During an acute gouty attack, the pain can be incredibly exquisite. Immediate treatment is needed to relieve the discomfort. Indomethacin is a stronger version of aspirin used to decrease the inflammation occurring in the big toe joint. This can be taken at the onset of pain and usually can decrease the pain within a couple hours. Once the pain has subsided, the drug should be discontinued due to its blood thinning effects.
Another drug that be taken on the onset of pain is colchicine. Colchicine, similar to indomethacin, will decrease the activity of the immune system within the joint, thus relieving the pain. Colchicine is most effective when it is taken within 24 hours of the onset of pain. Once the pain has subsided, colchicine (at a lower dose) can be taken to protect against gout attacks in the future. Colchicine is a strong drug that can cause nausea and vomiting, so it must be taken with caution.
While indomethacin and colchicine help with the pain, they do not address the root cause of the pain. Work with your rheumatologist to figure out if you are over producing uric acid, or not excreting enough of it. Additional treatments are available to address the origin of pain. Uloric is a newer drug that is showing promising results.
As mentioned before, consumption of foods like beer, steak, and other high protein diets can cause a spike in uric acid that can lead to gout. Avoiding these foods altogether, or minimizing the amount consumed at any given time can help to decrease uric acid levels.
If attacks become uncontrollable, there may be extensive damage to the cartilage in the joint and unrelenting pain. At this point, you may want to consider surgical options that would get rid of the pain permanently. A joint fusion is a procedure that you may consider to find relief. Discuss these options with your foot and ankle surgeon.