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Sutro

Started a thread a while back inquiring about pain killers & Coumadin, seeking info on ones that won't affect INR.

Been having ongoing problems with pain - joint pain in my shoulders - and ongoing problems with unstable INR's, typically too high. Now I'm wondering if a high INR can cause joint pain - i.e. painkillers didn't raise my INR, maybe my INR was already high and it was the high INR (i.e. too much Coumadin) that caused the pain.

Will a high INR cause joint pain?
 
Highly doubtful.....unless the cartilage in your joints cause a slight hemorrhage. You would notice this on your hands, near the joints.

I went through this with my hematologist 2 years ago. Diagnosed with the rheumatoid factor. Pain managed with Darvocet as needed. No INR fluctuations with that med.

Coincidentally since being on a blood thinner...... my pain in not as severe. Not sure where the correlation lies?
 
Hi Sutro,

I have been on supplements for more than 25 years, but in 2000 after my AVR surgery my doctor wanted me to eliminate all supplements for a while. I also eliminated my calcium/citrate and glucosamine. I had been taken these for my bones and pain in my right knee. After I had eliminated those supplements, the pain in my knee came right back and I was miserable. When I had to reintroduce the supplements one by one back into my diet, I chose the calcium/citrate first and next the glucosamine, and the pain went away. Since then I have been pain free.
You might want to try this.
These supplements do not interfere with my Coumadin intake, and I am stable at 20mg a day.

Christina
Aortic Stenosis
AVR's 8/7/00 & 8/18/00
St.Jude's Mechanical
 
There is a rare complication of a high INR called hemarthritis in which you literally bleed into your joints. But as Gina said, it is highly unlikely. I have only seen it in one patient and he had it in only one joint. It occurred about three times but it was always in the same knee.

If the pain causes you to become less active then it could cause your INR to rise. This is because you do not get your heart rate up when you do not exercise. Then the blood is pumped through your liver less efficiently. The warfarin is only metabolized when it is in the liver. Therefore, the INR will be high.

Glucosamine will work and not interfere with warfarin. The reason some people do not get relief with it is that they do not take it long enough or skip too many doses. For the first two weeks, people report little or no benefit. In fact, many report that Tylenol gives better pain relief. However, after two weeks without missing doses the glucosamine becomes superior to Tylenol. The body clears it out quickly, so missed doses cause it to lose its effect rapidly. Chondroitin adds little or nothing to glucosamine. In fact some studies have shown that the chondroitin does not even get absorbed into the blood.
 
Interesting: I hadn't known about being sedentary resulting in a high INR.

Alas, I really liked my theory about a high INR causing joint pain, as opposed to analgesics taken for joint pain causing it. Perfectly good theory shot down by inconvenient facts.
 
That happens a lot with warfarin.

It is never prescribed for something trivial. So people would rather blame it for their ill effects rather than admitting that ther has been a big change in their body.

I'm sure I'd be the same way - if it was a pill causing a problem then I could stop the pill and things would get better.
 
I gave glucosamine a 3 mo trial, at a good dose,
but got no relief whatsoever for my neck and shoulder and knee.
I finally went to a chiropractor and got results for my neck but have him stumped on my shoulder.
It is rotator cuff pain, and so I have had one intense massage treatment for the shoulder and neck. He wants me to try at least 3 more to see if I get better.
Gail
 
hemarthritis????

hemarthritis????

This topic caught my eye as yesterday for no reason I started having quite a bit of pain in my left knee. I did not injure or bump it at all. I am however back on Lovenox (started back up on Friday morning-60mg bid s.c.) Last night while getting undressed noticed under my left arm a 50 cent piece size bright purple bruise-lets face it-I didn't bruise my armpit! Thought to myself-hmmm, a vessel must have burst for some reason or something like that. The pain in my knee kept me up all night, and I am unable to apply pressure on it to go up and down the stairs. No bruising is apparant, and it is sore to the touch. Can't hit the gym today in this condition and I am leaving next Sunday for Australia so I have to get myself together before then. How is hemarthritis diagnosed? Just I just wait a few days to see if it gets better? Suggestions anyone??? Thanks. Gisele
 
Hemarthritis starts with pain in the knee. I'm not sure of the definirtive diagnosis, probably a CT scan or something. With the fresh bruise in an unlikely spot, I'd get it checked out ASAP. If you couldn't sleep you are going to be most uncomfortable on a flight to Australia.
 
Spoke with cardiologist

Spoke with cardiologist

Called the office to see who was oncall today. I rec'd a prompt reply and mentioned my knee (up all night) bright purple bruise by my armpit etc.... Also now pain in joint in left foot (where your foot flexes as you walk). Was told doubtful if caused by Lovenox. Take Tylenol,and if still in pain in the morning, call the office. X-ray will be ordered or referal to an orthopedist who would know about bleeding in joints. Hmmmm, today is my day off-certainly more convenient for me to have it checked out today rather than tomorrow, but I will follow their orders.
Was told to stay off my leg----I had big plans for the mall today seeing as I am leaving in one week! It's not easy being a patient some days. I guess I will wait until tomorrow and see how I feel then. I have to test my INR tomorrow ( Coumadin dose now at 12mg qd) to see if I have to continue Lovenox. Wish me luck! Gisele
 
My husb agrees with you, but......

My husb agrees with you, but......

you know how patients hate to go against the advice of their doctors. I can see it all now......ER physician calls over to doc on call who promptly informs ER doc "I told her to wait until tomorrow". If the pain worsens I will go to ER. If not I will wait till tomorrow and see how it is then. Thanks for the concern.
 
Thanks Janie

Thanks Janie

I will look for that at the same time I search for an adaptor for my curling iron. I do have problems with swelling but normally when it is humid out. I swear I must suck in all the humidity in the air and transform it into fluid pounds on the scale. LOL. I am going down with an ample supply of dyazide and lasix as it is hot and humid where I am headed-plus I cannot be swollen to fit into my gown. With all my meds (three different Coumadin size tablets), Lovenox, Protime equipment and my other meds I am afraid I will look like a traveling drug store. Do you beleive that Qantas airline will not refridgerate my protime supplies! My travel time leaving Boston arriving in Brisbane is 30hrs, then I have to travel six hours further north when I arrive. The lady on the phone was not helpful at all and couldn't care less that my supplies would spoil without keeping them cold. I guess I will have to implement Plan B. :D
 
Plan B is the brand name of the "morning after" oral contraceptive. I'm not kidding look it up!!!:D
 
Allodwick's diagnois was correct!

Allodwick's diagnois was correct!

Woke up today feeling worse than yesterday. Last night pain involved my left hip area. Difficulty walking. Called my cardiologist. They wanted me to see ortho guy. Couldn't see him until 4:00PM at the hospital. Diagnosis: bleeding in my joints/hip. INR this AM was 3.3 therefore Lovenox was D/C'd and my 12 mgs of Coumadin was dropped to 7mg for today. I am to do INR every day this week. Ortho doc said if I don't start improving I will have to have "HHP" ???? Was in so much pain I don't know if I have this correct. He doesn't want to give Vit K. Does anyone know anything about this? This has something to do with stopping the bleeding in my hip. Apparently it is some type of treatment that affects anticoagulation possibly given by IV. My husb is gone to pick up my Rx for pain (Vicoden). My pain right now is so severe I am not sure this will even help, but I will try it. I am kicking myself that I didn't go to ER yesterday. I will keep you all posted, and thanks so much for all your help. Gisele
 
I tried to post this before but the site was down and it failed. I'm sure that he meant FFP. This works faster and over a shorter period of time than vitamin K. However, I'm not sure that this is the proper treatment. FFP will reverse the effect of warfarin. But if your INR was only 3.3, I don't think that you want to reverse the warfarin. Then you will have no protection for your valve. I think you need protamine. This will partially reverse the effect of Lovenox. This is more likely the culprit causing the bleeding in this case. I think that you need a hematologist involved in this too. Most orthopedic doctors admit to being ill informed on the effects of anticoagulation.
 
OMG! I hope you are ok, and that the vicoden worked for the pain. I never would have thought with an INR of 3.3, you would have a problem lilke this. As you may recall my husband had gross hematuria in his urine, with an INR of 4.0


I hope this gets better really fast. Best wishes.

Marybeth
 
I do not think that the INR of 3.3 was the sole cause. She was getting Lovenox also and had some other potential problems. I suspect a Lovenox overdose which I why I thought that she should get protamine.
 
Still hanging in there!

Still hanging in there!

The cause of my bleeding was the Lovenox. I am testing my INR every day now and my MD is adjusting accordingly. I am still in quite a bit of pain and am hopeful that by Sunday I will be more comfortable to travel (30 plus hr flight). The Vicoden seems to help a bit although it doesn't totally eliminate the pain, but it is better than nothing. Last night was the most sleep I got since this all started. Things can only get better from here--right???? Gisele
 
I've been really concerned since you did not write back. It would look like things are going to turn around, doesn't it. Hope the wedding goes well.
 
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