Steroid or hydrocodone?
 

I have SLE Lupus and Sjogren's Syndrome - My question is: It appears I get similar relief regarding joint pain from the Medrol as I do from hydrocodone. I get negative side effects from the Medrol, and none from hydrocodone. Which is the better choice in treating my joint pain/inflamation from Lupus? (it seems as though the hydrocodone would be the easy choice since I am not experiencing any side effects, but perhaps there are long term side effects I'm not feeling, or different ways the medicine is helping/hurting I'm not aware of?)

I have been on varying doses of medrol since July from 12mg - 24mg daily. I didn't think I was getting enough relief from the medrol to put up with the side effects, mood swings, extra exaggerated emotions during my period, moon face, growing hair on my face (mustache and side burns). I asked my doctor to if I could stop them since they weren't making my joint pain and inflamation go away. Finally he agreed (after we went to injections on top of pills).
At the same time I was told to stop MTX temporarily due to hair loss.

When I started the Medrol in July only my hands hurt. After stopping the medicines every joint hurts. I hadn't realized I had gotten this bad because the medicines were doing something. I have loss of function and certainly pain in ankles, knees, hips, hands, elbows, and the occasional shoulder. I can't believe it got this bad so fast, and I can't believe the medicines were working that well. So I'll be starting back a lower dose of MTX next week and I have both the hydrocodone and medrol perscriptions... I'm just not sure what the pros and cons are in deciding which medicine to use over the other? Help please...

If possible, I would keep looking/ask your doctor about a third choice. The long term problems with hydrocodone are two, IMO.

One is that hydrocodone is often combined with either acetaminophen (Tylenol) which can be hard on the liver, or ibuprofen which has its own potential adverse effects. The antioxidant supplement N-acetyl-cysteine (NAC) may help counteract the effects of acetaminophen on the liver.

The second issue is that hydrocodone, like any other opioid, may develop tolerance in time, requiring higher dosages, or switching to a more powerful opioid.

Hydrocodone may also cause dependence, but some non-opioid medications can do that as well.

Doc

Thanks Doc for responding! I will certainly keep looking for a better optiion than the 2 choices I have now.

I have declined pain meds for 6 months, as the doc was sure I'd be better in 3 weeks, then that turned into one more month, and then 4-6months, and I'm now in month 6 and nothing is better, and in fact about 600% worse. I didn't want the pain meds masking the symptoms all the while making me dependant, so I've just gone without and waited and worked on getting better. The steroids were always supposed to be temporary, but at 6 months their not feeling so temporary any more. That and they don't relieve all the pain, just about 60%. That's a big number when talking pain, but it's still not reliable or functional so I could hold down a job. Add on top of that side effects and it really makes me want to consider alternatives. As a personal note, I have never gotten addicted to any of the pills that are supposed to be addicting. The ones they want you to taper I quit cold turkey and never have a problem. So I'm not as worried about the addictive qualities of hydrocodone. I am/would be worried about the tolerance issue if I expected this to be long term. I hope I never get to the point that I must live on pain pills permanently to exist. I'm not there yet. Right now I'd just like some relief while the doc figures out what medicine will actually get this mess of pain and inflamation under control. Then the hydrocodone can go back to emergency as needed use like the plan for the steriod was supposed to be.

As for your other concern regarding my liver, I'm not worried. My liver is going to hell in a handbasket so to speak, from all the other meds I'm on. Before the hydrocodone we tried 3200mg-4000mg a day of ibuprofen to try to get the inflamation from the lupus under control - no such luck. So you can see why I'm not worried about the 200-300mg in my hydrocodone pill. Besides that the methotrexate should have a nice head start at taking down the liver before the ibuprofen even gets to the party. (I say this in a kidding way even though it's serious because if you don't laugh you'll cry with this mess & I'd rather be laughing.)

If those are the only concerns to worry about (liver, dependence, tolerance) it makes my decision to go with the hydrocodone over steriod an easy choice. Thank you for your help!

In that case, you might look into NAC anyway.

Doc