Stopping NSAID (ibuprofen) for two weeks for MRI

[Antje77]

Completely unrelated to diabetes but thought to ask for thoughts here first because, well, you're my gang, my friends, and this is my home. And without a clear diagnosis so far, I don't even know where to start finding a more suitable forum for my questions.

In spring this year I got a surprise referral to a rheumatologist (went in to ask for a referral to a physio for back pain and recurring joint inflammation). X-rays were taken, bloodtests were done, I even got to see a dermatologist to rule in/out psoriatic arthritis, with none of this resulting in a clear diagnosis.
On the other hand, the rheumatologist didn't refer me back to the GP so she must think there's something there.

Recently I visited the GP with new and very annoying pain in my neck, and he ordered an MRI of my neck and lower back to see if there's evidence of AxSpA. The MRI has reluctantly been approved by the rheumatologist so I'll have it on Jan 25.
In the mean time, I'm now on 800-1600 mg ibuprofen prolonged release (instead of the regular over the counter ibuprofen I was already taking), which is a godsend because it allows me to sleep a full night. I regularly add 1000 mg of paracetamol as well, depending on pain.

Recent studies found that 1 in 4 AxSpA diagnoses are missed if the patient is on ibuprofen, and that patients should be encouraged to stop two weeks prior to an MRI if possible.
So this is what I plan to do, but I also want to sleep and not be miserable from pain.
I don't have a lot of trust in the rheumatologist, so far she hasn't really followed the official guidelines on a couple of things, so I guess I'm on my own here.

I'm not sure what my question is, but if it rings a bell, if you got any experience on the matter, or even if you have some random ideas, please share!

 

[EllieM]

Interesting article here about alternatives for people who can't take NSAIDs because of heart issues

Heart-safer NSAID alternatives - Harvard Health

Common pain relievers known as nonsteroidal anti-inflammatory drugs (NSAIDs) carry an added risk of heart problems. Use only what you need and for only as long as you need it. Men with heart proble...

www.health.harvard.edu

Will you be seeing a physio again before you drop the meds?

 

[JoKalsbeek]

You could try FODMAP for a while, but if they need to see the full impact of the condition, I'm guessing reducing inflammation isn't going to be helpful at this stage. Maybe e-mail the gp with this NSAID-info and request something to help you sleep in the interim? It'll be a miserable two weeks either way, but if sleeping through parts of it is an option for you, that might help. Once the scan is done though, FODMAP might make some difference.

Had me some cheese yesterday by accident, was distracted when I put in my order and only remembered to cancel bread, and within two hours my left shoulder and all fingers started protesting. They still are sore, probably will be for another day or so. If I was taking cowmilk products regularly, I'd be unable to brush my hair or handle a doorknob again. (Had very short hair for a while, and being a shut-in hermit at the time, helped with me not having to turn keys and knobs). I know that no cowmilk products is a no-go for you, and I can't guarantee for a moment it would work for this particular kind of inflammation, but as a temporary measure, between the scan and until results of the MRI are in and the rheumatologist wakes up? Goat's milk is truly delightful, and you could maybe even fit a goat in your garden if it turns out well.

In any case, hope you'll know what's what soon... It's all been taking far too long already for you to get some proper help with this!

Hugs,
Jo

 

[Prancy]

Completely unrelated to diabetes but thought to ask for thoughts here first because, well, you're my gang, my friends, and this is my home. And without a clear diagnosis so far, I don't even know where to start finding a more suitable forum for my questions.

In spring this year I got a surprise referral to a rheumatologist (went in to ask for a referral to a physio for back pain and recurring joint inflammation). X-rays were taken, bloodtests were done, I even got to see a dermatologist to rule in/out psoriatic arthritis, with none of this resulting in a clear diagnosis.
On the other hand, the rheumatologist didn't refer me back to the GP so she must think there's something there.

Recently I visited the GP with new and very annoying pain in my neck, and he ordered an MRI of my neck and lower back to see if there's evidence of AxSpA. The MRI has reluctantly been approved by the rheumatologist so I'll have it on Jan 25.
In the mean time, I'm now on 800-1600 mg ibuprofen prolonged release (instead of the regular over the counter ibuprofen I was already taking), which is a godsend because it allows me to sleep a full night. I regularly add 1000 mg of paracetamol as well, depending on pain.

Recent studies found that 1 in 4 AxSpA diagnoses are missed if the patient is on ibuprofen, and that patients should be encouraged to stop two weeks prior to an MRI if possible.
So this is what I plan to do, but I also want to sleep and not be miserable from pain.
I don't have a lot of trust in the rheumatologist, so far she hasn't really followed the official guidelines on a couple of things, so I guess I'm on my own here.

I'm not sure what my question is, but if it rings a bell, if you got any experience on the matter, or even if you have some random ideas, please share!

I took the opportunity to read up on AxSpA. It certainly does looks painful. How are you doing? I admire your courage to reduce a med temporarily that helps reduce pain. I get why you want to do it. I saw the article that describes patients using NSAIDS during the MRI. My reading about AxSpA lead me to Psoriatic Arthritis, which appears to be its cousin and a condition my cousin has.
I have no experience with this condition or testing, but I can say that often when people have pain, Gabapentin is prescribed. It works in a mysterious way, apparently…..blocks pain signals….you might explore it with your doctor. I took it for 2 weeks for pain. Regardless, I hope you are able to find some options to help.

 

[VashtiB]

I agree with @JoKalsbeek

I regularly take painkillers for my neck to help me sleep. I'm trying without over the Christmas break. Not great.

Unfortunately I suspect to get the most value out of the MRI you will have a couple of weeks of pain. I think while it will be terrible it is worth it to get the best possible likelihood of a result from the MRI- you've suffered long enough it would be good to get some answers.

Good luck.

 

[Rachox]

As you know @Antje77 I had surgery on my foot last month. My surgeon said to stop NSAIDs (which I take for arthritis in various joints including my neck) just before surgery and I continue without it post op to try and get my bones to heal properly. He said the bones need to create an anti inflammatory response to heal, so I am relying on an orthopaedic pillow to get my neck comfy in bed.
Your case is different of course but I’m guessing that they don’t want to mask any inflammation which they would need to see to help diagnose you correctly.

 

[filly]

As you know @Antje77 I had surgery on my foot last month. My surgeon said to stop NSAIDs (which I take for arthritis in various joints including my neck) just before surgery and I continue without it post op to try and get my bones to heal properly. He said the bones need to create an anti inflammatory response to heal, so I am relying on an orthopaedic pillow to get my neck comfy in bed.
Your case is different of course but I’m guessing that they don’t want to mask any inflammation which they would need to see to help diagnose you correctly.

I only had to stop 5 days pre op and started back on 2 days post op. No problems at all.

 

[Rachox]

I only had to stop 5 days pre op and started back on 2 days post op. No problems at all.

My problem is I had the operation originally in May, then I stopped Naproxen a few days before to six weeks after and the bone didn’t heal properly, so had to have the op redone, this time I’m off it at least til my 8 week follow up

Sorry for the derailment @Antje77 x

 

[Pipp]

I have had spondylosis of cervical spine for over 30 years. Can’t take any sort of NSAIDs at all, as they are contraindicated for a different condition.

What has helped? Swimming and other exercises in water. Gentle physio exercises using resistance bands, supervised at first by physiotherapist. Acupuncture, even if it is just a placebo effect, it helps. Bathing with magnesium salts added to the warm water. Heat pad applied to painful area. Tens machine. Oh, and I have to take strong antihistamines for allergies. If I have these in the evening I sleep soundly. Relaxation techniques / self hypnosis rather than meds. I meditate and take the mind away from the painful stimulus. That took some trial and error before getting it right, but I also use the method for having dental treatment without anaesthetic.

When I have an MRI scan I make sure I am positioned comfortably before being slid into the machine tube. Usually need to lie still for at least half an hour, flat on back, so make sure there is cushion supporting lower back and behind knees. It also helps to relax and zone out the loud noises of the machine.

Hope this helps a bit @Antje77

 

[jessj]

As you take paracetamol, is it possible for you to take co codamol, para with added codeine? To cover you for the 2 weeks, a bit of added pain reliever may get you through.

 

[AndBreathe]

I'm absolutely not allowed NSAIDs, due to another condition. My pain relief choices are paracetamol, or co-codamol, then ramp up to the opioids.

Thankfully, my needs have been limited in that regard, but the rheumatologist I saw (investigating RA - I don't have that, thankfully) was to look into Capsaicin. She explained it is a pretty natural sort of thing, and my GP could prescribe it, if I wanted to give it a go.

https://www.wwl.nhs.uk/media/.leaflets/6183b1ddd74498.98911999.pdf

I couldn't face wrangling my GP into any form of action, so looked it up, and lo and behold there are various recipes out there, to make it for yourself.

In essence, when rubbed on the skin, it generates warmth, which is sort of comforting, and allegedly works a bit like a TENS machine, by deflecting your pain receptors (they're too busy enjoying the warmth). I have quite enjoyed using it, when needed. I'd certainly prefer that to the pharmaceutical alternatives.

Capsaicin Cream for Joint Pain

Capsaicin cream is a topical pain reliever that can be used to help alleviate joint pain from arthritis.

www.arthritis-health.com

Pain is rubbish.

 

[Antje77]

Wow, so many friendly and useful replies to my rather vague question, thank you!
I'll go through them one by one.

Interesting article here about alternatives for people who can't take NSAIDs because of heart issues

Heart-safer NSAID alternatives - Harvard Health

Common pain relievers known as nonsteroidal anti-inflammatory drugs (NSAIDs) carry an added risk of heart problems. Use only what you need and for only as long as you need it. Men with heart proble...

www.health.harvard.edu

Will you be seeing a physio again before you drop the meds?

I think I'm not going to worry about the heart risk for now. It's only a small increased risk, and while I do ticks some other risk factors, there are no heart issues in my family history.

I haven't seen a physio at all (except once some 10 years ago for a tennis elbow). Two GP's and the rheumatologist advised me not to until more is clear. Which is fine with me, my insurance doesn't pay for physio. I have upgraded my insurance for next year though, so I can see one 9 times in 2024.

You could try FODMAP for a while, but if they need to see the full impact of the condition, I'm guessing reducing inflammation isn't going to be helpful at this stage. Maybe e-mail the gp with this NSAID-info and request something to help you sleep in the interim? It'll be a miserable two weeks either way, but if sleeping through parts of it is an option for you, that might help. Once the scan is done though, FODMAP might make some difference.

FODMAP? No cow's cheese? <Puts fingers in ears and loudly sings LALALALA>
Way too early into a diagnosis to start contemplating making my life so much more miserable for a small chance of improvement. Giving up bread and crisps was bad enough.

And yes, at this moment I don't want to do anything that can reduce inflammation. If there is anything to be found on that MRI, I want them to find it!

Goat's milk is truly delightful, and you could maybe even fit a goat in your garden if it turns out well.

I wouldn't mind swapping to goat's milk, but not goat's cheese only. My friend gave me a cheering up present of 35 euros to be spent solely on cheese, so if anything, I'll eat more of it in the near future!
Two goats fit in my garden, I used to have two, but they were male, no milk.

 

[Antje77]

I took the opportunity to read up on AxSpA. It certainly does looks painful. How are you doing? I admire your courage to reduce a med temporarily that helps reduce pain. I get why you want to do it. I saw the article that describes patients using NSAIDS during the MRI. My reading about AxSpA lead me to Psoriatic Arthritis, which appears to be its cousin and a condition my cousin has.
I have no experience with this condition or testing, but I can say that often when people have pain, Gabapentin is prescribed. It works in a mysterious way, apparently…..blocks pain signals….you might explore it with your doctor. I took it for 2 weeks for pain. Regardless, I hope you are able to find some options to help.

I think gabapentin isn't usually prescribed for this type of pain so I think I'll look into different approaches for the two weeks I'll have to do without ibuprofen. I'll keep it in mind though!
I'm doing pretty well at the moment, provided I use enough painkillers. Rheumatologist hasn't completely ruled out psoriatic arthritis either, I hope your cousin is doing well.

Sorry for the derailment @Antje77 x

No worries!
I can't remember ever having started a thread that didn't derail, and I certainly don't mind.
I hope your foot is slowly improving now.

I have had spondylosis of cervical spine for over 30 years. Can’t take any sort of NSAIDs at all, as they are contraindicated for a different condition.

What has helped? Swimming and other exercises in water. Gentle physio exercises using resistance bands, supervised at first by physiotherapist.

Those things I'm already doing, more or less. Twice a week aquarobics, once a week to the gym (not supervised by a PT and not gentle exercises either, but it doesn't hurt so it should be helpful), and once or twice a week a cold water swim, which may or may not help but doesn't hurt either.

Relaxation techniques / self hypnosis rather than meds. I meditate and take the mind away from the painful stimulus. That took some trial and error before getting it right, but I also use the method for having dental treatment without anaesthetic.

When I have an MRI scan I make sure I am positioned comfortably before being slid into the machine tube. Usually need to lie still for at least half an hour, flat on back, so make sure there is cushion supporting lower back and behind knees. It also helps to relax and zone out the loud noises of the machine.

Dental treatment without anaesthetic. You're a very brave person.

Not sure I have the patience to meditate. The pain is worst when not moving much for a couple of hours, so the last hours before waking up cause me to keep turning to find a way to be less painful, and the last hours before bed my neck is killing me. Moving and exercising are just fine.

I'll definitely ask for a pillow behind my knees for the MRI, I'm expecting having to lay still for half an hour flat on my back will be very painful even with a pillow. Thanks for the tip!

 

[Antje77]

As you take paracetamol, is it possible for you to take co codamol, para with added codeine? To cover you for the 2 weeks, a bit of added pain reliever may get you through.

Codeïne is a prescription drug in the Netherlands (except for some mysterious reason in just one brand of sweet cough syrup).
But the GP gave me a generous amount of tramadol, which I only needed for a couple of nights until I got the prolonged release ibuprofen.
I think those will be helpful to see me through the nights!

I'm absolutely not allowed NSAIDs, due to another condition. My pain relief choices are paracetamol, or co-codamol, then ramp up to the opioids.

Thankfully, my needs have been limited in that regard, but the rheumatologist I saw (investigating RA - I don't have that, thankfully) was to look into Capsaicin. She explained it is a pretty natural sort of thing, and my GP could prescribe it, if I wanted to give it a go.

https://www.wwl.nhs.uk/media/.leaflets/6183b1ddd74498.98911999.pdf

I couldn't face wrangling my GP into any form of action, so looked it up, and lo and behold there are various recipes out there, to make it for yourself.

In essence, when rubbed on the skin, it generates warmth, which is sort of comforting, and allegedly works a bit like a TENS machine, by deflecting your pain receptors (they're too busy enjoying the warmth). I have quite enjoyed using it, when needed. I'd certainly prefer that to the pharmaceutical alternatives.

Capsaicin Cream for Joint Pain

Capsaicin cream is a topical pain reliever that can be used to help alleviate joint pain from arthritis.

www.arthritis-health.com

Pain is rubbish.

Absolutely worth a try, so cayenne and coconut oil are now on my shopping list, and I copied the recipe to my CMT account!
If it doesn't work I can still use it to spice up food, seems a very versatile recipe.

@JoKalsbeek , this may be useful for you as well, and the recipe is ridiculously simple.

 

[JoKalsbeek]

Codeïne is a prescription drug in the Netherlands (except for some mysterious reason in just one brand of sweet cough syrup).
But the GP gave me a generous amount of tramadol, which I only needed for a couple of nights until I got the prolonged release ibuprofen.
I think those will be helpful to see me through the nights!

Absolutely worth a try, so cayenne and coconut oil are now on my shopping list, and I copied the recipe to my CMT account!
If it doesn't work I can still use it to spice up food, seems a very versatile recipe.

@JoKalsbeek , this may be useful for you as well, and the recipe is ridiculously simple.

Yeah, ah... Cayenne makes me swell up, rather allergic to the stuff, haha. But it may be something to look into... Maybe I don't balloon if it's topical, no idea. Hope it helps you!

 

[Rachox]

The trouble is with alternatives to NSAIDs which mimic their action, is they may suppress your body’s inflammatory response. By taking codeine (prescription only in the UK too) or Tramadol this won’t happen, because they are simply painkillers with no anti inflammatory action, and it may be the absence of inflammatory response that your Drs are trying to avoid for you MRI

 

[Antje77]

The trouble is with alternatives to NSAIDs which mimic their action, is they may suppress your body’s inflammatory response. By taking codeine (prescription only in the UK too) or Tramadol this won’t happen, because they are simply painkillers with no anti inflammatory action, and it may be the absence of inflammatory response that your Drs are trying to avoid for you MRI

This was exactly my thinking.
Not my doctor's though, she didn't say anything about stopping ibuprofen, my own idea after googling some studies.

I think I'll go with regular paracetamol throughout the day, with an added tramadol if needed for the night, plus @AndBreathe 's interesting recipe.

 

[Rachox]

regular paracetamol throughout the day, with an added tramadol if needed for the night

That’s what I’m doing while I can’t take my Naproxen, except I take codeine at night as Tramadol gives me a nasty headache.

 

[MrsA2]

I'm another suggesting non- drug solutions. To @Pipp suggestions I add changing pillow. I use a firm foam one that from the side looks like a figure 8, so head fits in dip and neck is supported. Also massage of shoulders and neck. Could the ibuprofen gel help instead of the digested? Would that sway results at all?
And hugs of course, lots and lots of hugs

 

[Antje77]

I'm another suggesting non- drug solutions. To @Pipp suggestions I add changing pillow. I use a firm foam one that from the side looks like a figure 8, so head fits in dip and neck is supported. Also massage of shoulders and neck. Could the ibuprofen gel help instead of the digested? Would that sway results at all?
And hugs of course, lots and lots of hugs

I tried one of those pillows, but even the lower side is too high. So now I use a feather pillow, old enough to be kneaded in the shape I want, sometimes with an added plush piglet under my neck. (Which was an accidental find, it just happened to be in that exact spot without me noticing one night, instant relief! )

I'm not sure about the topical ibuprofen, but for those two weeks I'd rather go completely without to be sure. I don't think any studies have been done on that, the study I found is from this year.

Massage sounds wonderful, regardless of it helping or not, but it's also expensive if you can't find friends who want to give it a go.