Is painkiller addiction/dependence ALWAYS wrong?

[Worrysaboutalot]

With the following caveats :-

: The person is a fully functioning adult person with reasonable mental health and able to make long term decisions.

: The person had one (or several) chronic conditions which are extremely painful and life long with no chance of pain ever ceasing.

:The painkillers have been prescribed by a consultant or GP who has all the medical record information and is monitoring the patient regularly.

:The person has been told they will be on these medicines life long.

I ask because I have several medicines, two of which are controlled and can be addicted. I can only have a month or less medication at a time, because of the risk of addiction. One of the pills I use for breakthrough pain, requires a GP appointment to discuss its use.

But despite all the 'it is addictive' concerns, yet I have been told I will be on this medicines for the next 30/40 years aka the rest of my life.

If I will be on these pills for the rest of my life, why the concern I will become addicted to them?

AIBU to not understand why I have to have the same facts repeated to me every few weeks, when this treatment is life long?

It does worry me. I don't want to get addicted to medicine but I can't live with the chronic pain, I was in before them.

There are many women on this site who have similar concerns, many who have to jump hoops and practical beg for the pain relief they need.

I am not sure of the answer really.

I agree there is a difference between addiction and dependency. I'm on chronic pain management for eight years . For 4 years I was prescribed Tramadol but when I tried to come off it I suffered horrific withdrawal. I was changed to Palexia SR 100mg twice daily and thankfully that seems to be a lot 'cleaner' drug with no highs and lows. I spoke with my consultant about being ' addicted' to pain killers but he assured me that I required them , similar to meds for a heart condition etc, and therefore would not be classed as addiction. However I'm always careful , as have fast acting Palexia for break through pain, but really try not take that unless Pain is intolerable.

@Bagelsandbrie

"People who have never suffered chronic pain will never understand."

This in buckets.

OP if you aren’t requiring ever escalating amounts of medication you are unlikely to be addicted- I’m on a similar cocktail of medication and sometimes if I’m having a good day I can completely forget a dose which reassures me that whilst I’m almost certainly dependent on the meds I’m not addicted.

Apart from being a bit sleepy occasionally and probably a bit calmer, I have no ‘high’ just a reduction in pain. Like you my situation is life long. I have a fantastic GP but live in dread of being deprived of what amounts to my ability to live my life as normally as is possible.

There's a difference between a chemical dependency (because your body is now used to the drug as many people are on any number of things) and addiction (where you're taking it because you are dependent on it).

Chemical dependency on an addictive drug can be hard to monitor. That doesn't make you an addict.

So yes, the fact that you're taking prescribed medication as prescribed for an ailment the drug is licensed to treat makes a world of difference. GPs don't always see that because they're under pressure not to prescribe medications that are addictive in the sense that the patient may not wish to come off them or, as happens alarmingly often, sells them on.

Watch Dopesick to understand the reasons behind this.

The danger is that you build a tolerance and need more and more which then turns you into a zombie. They also stop working as well.

Sone pain meds eventually cause pain. Being weaned off needs doing. And it's torture.
I have a friend who is constantly arguing with the GP about wanting more.
It'll kill you eventually: the pain or the cure for the pain.

Reading this makes me wonder why medical marijuana isn’t legal in the UK. I have a license because I have neuropathy relating to Lyme Disease, and it’s an absolute lifesaver in that it allows me to relax and sleep well 85 percent of the time. I probably am dependent, but on it I can be an involved parent, wife, friend and co-worker.

At the dispensary, there are many people with walkers, crutches etc. so I know that certain strains are also used for pain management.

I'm another pain patient. Until recently I was taking maximum dose of co-codamol a day & muscle relaxants. I also have slow & standard release Tramadol. Personally I find the Tramadol doesn't really work for me. Recently I was prescribed Duloxetine & stopped the Tramadol dead immediately. It took 3 months to start working & I then halved my co-codamol use. I must be lucky because despite being on them for years I had no withdrawal on either.

I've never had any "fun" aspect of either Co-codamol or Tramadol & purely take them for pain relief. I'm petrified that the GP will stop my opioids, (which my new GP surgery seem desperate to do) only for the Duloxetine to stop working. I'm sick of having to argue my case & being treated like a druggy begging for a fix with every repeat prescription!

My first GP answered this really well after I was diagnosed, he also worked in an addiction clinic, so lots of experience. He put It much better than I can, but he was saying people with chronic pain all get addicted, they're addicted to being in less pain, to bring functional, of course that's addictive. There's nothing wrong with being reliant on medication a doctor has prescribed to treat your condition or to ease symptoms. The dangerous kind of addiction is if you find yourself craving more even when you don't need it for your pain, if you find yourself reaching for it every chance you get, doubling up on prescribed amounts. I have horrible allergies so can no longer take any painkillers, despite being in 8/10 pain every day, I don't have any skin in the game, the way some doctors treat chronic pain patients is appalling. Of course people want to be in less pain, want to be able to have a decent quality of life, none of that makes them addicts, true addiction is very different from that.

I've been on 30/500 Co codamol for years, on a bad day I take the max dose of 8, on a good day its 3 or 4.
They help calm me down too as well as help with the pain. Previously been prescribed tramadol but I felt dreadful on them so stopped.
Chronic pain is awful and very misunderstood.

I can only have a month or less medication at a time, because of the risk of addiction.

It’s really, really easy to get into the habit of taking an extra painkiller here and there when you have a lot in.

Rather than going to the Dr and talking to them. It can start off as a one off because you had a busy day, or had a fall or the likes. Then it’s only every now and again and it’s easier just to take an extra rather than go through the faff of trying to get an appointment with the Dr…
Then eventually it’s a nightmare at the end of the prescription because you’ve run out .

Plus the more you take the more tolerance you build so the more you’ll need to be effective.

It’s really, really, really easy to slip into. And it ends up causing far more pain in the long run.

The thing is limiting medication to strictly one month at a time for people like me is really anxiety inducing… I have days when I may take just one 30/500 Cocodamol and other days when my pain is dreadful and I take the full amount. If they base my prescription on a good day I will run out and have the nightmare of trying to speak to a Gp / waiting for a prescription to be issued / waiting for my (totally useless) local pharmacy to issue and authorise the medication (they are really awful, you can go to them with an urgent prescription for antibiotics and it will take 3 days to sort out, I live rurally and they are exceptionally slow)! I understand the need to be very careful when prescribing drugs but keeping people like me strictly to the absolute bare minimum they require can cause so much distress and anxiety- and pain; trying to ration out the last few doses to last till the next prescription and the worry of whether you’ll even get them prescribed again!

Thankfully my Gp is very supportive and is happy to prescribe whatever I request whenever I put a request in - as they know I’m sensible and wouldn’t take too much or more than I really need. But I think other people would have a constant battle.

(In fact I’ve been behind someone in the pharmacy who was very upset to be told their prescription for Tramadol was on order and would take about 3/4 days and they had worked out they only had 1 days worth of tablets left - this wasn’t their fault, it was an issue with the doctors and pharmacy. They were standing there counting how many tablets they had left and how they could make them last …!)

Is Zapain cocodamol? Just curious,

Zapain is 30mg codeine/500mg paracetomol each tablet which is also called tylex it's on prescription only . . Co codomol is 8mg codeine/500mg paracetomol and can be bought over the counter.

Is Zapain cocodamol? Just curious

Yes. You can get cocodamol in different strengths, from 8/500 which you can buy over the counter as pp said, the stronger ones 15/500 and 30/500 are prescription only.

Just different brand names

The 30/500 Cocodamol I have is branded Solpadol, Zapain is just another brand of the same thing.

My chemist just gives me unbranded cocodamol 30/500

I would have a terrible quality of life if I didn't take take them. I have CNS damage that is irreversible from a chronic inflammatory disease. I live with pain that feels like flu aches and shooting pains and other nerve damage symptoms 24/7 and it will never get better. I've been in Tramadol for three years. I do not see anything wrong with it if it means I have a bearable quality of life and I can continue to work and look after my DC. I was actually overprescribed them for years until I pointed out to GP that I actually have only ever taken the minimum dose and didn't need that many. It can be controlled it's not always a slippery slope to addiction!

@regularbutnamechangedd

Is Zapain cocodamol? Just curious,

Yes it's co-codamol. Zapain is the brand name. Over the counter co-codamol comes in various brands in strength of 5mg, 8mg or 12mg codeine with 500mg paracetamol. Prescription strength co-codamol is 30mg codeine minimum with 500mg paracetamol.

I’ve been on oxycodone for years for chronic pancreatitis. Before a major surgery I was on fentanyl patches too. It is what it is, I hold down a good job, it doesn’t affect me despite high dose, I’ve tried reducing, the pains too much. It doesn’t worry me

It is good that so many posters are in happy, in control of their painkillers and have made peace with being dependence on these medicines. It helps me to hear that, I aim to get there too.

Sigh, I need to find my balance against my chronic pain. I need to led the best life I can, on the lowest set of medicines.

Both the Gabapentin and Amitriptyline doses are slowly being increased since November 2019, it does worry me but it is needed to keep the nerve pain under control.

Sigh, I need to find my balance against my chronic pain. I need to led the best life I can, on the lowest set of medicines.

For me, it involved changing my life and doing less physical activity, which enables me to avoid the spiral of ever increasing dosage. I need to respect my body's limits because whatever painkiller I was on, once I'd adjusted to it, if I was doing too much the pain would be back. It's hard for me to accept that I can't do everything I used to do. It took a while to find the balance.

@EllieLucy

Sigh, I need to find my balance against my chronic pain. I need to led the best life I can, on the lowest set of medicines.

For me, it involved changing my life and doing less physical activity, which enables me to avoid the spiral of ever increasing dosage. I need to respect my body's limits because whatever painkiller I was on, once I'd adjusted to it, if I was doing too much the pain would be back. It's hard for me to accept that I can't do everything I used to do. It took a while to find the balance.

I can relate to this. I think initially I was trying to mask the pain with painkillers so that I could lead what was my “previous to pain” life. But actually all that would happen is that I’d exhaust myself and the pain would still be there underneath it all and my joints would hurt more and more. I have had to cut right back on activities and find other things to do. I do worry about my health long term because of this - we live in a world where we’re all encouraged to exercise at every opportunity but actually that’s not good for me. It’s a definite balancing act.

I've name changed for this but have been on MN since before my teenagers were born.

From the other end of the spectrum, I've been dealing this morning with my older sister's care team as they have been finding her increasingly difficult to rouse in the mornings. Today they just could not wake her and called out the paramedics who were with her for over an hour. She refused conveyance to hospital (largely because she is desperate to avoid a medication review).

She has been on a cocktail of opioids for many years now and they are really taking a toll on her health. She is out of it for large portions of the day, incoherent or talking fanciful nonsense in a dream-like state, has had multiple 'falls' (sliding out of her wheelchair due to falling into unconsciousness after her meds), complains of feeling fuzzy and unable to think clearly and has tremors in her hands at times.

Her meds are provided in blister packs so theoretically she can't be taking more than she should. But I think the large gaps in the day are causing her to take her meds at irregular intervals and therefore the slow release opioids are sometimes being taken too close together causing the issues like we had this morning.

It's got to the stage where I feel 75% of her health issues are now being directly caused by the meds. I'm terrified that one morning she just won't wake up.