to take more than prescribed amount of painkillers - desperately in need of sleep :(

[Llamasally]

I slipped a disc two weeks ago, got an appointment with a spinal consultant next week and have had a few osteopath and acupuncture sessions. I can move a bit better than at the beginning and this seems to be slowly improving, but the pain at night is unbelievable. I’m getting a couple of hours at best then wake up in agony. Finally persuaded the GP to prescribe Tramadol last week hoping it would knock me out, but it’s still not doing the trick. I have been prescribed x1 twice daily, same for Naproxen plus x8 a day of codeine.

At the moment, before bed I’m taking 1 tramadol, 1 pregablin (I had in the cupboard, GP won’t give me any, seems to help a bit) and a naproxen. I sleep for about 3 hours max then it wears off and I’m awake with the pain. I’m then very limited as to what I can take for the rest of the night and end up staying awake. I’ve now been awake since 1.30. It’s killing me, I have a baby and toddler and I can’t do this for much longer.

Would I BU/would it be dangerous to take 2 or 3 of the tramadol to really knock me out so I can get some sleep?! And to take more when they wear off in the night? I really am desperate:(

I would go back to the doctor and ask the question. I am currently prescribed 8x 50mg Tramadol per day following spinal surgery, but they definitely work less the more you take. Don’t take 3 at once, the maximum I have been told is 2. I try to take them 1 at a time to spread them throughout the day/night and leave minimum 4 hours between doses of 1 tablet.

It really is dangerous, and can stop you breathing while you sleep. Sorry you’re in so much pain

Does your codeine have paracetamol in it ie co-codamol? If not then you could add 8 paracetamol to that mix. How strong is the codeine ? 30 mg per tablet?

Also is the naproxen 500 or 250?

Can you not take the normal dose and an actual sleeping tablet? My friend died from overdosing (accidentally) on pain relief when she broke her arm. I'm not sure if the same tablets, but still. That was 20 years ago and I still panic about taking too many

Yes, that would be dangerous. In your shoes I’d go back to the GP to ask for more pain relief. In the meantime you could try staggering the painkillers, eg take the tramadol before bed and the naproxen if you wake up in the night. Also are you taking any paracetamol? Paracetamol taken regularly (so four times a day) is much more effective than people realise and will help the other painkillers work better (unless there’s a medical reason you can’t take paracetamol or you’re already taking co-codamol).

I would soak to your GP again, I've find that tramadol at higher doses stops me sleeping.

I'm currently on a pian relieving patch (butrans) which is much better as it stops this cycle of boom and bust that you are in.

If you speak to the GP you can ask about this or even modified release painkillers that release over a longer time period.

You poor thing, sounds awful

It can be dangerous especially if you’re mixing it with pregablin. There are several studies suggesting that the risk of accidental opioid (which is what tramadol is) overdose is higher in people who are also taking pregablin or gabapentin.
It’s really not worth the risk (especially if you’re looking after young children).

Can you speak to your GP to ask if there is any other medications they can prescribe in the short term (at least until you can talk to the spinal consultant about other treatment options). Please be honest with them about what you’re currently taking (if you’re taking over the recommended dose/taking additional medications) so that the medications they prescribe are safe for you.

Go back to the GP, as tranadol is a controlled substance if you use more than driceted by the GP you will run out earlier than you should and not be able to get more until it would be due again.

There are plenty of other options even prolonged release tramadol which may work better for you.

Upping your dosis of painkillers can have disastrous consequences. You're better of trying to sleep in different angles or positions etc. I dont have your same problems but I have frequent pain in my ribs and the only way I can then sleep is sitting up in the bed. Which is a disaster, but it does work. And beats laying down and just being in agony the whole time and not being able to sleep. Do see your doctor again though

Please don’t. This time last year I was in the exact same position so know that you are prepared to make deals with the devil to get shot of the pain. I had a rare condition but the only thing that would stop the pain was lying in one particular position and not moving. Oh, and a ten hour operation to sort it.

I had doctors giving me oral morphine but it really didn’t do anything. In the end I stopped taking it as it seemed pointless to be high as a kite but still in the same amount of pain. Plus it really bunged me up and then had to take further meds (and an enema) to sort that out.

The sleeping isn’t the issue here, it’s the getting on top of the pain. If the pain is in check then the sleep will come. I would be hammering down the door of the GP to get them to tweak your meds.

It’s also pretty dangerous to be taking Pregabalin unless prescribed by a doctor. They are controlled drugs. You need to be weaned off them even if you only take them for a short period. What are you going to do when you run out?

The GP has not been helpful at all, I don’t feel like I’m being taken seriously and have had to battle to get what I’m on now. So don’t feel confident going back to them will get me very far. And I just don’t have the energy for it :( but I didn’t realise it could stop you breathing, so I definitely won’t try that approach. Sigh..

Please don’t, I tried it following injuries from a car accident and ended up in A&E and it’s now on my records as an overdose.

Huge sympathy, I have a chronic health condition and I’ve been there.

Please be careful, tramadol can be fatal in overdose as it suppresses your respiratory rate and can put you into respiratory arrest, the pregabalin will only increase that risk. People develop tolerance to tramadol so if you’re on 50mg, ask your GP if they’d consider increasing the dose to 100mg or putting you on a sustained release version so it doesn’t wear off so fast. Or they may suggest adding another painkiller alongside it like codeine or amitriptiline. Or they may swap the naproxen for diclofenac. If it’s muscle spasm caused by the slipped discs they may add in a muscle relaxant like diazepam. There are so many meds and combinations of meds they can try, please phone them and ask for an urgent meds review as they can probably adjust it via the phone. When my pain was unmanageable with tramadol they switched it to a combination of slow release morphine and an antidepressant that helped to block pain and induce sleep.

Also I recommend weaning off the pregabalin unless it’s still prescribed, as sudden withdrawal from it is horrendous. GP might suggest gabapentin instead as pregabalin has a high abuse rate, they’re often wary of prescribing it nowadays.

All my sympathy @Llamasally.

I’ve had slipped discs, spinal fracture and cauda equina. It’s horrendous and you really don’t realise how much movement in other parts of your body affects your back with pain.

OTC antihistamines like promethazine are also used as sleep aids. Also can reduce anxiety as a ‘rescue’ add on medication.

Pillow between your knees and ankle when you’re on your side. Avoid any asymmetrical movements as they can cause bloody agony (and scary yelps/swearing!)

Watch out for numbness around your bum and vulva and not being able to urinate. This is rare but an emergency so please be aware of this.

All my sympathy

I doubt upping the dose would help anyway. But as others have said, don't risk an overdose especially as you're taking things the doctor doesn't know about.

I don't find tramadol works for me at all, no matter how high the dose. I sympathise with the doctor issue - I felt that mine didn't care at all how much pain I was in. I was told just to not pick up my (very young) baby - as if I could just leave her in the cot all day unattended! They prescribed tramadol, gabapentin, naproxen and co-codamol but it didn't touch the pain.

I found the hospital consultants to be even less help than the GP. The consultant advice was quit my job so I don't have to commute . Not very realistic. They weren't willing to do anything about the pain other than refer me back to the GP.

Only listen to the people on here saying NO! Please talk to an HCP before doing anything.

OP have you tried using heat? I have a long standing spinal injury and take a cocktail of meds but my heat mat (Amazon) is so comforting. I actually find tramadol gives me psychedelic dreams so I avoid it around bedtime and take cocodamol and amitriptyline at night (prescribed obviously).

Ask at your practice if any of the GPS specialise in pain relief. They will always want to give you as low a dose as possible and frankly no drugs are likely to render you pain free but combining meds is more used than taking huge doses very often and paracetamol enhances opiates so is worth taking even if your pain seems too much for it to help.

If you are in spasm heat will help but diazepam is helpful. You need a sympathetic GP onboard. Often one who has had an acute back.

Best wishes.

When I hurt my knee the drugs didn’t help but then the doctor gave me ralvo patches which you wear for 12 hours out of 24. They are impregnated with local anaesthetic and worked wonders. Not docs first choice as expensive but worth asking for @Llamasally if you can reach the area to apply or have someone at home who can help.