To ask for medication advice

Yes the pain clinic looks beyond pain relief, but this is because when we have chronic pain our brain gets involved. Pain wind up is a very real thing where the brain anticipates the pain and effectively creates it before it starts. In our area it is called the integrated pain and spinal service IPASS so it looks holistically at pain relief, physio and CBT to help manage the pain. Yes you may have a 1 year waiting list, but if you are not even on the list you are never going to get seen. The medication side is often run by specialist anaesthetists who are much, much more knowledgeable about the different types of pain relief their risks, side effects and benefits than any other type of doctor.

I have been in a similar situation to you.

Regarding seeing a pain consultant privately I did this after a particularly unpleasant experience with one of his colleagues in the NHS pain clinic. He was very nice but adamant that he wouldn’t be prescribing strong opiates privately. There is a lot of misuse by wealthy addicts and so many doctors don’t want that type of private work.

i have been on a combination of cocodamol, tramadol, naproxen, pregablin and amitriptyline (plus omeprezole and stool softeners) for over ten years now. They still help immensely and I have never found that I have needed to increase the doses to get the same effect. I guess I’m ‘lucky’! When my back goes into spasm I take the odd diazepam but that really does lose its efficacy if taken more than occasionally.

All the best. Getting the right combination has been key for me and I am still restricted in what I can do but most people wouldn’t realise my condition. I’m extremely good at masking my pain but equally that’s silly if it is going to create worse pain later.

Its a juggling act.

I saw a pain consultant privately.

He was the same guy who ran the pain clinic at my local hospital.

He was very helpful and gave me a lot of useful advice about medication.

Pain clinics differ from place to place. I have not been to my local one.

Yes, you need to be able to function, especially when you have kids. I had no-one to help me so had to take the meds in order to do everything young kids need. Good luck, it’s horrible living in constant pain

It’s a tough decision for sure. For me being on meds has been the difference between living, and existing. They do have their downsides, but they also help an awful lot. I guess see how you go when you reduce. If after a few weeks your pain level hasn’t reduced then don’t reduce again. I reduced my oxy this year, but the pharmacist is helping with this, and it’s been slow. I wanted to reduce as I was worried it I get acute pancreatitis again or need another surgery then i’ll really struggle to manage the pain post surgery like when I had my whipple. Thankfully the reduction hasn’t caused more pain and i’m now on a much lower dose, but still high in the grand scheme of things.

If I came off mine i’d have been in bed in agony. What kind of life is that? Docs have never suggested I come off pain meds as they know they mean I have a quality of life. I don’t worry about being on them as the alternative is no life and I am always very respectful of the meds, yes I’d dependant on them but i’m not addicted.

My GP managed my pain relief mainly, I preferred that to the pain clinic. Is there anything they can do for you, surgery wise? Or is it a case of waiting? Surgery for me changed my quality of life massively, though it was a massive surgery and I had a lot of complications. But my pain is a lot better than pre surgery and I can eat normally now, or almost.

The docs you’d see privately would be the same as NHS. If there is no treatment then i’d pay it as your sick pay will run out before you get to the pain clinic

Sorry that should say referral can take a while. Not sure what happened there, and too late to edit now.

I don’t think tapering is the right thing to do when you’re in so much pain. You’re in severe pain, you need pain relief. I’d move away from worrying about addiction. In the 14yrs i’ve been on opiods i’ve never abused them, and I know I can taper off as I did from the fentanyl after my major surgery. But I know I need some level of pain relief in order to lead my life. It is what it is. I’ve reduced recently, but can’t come off them as then my qualify of life would be far worse.

I don’t understand why they are trying to taper you off when you’re still clearly in an awful lot of pain. My advice is to keep pushing for treatment, and don’t worry too much about the pain meds. Respect them and never take them as they make you feel good (I never got a high from mine as I increased gradually). But equally don’t avoid taking them as you worry about being on pain killers. Not everyone who takes long term pain killers ends up addicted to them with their life in tatters.

Agree in referral to a pain clinic as you need a long term plan until any treatment can happen (referral can take a snmmmmmmmmmm. I’ve been on strong opioids for 14yrs due to a pancreas disease thanks to a rogue gallstone. Until I had whipple surgery I was on fentanyl. I am now on slow release oxy, twice a day and immediate release oxy 3 times a day. Plus pregablin. I have reduced the dose in the last year. Through choice.

Agree with ibuprofen. I got a lot of stomach ulcers from anti inflammatories.

Yes I did this.

I was in an accident ten years ago. Was on tramadol.

Every time I dropped the amt I was taking my pain would go back up. It would take about six weeks to two months to settle down.

I used ibuprofen and paracetamol to help during those periods.

I mostly only did one reduction a year as it really did stop me walking as far and being as active.

I also took amytriptyline which helped with the nerve pain from my accident.

Just to throw in another take, buprenorphine is a partial antagonist to opiates. So that means that at a higher dose it blocks the effects of opiates like codeine. Usually they won't be prescribed together.
Bup is very effective and easier to reduce off than other opiate meds. But yes, there will be withdrawals if you stop the patches. There probably won't be withdrawals if you come off the codeine as their effect may have been minimal.

I gave up my job after years of thinking I was either too doped up to work or in so much pain I could not concentrate BUT I now freelance from home and work every day but in short bursts.

Problem is work doesn't always fit in with the leg and back but the work pays for the physio etc. For me, a private physio is cheaper than the taxi to the NHS hospital physio.

On a good day I can potter like you do. I am hoping that once you can stabilise your back by taking the right amount of meds with the right physio and level of pottering you will get back to work. I managed to work for years once I had got over surgeries or falls etc and I still find work a great distraction.

Hopefully, even if it isn't the same job, there will be opportunities once things are a bit more stable.

@lilytuckerpritchet When you take opioids again and again over time, your body doesn't make as many endorphins. The same dose of opioids doesn't make you feel as good. This is called tolerance. One reason opioid use disorder is so common is that people who build up tolerance may feel like they must raise their doses to keep feeling good. They also may start having cravings for opioids. If they don't raise their doses, they may start having withdrawal symptoms, including worsening pain, goosebumps, anxiety, yawning and diarrhea.

That's off mayo clinic that kind of explains what I'm trying to say