Cortisone Injections v Tramadol?

[FrenchieBoy]

I went to the doctor on Thursday to see about an alternatives to taking Tramadol to ease the constant pain in my hip and knee. I've been on Tramadol (2 x 50mg tablets to be taken four times a day) for the best part of over 5 years now and was not too happy about being on these darned awful tablets for so long. For those who don't know anything about Tramadol they are Morphine based and are believed to be quite adictive as well as having some pretty nasty side affects.

The outcome was that the doctor decided to send me for some x-rays to see how the wear in my hip and knee is progressing and on the x-ray request letter it said "x-ray right knee and right hip - Considering replacements"! (The x-rays were done on Friday but I have to wait for the results to filter through to my doctor)

However while chatting to the doctor he said that he thought a replacement operation was unlikely due to the problems/treatment I have had with my heart over the last 6 months. What he is suggesting now is that I should have a Cortisone injection in my knee (which he will be doing next Wednesday) and then I will have to go to the hospital for another lot of Cortisone injections in my hip. This will not cure the "root problem" (Hip and knee both wearing out due to me being an old fart) but at least it will hopefully aleviate the pain and the need for these wretched Tramadol tablets for "pain relief", and help towards improving my mobility and lifestyle!

I am not complaining about "my lot" and I realise that there are a great many people out there who are a lot worse off than I am so I am quite "comfortable" with this decision (Especially if it means that I can get back into more serious stalking/shooting without so much pain) but even so are there any SD Members who have got/had any experience of Cortisone injection that can tell me how effective at pain relief these injections are please?

I realise that some do not like talking about "personal health problems" on an open forum so please feel free to reply by PM if you prefer.

 

[finnbear270]

Last time I had cortisone jags, I was informed that there was a limit to around three or so, before they would no longer be given, not sure if this is still the case as maybe they have been re engineered a bit?

 

[FrenchieBoy]

Last time I had cortisone jags, I was informed that there was a limit to around three or so, before they would no longer be given, not sure if this is still the case as maybe they have been re engineered a bit?

Thanks for that reply! Unfortunately if what you say is right (And i have no reason to disbelieve you) it hasn't exactly filled me with confidence.

 

[deeangeo]

Tramadol is a synthetic opiate derivative and as with most painkillers has side effects starting with bunging you up! I don't envy you having to take these over such an extended period....so I'd guess some relief from a different direction has to be worth a try. Good luck with that & I hope the relief lasts a considerable time.

 

[N.F.W.M]

You think Tramadol are bad whilst taking them......It will not be an easy ride stopping taking them after 5 years. Strongly suggest you take doctors advice on how to cease their use.

 

[big ears]

Hi to be honest I would not accept either. I would ask for a referral to an orthopaedic surgeon. There are things that will not show up on X-ray that can be treated. Knee pain can also be referred from the hips. As to not being able to have a replacement they operate under spinal anaesthetics so your heart may not be such an issue. Tramadol is a nasty drug and I agree you should try to get off it if you can.

BE

 

[Vipa]

You think Tramadol are bad whilst taking them......It will not be an easy ride stopping taking them after 5 years. Strongly suggest you take doctors advice on how to cease their use.

+1 on that... I was on Tramadol for 5 days and suffered quite severe withdrawal symptoms.. Good luck Frenchie, hope they get you sorted

 

[finnbear270]

On the issue of pain in the joints (generally speaking), I have periodic attacks of gout, sometimes completely disabling from the point of walking or using the car foot controls, I use when absolutely can't cope anymore, an NSAID, called Piroxicam, it usually defeats this pain within either a couple of hours or at most a day or so, it might have an application in your case, why not ask the doc about NSAID's.?

 

[Hornet 6]

See how the cortisone works for you before worrying about anything else is my advise.
I have in the past had cortisone treatment in both shoulders and left knee, and recently my right knee.
Both shoulders improved a great deal, both needed surgery in the end, but it bought 10 years for my right shoulder and 20 for the left.
I broke my left knee cap aged 18, I had years of pain and stiffness from that, a cortisone injection at age 25 ended the pain permanently, or at least has worked for the last 30 odd years. My right knee is a different story, cortisone twice in the last 5 month, no lasting benefit at all, last week I had a different injection, will see how that goes, hopefully they will find an injection that works for me, because I am not having a new knee at my age until it is the only choice that will keep me out of a wheel chair, I know of far to many people who have had replacement knees and wish they had not bothered.

Neil.

 

[Greymaster]

You will certainly feel some immediate benefit from the injections, and there maybe a prolonged but finite improvement in the base level of pain. They are palliatives nevertheless and surgery may be the only long term solution. I had heard about the 3 injections maximum per year. This tends to come about due to say a 3 month wait to get the first injection, then a three month wait for a follow up consultation, then maybe a shorter wait for another injection, then another 3 months wait for a consultation etc.

I wish it could be that you could use the wait time concurrently, i.e. be on the waiting list for the post injection consultation and also for the next injection you know you will need.

I feel if they could really zap the inflammation with three three-monthly injections, then you will only suffer from the grinding pain of bad joints, which is bad enough, but it is exacerbated by the inflammatory synovitis and effusions.

As I say, longer term it will be only the surgery that will resolve the situation, but it is no use being old and decrepit with great hip and knee joints, you need resolution now while you are still fit enough to get out and about and want to get out and about. It is the appreciation of this aspect which is sadly lacking by the medicos, IMHO.

 

[AN DU RU FOX]

hi frenchie ive had a few injections now the first in my shoulder worked for a few months but ive had three or four now and the pain/and soreness is still there but nowhere near as bad,im thinking of going back and asking him to do one of my knees,im still on tablets but i limit when and if i take them,

 

[Muir]

Here in the states we often use and injection Triamcinolone 40mg with Bupificaine 0.75%. If your knees are not bone-on-bone this will work very well on inflammation. Results vary with the precision of the injection. Ultrasound guided are usually the best. If the joint is really grating, there s a long term injection you can get which is Synvisc. It is a synthetic synovial fluid made from rooster combs (no joke)so it is contraindicated for people with egg allergies. I don't know if any of these treatments are available in the UK but I've seen good results with these drugs.

FWIW, I had bilateral hip replacements over the last 6 years. It was a new lease on life. If you get cleared for replacements don't hesitate.~Muir

 

[FrenchieBoy]

Thanks for all of the replies guys. They have certainly given me something to think about.
The thing to remember is that no matter how hard a kick in the teeth life seems to have given you there are always plenty that are worse off than you that don't winge and complain so what the heck do we have to complain about?

 

[paul o']

from my many jabs in joints one hurts in a dry joint and one stop's you from having a good crap its your choice enjoy the ride would add use soft wood to bite on it saves a trip to the tooth doc later on !!!

 

[bobjs]

I'm on year 3 of tramadol and now still taking them all be it just 3 x 50 mg a day with a top up in the middle of those three I have a morphy 10 mg slow release pills,

Thisvis due to the new knee going a bit tits up, ( bread on the knee) andi prefare the pills even it hey are harder o get of,

I had a few years of lower spinal jabs once a month that only seamed to do anything for the first 3 days and then nothing .

Sonce the op on l4/5 I have had no issues, but was that down to the op or the fat that I had other things going on to take my mind o the pain, in my eyes the jabs where not that pod,

Jmo,

Bob

 

[bobdabob]

Hi Frenchieboy

Sympathise entirely with what your going through! been down the same route with the tramadol and diclofenac! Nasty stuff indeed but ive found that diclofenac does work even though there have been concerns about problems relating to the heart and a lot of gps aren't to keen on using it, preferring naproxene! whilst on them ! That said I had a triple heart bypass 5 years ago and basically said id take responsibility for the diclofenac worry! The cortisone is different for every body ! But take it from me mate ive osteoarthritis in both hips and when it gets to a certain level of wear and tear they don't do a damn bit of good ! My advice is act now to get yourself on the down the joint replacement route ! Im now on morphine so have been through what your going through ! theres that long a back log for orthopaedic surgery its a case of they'll fob you off with anything till they catch up on the back log ! Hope I haven't burst your bubble but don't give them an inch ! weve all paid for the NHS afterall ! By the way im an old 49

Alan

 

[Cootmeurer]

I have always had a problem with opioids/opiates (LOTS of bad and strange side effects). For my shoulder, which has still not required surgery, but will, I have had the cortisone injections and was quite pleased.

any pain I still have can be managed by simple OTC meds, and joint management (there are certain motion ranges that do not aggravate, and one specific range that is guaranteed to aggravate - so I stopped doing that one)

 

[tomblincoe]

Lots of reasonable advice here.

There is really no downside to the steroid injections apart from a very small chance of introducing infection into the joint, the injection is obviously done in a sterile fashion to minimise this.

As Muir said the steroid is usually a mixture of Triamcinolone (the steroid) and Bupivicaine (local anaesthetic) as a temporary measure to put off definitive treatment/joint replacement. The reason there is a limit to the steroid injections is to reduce the chance of adrenal supression, a side effect of any chronic moderate to high dose steroid use.

Tramadol is a safe, moderately strong opoid (although it also has actions on the serotonin receptor) and you are clearly tolerating it well if you have taken it for 5 years! Coming off it will potentially be hard, don't underestimate the effect on your mood, bowels, sleep etc when you start to reduce the dose.

If you want an idea about whether your previous heart problems will make anaesthesia/surgery risky feel free to PM me some more details.

It would be a good idea to ask for a referral to the orthopaedic surgeons in the meantime just to get the ball rolling, if they consider a joint replacement necessary you will be referred to an anaesthetic preassessment clinic where a decision will be made as to your fitness for an anaesthetic.

Tom
(Anaesthetic Registrar)
GMC No. 6149794

 

[DK.260]

Hi Frenchie

My husband just threw this at me since I splurged WTF at the question. My answer would be neither, until you have got a lot more answers. I'm a stalker and physiotherapist - I work with high level sports people for a day job and old gits with guns in my spare time! If you read the NICE guidelines (Osteoarthritis | 1-Recommendations | Guidance and guidelines | NICE) which are the latest in evidence for various conditions, you'll see that exercise is well recognised for OA. A lot of the guys I see are fit, but have poor leg strength (and some good bought-and-paid-for bellies...). You don't mention anything about strength and conditioning. You will also see that treatment is incremental - you appear to be at the "whoa there" stage, with no mention of the previous, well recognised interventions. Having said that, once you get to the stage where the Ex/weight loss/paracetamol/rub on anti-inflammatories/oral anti-inflammatories and then opioids are not working, you will see that CSIs and then replacements are well indicated. You need to understand that post-operation can be blooming painful so you must get pain relief sorted and GET GOING to see good results. I see very successful replacement hip and knees in the shooting fraternity (two of whom I stalk with regularly and they beast me up and down the hills!).

I agree with Tom that a referral to a surgeon who does replacements in fit, active populations (do check out the surgeon online as different ones have different specialties and you will want to see someone who is well practised in what you are going to have) would be a good idea but would highly recommend, if you've not done any specific strength work, to book a reputable sports physio (no I'm not touting for business!) and get strong which will either fix it, or be excellent pre-hab before an injection/surgery.

Best of luck and good shooting.

H

 

[rabidrobin]

Hi FrenchieBoy, dodgy hips and knees are a pain! Had mine done a few years ago. Rt hip resurfacing, Lt full replacement, Rt knee replacement and a quadruple heart bypass all within the last 10 years. Result - no pain no problems, 85% mobility. I had complete faith in my doc, consultant , QA Hospital Portsmouth and the NHS. Good Luck.