AIBU to think 30/500mg should relieve pain?

[SecretSleeper]

Where would you go next? What is stronger?

I've a chronic pain autoimmune condition.

Am paralysed with joint pain some days.

What can I take if these don't relieve pain even a little?

The co-codamol do nothing at all for me. I had hoped they would as GP seemed quite cautious when prescribing.

30/500 - so total dose of 60mg codeine, 4x per day? Or just the odd dose at 30mg total?

Are you taking anti-inflammatories?

Referral to pain clinic and construct a pain ladder with consultant. There's a hell of a lot stronger stuff out there if that isn't cutting it. You deserve not to be in pain. It took me several years with the pain clinic to find what works. I'm currently on 40-70mg oral morphine daily.

I agree with kity- I'm also on oral morphine along with a range of other things. You need to try to find something that works; hope you get some relief soon .

Speak to GP about other options as there are other things they can prescribe.

I have constant and ongoing pancreatic pain which is a bugger to control. At its worst even morphine in hospital barely took the edge off. I've had reasonable results on gabapentin, enough that I can live my life with a pain level that is there but ignorable. Amitriptyline was less good for me but works well for some. There are people I know with this on fentanyl patches - that's stronger than morphine. It's a case of getting the right med for you and that can take a bit of trying out.

You can be referred to a pain clinic if the pain is long term and uncontrolled. They haven't done it for me as my GP's surgery are tight buggers who refer you for nothing ever but I know lots of people who are under them.

Go back and say your current pain relief isn't working. Put the ball in their court.

I'm really sorry to hear that you're in pain. However maybe you'll have to find other ways of dealing with it than drugs. Here in the USA pain killer addiction is rampant, partly because doctors keep on prescribing stronger pain killers, and the many drug adverts on TV promise so much that they can't deliver.
I know that will be many posters who will be much better qualified to give constructive advice, but please think carefully before upping medication.

Autoimmune pain can be treated with amitriptyline, duloxetine, gabapentin, which can help with the type of pain caused by AI conditions. Amitriptyline and duloxetine are "old-style" anti depressants and gabapentin is usually prescribed for nerve pain such as fibromyalgia or diabetic neuropathy. There are other medicines in similar categories available too. In the opioid category you can move to stronger types such as oxycodone or tramadol, which are controlled drugs. Severe chronic conditions are usually treated with a combination as an individual medicine will usually not be sufficient on it's own. Go back to your doctor and discuss pain management, without you telling him/her, they do not know how badly the pain is affecting you as it hits people differently.

Gabapentin or Pregablin thought they dont work for everyone
Tramadol instead or with your cocodamol
Oral morph

Ive tried everything for arthritic knee pain including Tramadol and 30/500 cocodamol with little lasting relief. Lately been so bad at night was regularly getting only a couple of hours sleep each night. Found out about amitriptyline researching online and now have a combination of drugs that have allowed me to sleep, go back to heavy work in the garden, even cope with a city break. I take 40mg amitriptyline at 5pm, 1000mg naproxen ( with lanzoprazole to protect my stomach lining) at midday and 2x 8/500 cocodamol 4 x daily. I think the secret is to take them regularly, not just when the pain is bad. I took some convincing as I hate the idea of taking so much medication, especially as individually they didn't do the trick, but in combination they seem to be working.

Are you in constant pain? If so you're likely to have better results with a slow release opioid / opiate and then a fast acting one for breakthrough pain. Unfortunately if you're already struggling when you take the meds, it takes a lot longer to get on top of the pain and requires higher doses. I've been on opiates, mainly morphine, for 12 years now. The neuropathic pain meds mentioned may also help you. Have you seen a pain specialist?

I take a slow release one (tramadol) as well as 1800 mg gabapentin with oramorph for breakthrough pain (there are other mess as well for various things, but these are the main Ines for pain). It took a long time to get here, though, but it's worth trying things til you find what's best.

Hi op

You've had some good advice from fellow sufferers up thread, I am a similar sufferer and in a previous life I specialised in pain relief

I find co-codamol slow to relieve pain, regular nortriptyline helps me and has fewer sedating effects that amitriptyline in my case

You really need a gp referral to the chronic pain team for assessment but you could start with having your b vitamin levels checked

Anaemia is associated with increased levels, I can always tell if my b12 or ferritin levels have dropped as my pain is noticeably worse so it may be worth checking that first

I also flare without fail every autumn but now recognise that fact and don't worry too much

What does your rheumatologist suggest? GPs would be reluctant to prescribe something not recommended by your rheumatologist who has responsibility for managing your condition.

A substantial minority of people don't metabolise codeine in order for it to be an effective painkiller. If you are getting little relief from 30mg then it is quite likely you are in that minority. Talk to your GP about that and see what else they suggest. For comparison, I've taken higher dose codeine for bad toothache once or twice, and 15 mg IIRC is enough to put me to sleep for a couple of hours. And I'm not at all petite.

Grass - yes I've taken up to 30mg and it makes me really woozy, was on it at work and couldn't achieve anything.

You can start by asking for 60/500's for a start however the GP should have a set protocol "pain ladder" for your condition to which she can refer.

Have you been prescribed naproxen? A very strong anti inflammatory. That helps with joint pain.

Feel better soon.

All of the above but also, a substantial number of people don't physically process codeine so can derive no benefit from taking it.

Get specialist advice and use clever medication combining for the best results. Also, of course, self care such as heat, rest, activity pacing, taking gentle exercise and eating well.

I've done a pain management course which used a lot of mindfulness and whilst not a cure, it does help me for sure.

I treat my pain as a jigsaw with many pieces which all add up to the full picture.

Amitriptyline and duloxetine are "old-style" anti depressants

Amitriptyline might be described as "old-style" but I don't think you can call duloxetine that.

A good fraction of the population get no effect from codeine. Ditto amytryptyline.

I'm on Amitriptyline and Tramadol presently whilst awaiting diagnosis, doesn't stop the pain of the joints moving but stops the constant maddening ache. Can't take anti inflammatories due to IBD.

I have mid-foot arthritis, and take Paracetamol 2x500mg, plus Dihydrocodeine 2x30mg; both 4 times a day.

I'm on oral morphine (also been on oxycontin and fentnayl patches previously). The problem wtih opiates is that although they work well for a few weeks, after that you start getting tolerant to them and find you need a continuously higher dose to control the pain. There's also the problem of physical dependence and possible psychological addiction. This has really affected me over the last few years, so I always caution anyone before they try opiates. I think they work best if you take them only as required when the pain flares up.

On the other hand the nerve painkillers like pregabalin/gabapentin don't have this problem and you can take them long term. I know NSAIDs works well too as long as you take a stomach protector.

I know that some people do get relief with acupuncture - it's one of the alternative forms of medicine that has evidence behind it.

Duloxetine is a tricyclic, Dixie, the same class as amitriptyline. They are generally considered older generation antidepressants, as in, older than SSRI's.

Apologies Dixie, I'm not correct, you are. I'm thinking of dothiepin. Duloxetine is an SNRI and not older generation at all, forgive me.