Reply To: Three Stage Gout Pain Prevention Plan

Stopping Gout Together Forums Help My Gout! The Gout Forum Three Stage Gout Pain Prevention Plan Reply To: Three Stage Gout Pain Prevention Plan

Keith Taylor

1. Looking forward to it.
3. Yes, but personally I stop any gout pain relief the moment the pain becomes tolerable. I include colchicine in that. Because it contributes to the gout relief package without actually relieving pain.

Now the biggie.

2. I’ve never been aware that one NSAID is stronger than another. I naively assumed that a dose dependent amount of gout pain relief was available from any NSAID. Also that the choice was down to personal tolerability and preference.

I’ve never had any problems at all with ibuprofen. So, I’ve never felt the need to risk anything else. But, for completeness of my knowledge, I’d love to see some references to pain relief comparatives between different NSAIDs. Please share some links.

Speaking of link sharing, I hope they are better than the Arthritis Research UK link. Because they spend over £4m annually on “Information and Awareness” (2015/16 accounts). So, you’d think they could do a better job.

To clarify:
– Uric acid lowering section gives no explanation of debulking. Also, it is confused by a pointless reference to high purine foods that makes no distinction between food from plant and animal.
– Ice pack suggested with no reference to warming joints after ice pack application. Or, just using a warm compress.

More importantly, we are talking about colchicine:
So, where the F has “You shouldn’t take colchicine at the same time as NSAIDs” come from?
– The big seller, Colcry$ (due to Americans loving their insurers spending too much money) has no mention of NSAIDs.
– What should be the biggest seller, Mitigare (due to it being a very affordable alternative to Colcry$) has no mention of NSAIDs. Both Mitigare and Colcry$ warn against use in conjunction with drugs that inhibit both P-gp and CYP3A4.
– A UK colchicine provider, Wockhardt/CP Pharmaceuticals Ltd (who provided the colchicine that my doctor prescribed alongside ibuprofen) has no mention of NSAIDs. But, it does have a completely different list of other medicines, compared to Mitigare and its expensive cousin.
And, finally…
Australian Rheumatology Association provides a free fact sheet on colchicine (brands Colgout & Lengout) which includes:

Colchicine may be taken if needed in combination with other arthritis medicines, including […] anti-inflammatory medicines (NSAIDs) such as naproxen (Naprosyn) or ibuprofen (Brufen/Nurofen)

Interestingly, the Colgout label does warn against combining NSAIDs and colchicine in patients with stomach problems. So, it might be better to try them individually at first. Then, combine if no stomach problems. Personally, I’ve been medically described as having a “cast iron stomach”. Because I’ve never had any ibuprofen problems, even at the maximum prescribed dose.

The Lengout label looks very similar to Colgout. But, I haven’t done a complete comparison. Notably, both these Australian colchicine brands have a comprehensive list of other medicines to avoid at the same time as colchicine. Also, they indicate that colchicine should only be taken if NSAIDs can’t be tolerated or don’t work. So, this suggests an “either/or” approach instead of my beloved combination. Which kind of supports my other main tenet:

Gout pain relief combinations must be developed by doctor and patient working together for the patient’s best interest at the time of treatment