The biggest cause for concern with many diseases and bodily ailments is the pain that comes with it. I have not heard of any illness that does not manifest itself in some type of pain at some points, even if it is only discomfort-style pain. The issue with pain is the treatment/management of pain. On-going pain requires on-going pain treatment/ management plan. Many autoimmune diseases present with on-going pain of a strength which requires localised and specific pain management medicines. The two most common permanent and low-risk medications are mentioned below.

As I mentioned earlier there are a few types of management and treatment for pain, depending on the type of pain or the source. For the occasional pain it is okay to use ‘Over The Counter’ (OTC) medication. However, when the pain is regular or persistent in its presentation, gradually increasing over time or localised to a specific location in the body that has no perceivable cause for occurring then it is necessary to visit a doctor for prescribed pain medication.

As always, I speak from my own experience and so I would like to specify to begin with that I can only cover topics which I have worked with. I have been diagnosed with three autoimmune diseases in the last 10 years, Systemic Lupus Erythematosus (SLE or Lupus), Rheumatoid Arthritis (RA) and Cerebral Vasculitis (CV). As well as this I have had many coinciding side-illnesses as a result of my compromised autoimmunity, all of which are covered individually and can be found here.

Disease Modifying Anti-Rheumatic Drugs (DMARDs)

So you know how I like to try to break down words to their origins for an understanding of what it means to a point.

Well, here I won’t because it is actually very clear. DMARDs are a collection of Drugs which have all been identified as, and subsequently are used for the best for, Modifying through reversal (Anti) Diseases of a Rheumatic nature.

Get it? Got it? Good.

The way these drugs work is all specific to the individual drug but they all provide the same effects of reducing inflammation of the skeletal system and at the joints, provide protection against erosion and wear to the components found in the joints and reduce pain. They act by attending to the disease itself more than individual symptoms. The pain reduction is an effect of the reduced inflammation and alleviating stresses on the site of injury rather than erasing the neural transmissions.

I am often asked by people if I am on a prescription for, or have ever tried, Methotrexate. To which I unfortunately say no, I was initially started on a course of Hydroxychloroquine (Brand name Plaquenil) and responded well to it so have continued on this drug ever since my initial diagnosis 8 years ago.

Potential DMARD possibilities for the treatment of rheumatic and on-going pain illnesses may be any of the following:

• azathioprine
• ciclosporin
• cyclophosphamide
• gold injections
• hydroxychloroquine
• leflunomide
• methotrexate
• mycophenolate
• sulfasalazine

These medications take time for the body to synthesise and thus do not begin to show their effects immediately. In actual fact it is very difficult to identify at all if the drugs are having an effect on your body if they are working correctly. However, if you were to miss a few days of doses, or stop the cycle all together you may notice relatively quickly return of the pain and even other illnesses you weren’t even previously aware of. For me this occurred as Erythema Multiforme.

If the on-going pain is not a product of a rheumatic inflammatory illness of some type then DMARDs may not be the way your doctor will choose to go and they may opt for a non-steroidal form of anti-inflammatory, also known as an NSAID.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Again to elaborate on a regular medical term I will break it down. NSAIDs are Drugs which are effective in the reversal (Anti) of Inflammation in the body like steroids (cortisone or prednisolone) but are Not Steroids themselves. It is important to note the non-steroidal nature of these drugs, as the side effects can be notably different and the way they operate in the body, given they are not designed to replicate a naturally occurring chemical.

NSAIDs are also used to treat inflammatory illnesses, rheumatic and other autoimmune ailments. The body creates a range of chemicals that encourage the inflammatory response to protect the body whilst it is healing from an injury, including platelet development and distribution. NSAIDs reduce the release of these chemicals, thus diminish the inflammatory response of the body. Hence inflammation occurs less and in a lesser form.

Commonly used NSAIDs include:

• aspirin
• celecoxib (Celebrex)
• diclofenac (Cambia, Cataflam, Voltaren-XR, Zipsor, Zorvolex)
• ibuprofen (Motrin, Advil)
• indomethacin (Indocin)
• naproxen (Aleve, Anaprox, Naprelan, Naprosyn)
• oxaprozin (Daypro)
• piroxicam (Feldene)

Similarly to Hydroxychloroquine (Plaquenil) the first NSAID I tried was Naproxen and that was sufficient for regulating my Rheumatoid Arthritis. As I did not have a physical reaction to this drug I remained on the dosage prescribed by my Rheumatologist for a long time afterwards. Of course I did try Aspirin, but recently found I have an allergy to that and Ibuprofen, so now I no longer take those drugs, nor do I need to take regular doses of Naproxen. If I have a minor relapse I simply take Over The Counter (OTC) NSAIDs such as Celebrex.

Neither DMARDs or NSAIDs pose a high risk of addiction, nor do most incur a high risk of severe long or short term side effects. I say this extremely loosely as I know Hydroxychloroquine does in fact have a potentially worrying long term side effect but that will be covered in another post.

My information and for further reading please visit the below

WebMD DMARDs

UpToDate DMARDs

ArthritisResearchUK.org

Better Health NSAIDs, Victorian Government

MedicineNet NSAIDs

 I am currently studying my first Bachelor Degrees in Education at a local university in Perth, Western Australia. This means that I am not a health professional in medicine, psychology, pharmaceuticals or remedial therapies of any kind. My summation here is from the perspective of a chronically unwell individual who has been in the medical system for a long time and has collected this information from multiple sources and compiled them here. I have not encountered all of the medicines that could have been used in cases similar to mine so I may have missed some or not discussed potential effects, reasons for use or exact reactions within the body. For this I apologise and please feel free to contact me and I will update these where I can.