How long until I feel relief from hip and knee pain and swelling while taking tramadol and flexeril (cyclobenzaprine), and using lidocaine patches, diclofenac (Voltaren) pills and gel, and biofreeze?

Managing Pain from Hip and Knee Osteoarthritis

Tramadol and cyclobenzaprine (Flexeril) may take up to 1 week to provide adequate pain relief for osteoarthritis, and your current regimen should be supplemented with more effective immediate treatments. 1

Current Treatment Assessment

Your symptoms suggest osteoarthritis of the hip and knees with active inflammation (swelling, warmth). Your current regimen includes:

• Tramadol (opioid analgesic) 1
• Cyclobenzaprine (Flexeril - muscle relaxant) 1
• Lidocaine patches (topical analgesic) 1
• Diclofenac pills and gel (NSAID) 1
• Biofreeze (topical menthol) 1
• Ice application 1

Expected Timeline for Relief

• Tramadol: Takes 1-2 days for initial effects, but optimal pain relief may require 3-7 days of consistent use 2
• Cyclobenzaprine: Limited evidence for effectiveness in osteoarthritis; may take 24-48 hours for muscle relaxation effects 1
• Topical NSAIDs (diclofenac gel): Can provide relief within hours but works best with consistent application over several days 1

Recommended Immediate Actions

1. Prioritize topical NSAIDs (diclofenac gel): Apply consistently as directed - this has high-quality evidence for effectiveness with fewer side effects than oral medications 1

2. Continue oral NSAIDs (diclofenac pills): These provide more immediate relief than tramadol for osteoarthritis pain, especially during the first 1-2 weeks 3

3. Use ice for 15-20 minutes several times daily: Particularly important since your knees are warm and swollen, indicating active inflammation 1

4. Ensure adequate rest: Limit weight-bearing activities until swelling decreases 1

5. Consider acetaminophen: Can be added safely to your regimen for additional pain relief (up to 3000mg daily, divided doses) 1

Medication Adjustments to Consider

• Tramadol: Continue as prescribed - it takes longer to reach full effectiveness but can provide meaningful relief when used consistently 2, 4

• Cyclobenzaprine: Has limited evidence for osteoarthritis pain; consider discontinuing if no benefit after 7 days 1

• Topical treatments: Use consistently - evidence shows topical NSAIDs are among the most effective treatments for osteoarthritis pain 1

When to Seek Further Medical Care

• If pain and swelling don't improve within 7 days of consistent treatment 1
• If you develop stomach pain, black stools, or other signs of NSAID side effects 1
• If pain becomes severe or you develop new symptoms like fever 1

Important Cautions

• Tramadol: While conditionally recommended for osteoarthritis, it has modest benefits and potential for side effects 1
• NSAIDs: Use caution if you have cardiovascular, kidney, or gastrointestinal risk factors 1
• Opioids: Current guidelines recommend against non-tramadol opioids for osteoarthritis due to limited benefits and high risks 1

Long-Term Management Considerations

After your vacation, consider discussing with your doctor:

• Physical therapy and exercise programs: Essential for long-term management 1
• Weight management: If applicable, can significantly reduce joint pain 1
• Orthotic devices: May help stabilize affected joints 1
• Intra-articular corticosteroid injections: May provide temporary relief for inflammatory flares 1

Remember that most patients experience significant improvement within 1-2 weeks with appropriate treatment, but finding the optimal regimen often requires some trial and error 1, 3.