Phil, thanks for taking the time to explain your situation.
I can’t give specific help without a proper history of your uric acid test results. I need dates and numbers. For uric acid results, “slightly raised” is in the same ballpark as “a little bit pregnant”. It tells you which medical condition you have. But it’s meaningless in terms of treatment and care.
Generally, there are two dosing schedules for colchicine. And, anything I say must be cleared with your nephrologist. First, you are right to say colchicine is a poison. It stops your immune cells from replicating, because that is what leads to inflammation. But, it does nothing for existing pain.
So, if you are taking it ad-hoc, take it at the first suggestion of a twinge. But, if the flare has taken hold, you need anti-inflammatories as well. Otherwise, it can take 2-3 days for the existing inflammation to subside naturally.
That’s why, when you start allopurinol, most doctors advise preventative pain relief for up to six months. It has to be managed case-by-case, and depends on your reactions and test results. Personally, I was advised to take colchicine for two months as a preventative, then review. In fact, I was confident enough with my pain control procedure that I changed the colchicine to ad-hoc very quickly. But for anyone not confident, I’d recommend preventative colchicine, if you get no adverse events.
My main worry, from what you’ve said, Phil, is that your colchicine prescriptions haven’t been supported with anything for when you take the colchicine after the flare has started.
I’m sorry it’s not as simple as colchicine as a course, or ad-hoc. I understand that doctors don’t have the time to explain different pain control combinations. But I feel, once you understand how different drugs work on different aspects of gout pain, you can control it better.
I think we might have to go back-and-forth with more bits of information before we can tie things together properly.
1. Your uric acid test result history will give me a better picture of where you stand now.
2. Your future uric acid test schedule will give me more confidence that you have an effective uric acid control plan.
3. Your attitude to (and tolerance for) colchicine and anti-inflammatories is important. Colchicine alone is rarely enough to support gout patients during the first six months of uric acid lowering.