To ask for medication advice

Have you tried adding yoga into the walking you are doing? I tried Pilates but it aggravated my sciatica. I've been regularly doing yoga for the past year and it really helps with the pain and stiffness. I don't need any pain meds as long as I do this and cardio too. If I miss a week, I'm in pain and struggle. I also do my physio exercises daily which are pretty much yoga stretches. When I was really bad I paid for weekly physio sessions and he was amazing. I'm more flexible and stronger which has made a really big difference

Hope you’re improving @lilytuckerpritchet?
I’m taking Naproxen which is a similar drug to Ibuprofen but with Amitriptyline for the nerve pain.
Has this ever been suggested for you?

That is the guidance yes but when you have severe nerve damage and spinal damage, having had multiple surgeries, as well as the SCS I mention earlier there are few, if any, other options left. Not sure what your problem is?

Correct on all points. I am unsure why you're choosing to doubt me.

Nope I'm afraid you're wrong. For a number of weeks he stopped taking them cold turkey when he had a spinal chord stimulator fitted. It worked brilliantly and no he didn't feel the desire you mention. Unfortunately the SCS was removed due to a serious infection he developed.and it was not possible to reinsert.

Also, are you searching me from the other thread to randomly reply to this? Weird.

As I said, he's not considered addicted nor does he describe himself as such, he would stop taking them in an instant if he didn't need them. Hence described as dependent, there is no other medication that works and no surgical solution left. His medication is prescribed to him, not sure how else you think he'd get it .

Hello, sorry to hear you're struggling. I'll share my situation in case it's helpful.

I'm on a cocktail of meds for back, hip, knee and ankle pain, mostly accident related. I need an ankle replacement. I've been on regular opiates for 15 years. I was initially on a much higher dose but since then some problems have been improved by surgery.

I have been stable on the same dose for the last 5 years. I am on a slow release type of med so it's always in my system. I also have a 'rescue' version of the same med, which is fast acting if I need a top up. I hardly ever use that at the moment.

I also take a slow release version of ibuprofen (I'm not in the U.K. so not sure if it's available there). I'd tried various NSAIDS in the past but OTC ibuprofen seemed to help the most. The doctor suggested a slow release version as apparently it works better. Adding it in made a big difference to me, so I'm not surprised it helps you. I take 1600mg once a day, which sounds a lot, but is only the same as 2x200mg 4 times a day. I take it with dinner, and it's great not to have to worry about timing doses to take them with meals. I've tried to halve it but it's tough pain wise. I take Esomeprazole to protect my stomach. To be honest most doctors I see are more worried about the effects of ibuprofen on my kidneys than me being on the opiates. I take paracetamol as well and pregabalin, for nerve pain. Have you tried this type of med? It might help.

I'm sure I am dependent on the opiates but I don't feel any need to increase the dose. I do physio as well but the thing that has helped my back most in the last few years is my brilliant osteopath, who I've been seeing since 2018. I used to only go in a crisis but I now go every 4-6 weeks for maintenance. I have fewer crises and they tend to last less time.

During my time on the opiates I have worked on and off from home. It's been tough working full time, even for a couple of weeks, so I haven't done that for a while. I am tired but mostly not unmanageably so. I can drive short distances (up to half an hour). After that I'm in too much pain.

I have tried cortisone and PRP injections without success, and infusions of ketamine and lidocaine at a pain clinic. The infusions helped a bit but in the end I felt the hassle of going wasn't worth the benefit.

For what it's worth I kept my pain meds high for the first two years after my accident as it meant I could access physio and was able to really build my mobility back up.

It was only when my mobility plateaued that I started reducing pain meds.

I have been on pain meds for ten years and have slowly reduced them in that time so while I understand other people ask for more and more pain meds this is not my experience and I have been able to reduce significantly over time.

It's often quite a personal decision on how best to balance pain, physical therapies, medication and the risks/ side effects, especially when you know the condition isn't likely to ever go away.

Sadly medication is the 'easy' option for prescribers to offer, with resources for other options very limited in the NHS. it's not uncommon for the dose to get adjusted upwards in response to unresolved pain (and almost never reduced when things are stable). I see patients who have been opioids for 10+ years with doses slowly edging up and who are now on huge doses and very reluctant to even try reducing. It's not only the worry of addiction as a PP mentioned but the links to cognitive decline, falls and other medical conditions which are concerning.

Is there a particular reason that they didn't want you on ibuprofen longer term? Any history of stomach ulcers/bleeds, age >65 or other meds that crease your bleeding risk?

All pain relief medication has side effects but ibuprofen is a useful drug to reduce the need for opioids and to help manage pain at times when you are reducing opioid doses.

I would be having a review at least every 3-6 months, with a view to trying to reduce the dose whenever if it feels like the pain is stable/ manageable.

You could ask your GP (or Google) about chronic pain clinics and/or CBT (availability varies depending on location) or self refer https://www.nhs.uk/nhs-services/mental-health-services/find-nhs-talking-therapies/what-happens-when-you-refer-yourself/

TENS machines, acupuncture, meditation and mindfulness are all options worth exploring.

Employer assistance programs sometimes offer access to CBT or counselling. This site,
https://livewellwithpain.co.uk/resources-for-people-with-pain/ may also be helpful

Long term opioids have significant health implications, including making you more sensitive to pain, which leads to needing higher doses and so it goes on.

This is a really useful place to start looking for info and also somewhere to point your GP towards, https://www.fpm.ac.uk/opioids-aware

Info on harms https://www.fpm.ac.uk/opioids-aware-clinical-use-opioids/long-term-harms-opioids