Muscle relaxant/NSAID alternatives?

[Wiggles]

Hi all

As we all know, NSAIDs are generally considered a bad choice for people with IBDs/Crohns Disease.

I have a shoulder/neck injury which is giving me hell. I think it's probably posture/repetitive use related due to my job. Before I was diagnosed (a couple of years ago now) I was put on some funky NSAID which did wonders for my shoulder but seemed to make my Crohn's symptoms much worse (at the time I didn't know I had CD but it gave me severe D etc).

I am now trying to figure out what I could take as an anti-inflammatory/muscle relaxant for my shoulder. Has anyone found an effective and safe alternative to things like asprin, ibuprofen or the more exotic NSAIDs? What about muscle relaxants, as opposed to anti-inflammatories?

I should add that I'm taking Endep (amitriptylene) in low doses to help with my CD symptoms. It's very hard to work out what interactions it might have!

Any thoughts would be greatly appreciated - funny how when you get one major health problem it becomes a lot harder to treat other, less significant problems!

 

[roundtuit]

There are topical NSAID's now. I was perscribed one by my PCP and tried it with my GI's blessing. It worked great for my shoulder pain.
I have stopped using it as I am now in a full blown flare, which may or may not be a coincidence. I suspect the increased joint pain and the reason I started using it, may have been the start of the flare ( along with some other flair-ish symptoms). Once things calm down, I may try it again. It is called Voltaren.

 

[Rebecca85]

If you don't want to risk ibuprofen gel like Voltareze, you could try Deep Heat. This heats the skin up anfmd has a similar effect to putting a hot water bottle on it.

I have also heard of a new NSAID which is supposed to be gentler and OK for people with IBD to use, can anyone remind me of the name??

 

[DustyKat]

Are you thinking of Celebrex?

 

[beth]

There are a number of COX2 inhibitors that may help, but do consult with your GI. Mine did not like the idea of any of them let alone the ones recommended by my rheumatologist.

(reminds me; must flesh out the nsaid pages more on topical gels and cox1/2 inhibitors because the chemistry is very significant to us, any that gets into the blood stream will screw with your guts)

I would recommend Gabapentin, or the newer Pregabalin. The former was the only thing that allowed me to keep my sanity when my jaw and back pain started up. It's very good stuff, but quite sedative and if you have a 'thinking' job may have an impact on your work.

 

[DustyKat]

Unfortunately over time the new NSAID's have proven to have many of the side effects as the original one's. Although many studies appear to support the claim that there are less GI side effects they still do exist.

Working in the health field we received warnings early on in the release of these newer drugs that the side effects weren't as significantly reduced as claimed. The complaints from the patients that I dealt with regarding GI upset wasn't much different as to when the older drugs were used.

Dusty.

 

[Crohn's 35]

I use Myomed, it is a natural sportsmedicine rub, pretty pricey but it seems to work, and not all that smelly stuff :stinks:

Myomed was made by professionals for persons who can't use steroids etc. My is almost $27.00 cdn.

 

[HeatherMN]

Tramadol or Ultracet is usually well tolerated, I have taken those for pain. Flexeril is a muscle relaxer I take at night as it makes me very tired. There aren't many muscle relaxers that don't have that effect, but there is one called Skelaxin that doesn't make people as sleepy as some.
Physical therapy, acupuncture or trigger point injections may be of some help to you also. I have neck/shoulder issues as well, mainly from my fibromyalgia.

 

[D Bergy]

I would take a look at this thread and see if it might do the trick.

http://www.crohnsforum.com/showthread.php?t=12718

dan

 

[Astra]

Hi Wiggles

I've seen an osteopath 3 times, he said my neck and shoulder pain is Arnolds Neuralgia

http://en.wikipedia.org/wiki/Occipital_neuralgia

I have a lot more mobility and movement now!
As well as that, my GP has given me 25mg Amitryptiline, and I take 2 paracetamol every 6 hours, he explained it to me how this works, instead of two every 4 hours then maybe a lapse of 9 hours without when you sleep, won't work. I take them 6am, 12 noon, 6pm and 12 midnight. (8 tablets in a cycle of 24 hours) and doing it like this has stopped the pain. Try this for a while, it's worked for me.
xxx

 

[Wiggles]

Are you thinking of Celebrex?

That's the one I was put on initially - couldn't remember the name. Made me sick as a dog! But, frustratingly, helped my shoulder like magic.

 

[Wiggles]

Thanks all for your thoughts. I don't know much about how topical NSAIDs - does the stuff get into the bloodstream if it's applied topically?

Astra, do you find the amitryptiline knocks you around? I take a nightly 10mg dose to control my CD symptoms (which interestingly it does quite well in my case) but even that dose makes me extremely sleepy.

Unfortunately the suggestions that involve things that make you drowsy probably aren't really options for me either - beth as you guess I have a "thinking" job and am drowsy enough due to poor sleep habits!

I will talk to my GI about topical stuff, I think.

 

[Wiggles]

I would take a look at this thread and see if it might do the trick.

http://www.crohnsforum.com/showthread.php?t=12718

dan

Interesting - I wonder if that stuff is available here (Australia). I will have to investigate.

 

[beth]

You need to crack the poor sleep then for a start. I've got a bit of a tee-shirt there... Why are you sleep patterns messed up? from the CD, toilet emergencies/etc or brain can't switch off...

The shoulder pain I can also sympathise with. I think I did a little damage some years ago when I didn't tuck a shotgun stock into my shoulder quite right. At least it gradually started hurting after that and sitting at a desk can provoke it to hurt alot.

Anyway, how about pain relief patches and physio exercises?... I'd hesitate to recommend you try oral opiates, I found Butrans 5ug/h patches tho were enough to take the edge off the pain without bunging me up to the armpits. The occasional break through pain could then be controlled with normal paracetamol and codeine.

Topical NSAIDs get through the skin just like a patch can deliver drugs into your blood stream, and from there reek havoc with the internal lining of the gut. The skin is not an impervious membrane. Albeit less then oral or IV, for sure. However I really wouldn't risk it especially so for chronic use.

Amitriptyline may not be what you want with a 'thinking' job either, it's quite sedating, and may be messing up your sleep by itself. Have you talking to your doctor about coming off it, or alternatives? And have you seen anyone at a pain clinic? Round here there is a team dedicated to solving rricky cases of chronic pain relief. It would be worth seeing someone who may have a fresh look at everything you are struggling with and see a way through the fog!

 

[Astra]

Hiya Wiggles

Yes the amitryp certainly knocks me out! but it's a godsend! I was writhing in agony without any quality sleep, now I'm getting a full 8 hours easy! I'm a bit groggy when I wake up and I have a very stressful, thinking job too, with ASD kids, but doing ok with 25mg Amitryp, and hoping to reduce to 10mg this weekend. I have also found that paracetamol doesnt make you sleepy, but other painkillers do, and the topical gel I use sometimes is called Ibugel, with ibuprofen in it, it is localised and doesn't enter the bloodstream, and it works!
xxx

 

[roundtuit]

"...the topical gel I use sometimes is called Ibugel, with ibuprofen in it, it is localised and doesn't enter the bloodstream, and it works!..."

That is what my Dr told me too...that the first study feedback was positive and the NSAID in the topical was staying localized. He also noted there was not enough info available yet on the effects on crohn's sufferers to be sure what would happen in each case and the trunk ot the body would likely be a risky choice for application.

 

[Astra]

Yes Joni, this makes sense about trunk application, but regarding neck and shoulder pains or knee and ankle pains, my gastro and GP are both of the opinion that it's ok. I've been applying Ibugel for a while now, it has a lovely hot feeling! But it stinks like fish! lol
xxx

 

[Wiggles]

You need to crack the poor sleep then for a start. I've got a bit of a tee-shirt there... Why are you sleep patterns messed up? from the CD, toilet emergencies/etc or brain can't switch off...

Sleep's always been an issue for me - mostly the "can't switch brain off" type of sleeplessness. Before I got sick I really only needed 6-7 hours to be fine, nowadays no matter what I do I can't get good sleep and even when I do sleep I feel no different on 7 hours or 12 hours(!). I probably have plenty of red flags for sleep problems - caffeine, booze, insufficient exercise, insufficient relaxation time, stressful job, depressive personality... the works!.

Anyway, how about pain relief patches and physio exercises?... I'd hesitate to recommend you try oral opiates, I found Butrans 5ug/h patches tho were enough to take the edge off the pain without bunging me up to the armpits. The occasional break through pain could then be controlled with normal paracetamol and codeine.

I have been getting physio treatment for a month now - it's actually worked wonders, I'm in far less pain than I was. I wish I'd done it a couple of years ago!

Amitriptyline may not be what you want with a 'thinking' job either, it's quite sedating, and may be messing up your sleep by itself. Have you talking to your doctor about coming off it, or alternatives? And have you seen anyone at a pain clinic? Round here there is a team dedicated to solving rricky cases of chronic pain relief. It would be worth seeing someone who may have a fresh look at everything you are struggling with and see a way through the fog!

The thing about the amitriptyline is that I'm taking it for its side effect of being a smooth muscle relaxant, rather than pain per se - basically to slow my digestive system down a few notches. It works reasonably well for this purpose, it's certainly more effective than other things I've tried in terms of controlling symptoms. I am considering coming off it though, I am just so damn fuzzy all the time!

 

[Wiggles]

Hiya Wiggles

Yes the amitryp certainly knocks me out! but it's a godsend! I was writhing in agony without any quality sleep, now I'm getting a full 8 hours easy! I'm a bit groggy when I wake up and I have a very stressful, thinking job too, with ASD kids, but doing ok with 25mg Amitryp, and hoping to reduce to 10mg this weekend. I have also found that paracetamol doesnt make you sleepy, but other painkillers do, and the topical gel I use sometimes is called Ibugel, with ibuprofen in it, it is localised and doesn't enter the bloodstream, and it works!
xxx

How did you go coming off 25mg?

Unfortunately I find paracetamol fairly ineffective... god I miss asprin! Only non-opiate painkiller that ever really worked for me.

 

[Astra]

Hi Wiggles

I decided to stay on 25mg for another month, this is cos I'm coming off the Pred this week, need the amitrip to back me up!
How are you doing now?
xxx

 

[Wiggles]

Hi Wiggles

I decided to stay on 25mg for another month, this is cos I'm coming off the Pred this week, need the amitrip to back me up!
How are you doing now?
xxx

I actually took the opportunity over Christmas to get off meds altogether. So far it's going ok - certainly no worse, so I suppose that is a sign that the meds at best were doing very little for me any more. Symptoms still come and go but they're a lot more stable than they were a couple of years ago.