AIBU to attempt an intervention of sorts?

[ToastMama]

I'll try to keep this brief.

My DM had a nasty bout of Shingles back in early 2010, leaving her with Hepatic Neuralgia as a result. She's always been pretty liberal with painkillers (has suffered from migraines and endometriosis since her 30s), but since having Shingles she's been on co-codamol 3-4 times a day for the last 5.5 years ...and then using wine every night as a "top up".

She has a prescription for the co-codamol, but prefers to buy Boots own brand as it's less salty and doesn't contain aspartame. She's known to all of our local branches, and is quizzed mercilessly on her usage every time she buys some. She asks family members to get her a pack whenever she thinks we might be going near a chemist. I used to oblige, but feel fairly reluctant to carry on.

My DM is in her late fifties, but as a result of all the pain and painkillers she now has the lifestyle, posture and attitudes of someone much older. She's permanently exhausted, struggles to spend quality time with her friends and grandchildren and yet is a bit of a matyr with the house and garden.

I'm so sad that she's suffering, as the pain from hepatic neuralgia sounds awful to live with, but I'm struggling with her use of codeine. I haven't seen the prescription, but surely if it's being prescribed then it's safe to be taking it day in day out? I just feel like she doesn't know how much pain she's really in, as the drugs have been masking it for 5yrs... But then I've never lived with a condition that would require daily pain relief.

It just makes me sad that my DM has changed so much, and I can't see anything improving for her.

AIBU to feel so uneasy about her use of codeine? And if not, to find a way to talk to her (other than gently in passing as I've already tried) about getting off the co-codamol to see if she feels better for not being pumped full of opiates?

Sorry to hear that Maisy, and all the others with similar situations, I hope he's better now?

We're in the South East, but I'll definitely persue our options and see what's available. My maternal side of the family have fairly poor medical history when it comes to stomach cancer, so that's been an additional worry that she'll do damage to an already potentially weak area.

Going to make notes of all my concerns both medical and emotional, and some of the alternative drug suggestions, pain clinic etc, and then see if she'll open up to me over tea and cake.

Thank you everyone.

If she gets her prescription dispensed at Boots, go and have a chat with the pharmacist. It may be possible to specify that she be given Boots own brand instead of whatever generic they may stock in the pharmacy; we do this for a few of our customers. This means that the pharmacist and doctor will be aware of how quickly she is getting through her co-codamol, if she is asking for repeats earlier than necessary.

To be honest,2xco-codamol four times a day is pretty standard. We have a lot of customers who are on that indefinitely. In a small pharmacy, I would say about 5% of prescriptions will include co-codamol.

If you are still concerned then have a word with her dr, just asking if they can look into her pain relief. Obviously, they cannot talk directly with you about her medical care, but they may be able to see if it can be tweaked.

The most important thing is to make sure that she is getting it on prescription, so dr is aware of what she is taking. This is so that he can make sure that there are no negative interactions with any other medication that they may prescribe for her.

Certain medications should only be taken long-term under dr guidance.

We have a lot of customers who we refuse to sell co-codamol and other OTC medications to as they are clearly addicted to them.

I see the pain team in the south east and have been on codeine for yonks... I try not to take more than 8 a day. I have crohns, short bowel and numerous bits that go with it. I also take it as it slows the bowel down ....

I've been on codeine 60 mg for years, it really isn't uncommon for chronic pain control.

What is concerning is she is buying the codeine. Does she really have a valid prescription? or may be using above the prescribed dose (this could be very dangerous with the paracetamol)? If she really has a prescription she should speak to pharmacist as they might be able to order in the specific brand she likes.

Also they usually try other options for nerve pain like amitriptyline, gabapentin, etc, as they often work better. The argument they 'mess with the brain' is a bit misinformed because Codeine will also alter the chemicals in the brain - this is why some people get addicted because it creates a nice calming effect, relaxing, etc.

YANBU to ask if she has recently visited the GP to review options. But you would be very unreasonable to outright say she should stop; chronic pain is invisible and it is too easy for those that haven't experienced it to judge others. The exhaustion could be from the pain or a side-effect of the codeine or even depression that often goes with chronic pain.

My dgm has been on codeine for nearly ten years.

If your mum pays for her prescriptions then 100 tablets would cost £8 if she buys them over the counter 32 cost less than £2 which is cheaper and may be a reason for buying them otc.
Also 2 tablets 4 times a day is 8 tablets a day, 56 a week and over two hundred a month. A standard prescription only has 100 a month so that could be why she is topping them up.

Codeine is shit for neuralgia. She needs to see a pain specialist or her gp needs to wise up and give her the right medication for her pain type.

The other concern with co-codamol is the amount of paracetamol she's taking 1g is the 4-6 hour dose and no more. So if she's taking more than 2 co-codamol she's doing her liver in.

My GP had me on Kapake 30/500 for years! Started when I was 19 then pain meds were increased and increased because they didn't want to refer me to an ortho sugeon. By the end I was on 60mg of morphine twice daily just to keep the pain under control. Eventually I had my hip replaced! But I had to live with painkillers and their side effects for well over a decade!