Well, everyone is different. you just have to take it and see. I took it, did great for first couple of weeks, then it went haywire when I had to double my dose. Other folks take it without any incidents.
Good news is, that if it does cause problems, they seem to go away PDQ after you stop taking it.. Least, that's the way that it worked for me. All the best, OK?

 

[elp888]

hi lily,

i've been on Aza (125 mg a day) for about 5 weeks now, apparently still too early to notice any effects, but i'm not feeling any side effects either, so i guess that's good. i take it with my 'dinner' (which at the moment is just a clear bouillon...)

good luck
e.

 

[Lily24]

Hi guys,

Thanks for the reply. Hope all goes well for me too. Can Azathioprine be taken during dinner time? I just took it in the afternoon but have severe pains and cramps after that and could not even eat my dinner properly and was suffering the pain all night till today morning. Therefore, is it ok to take it after dinner? How about iron tablet? Doc asked me to take ferrous ferumate ( iron tablet ), 1 tablet 3times daily, but some say it is not good to take iron tablets at night. Have anyone taken it at night?