Dr prescribed my 14 yo tramadol for headaches - this normal?

[BayesianBlues]

We live abroad so wondering if this would happen in the UK.
14 yo daughter has been suffering from headaches for a month or so. Not totally debilitating like migraines but not nice and quite frequent. She usually would take paracetamol which takes the edge off enough that she can function. Sometimes ibuprofen. Probably every other day on average she's been getting through maybe 4 paracetamols and a couple of ibuprofen if needed.

So the doctor said that this amount of paracetamol is not good for the liver and the ibuprofen isn't good for the stomach and that DD should take tramadol for her headaches. She's prescribed us 10 50mg tabs to take home.

I was a bit shocked that she jumped straight to tramadol. And I wouldn't have thought 4 paracetamol and a couple of ibuprofen every other day is that terrible?

I'm not a dr but it's a VERY different medical culture here (very very quick to prescribe meds and had to push back against the over use of antibiotics) so I'm wondering if this would be considered normal in the UK if anyone has any experience?

Is Tramadol the one with codeine in it?

Not being funny but why didn't you question the doctor about this at the time??

Definitely not normal. If the pain can be managed with paracetamol and Ibuprofen then I see no need to prescribe opiates, especially at that age. Paracetamol is only bad for your liver if you exceed the recommended dose, ibuprofen can cause stomach irritation but not normally an issue if you take it with food and not for long periods of time.

Go and see another doctor.

Paracetamol every other day doesnt sound healthy. Hope she feels better soon. Do you know what the cause is? Tramadol does sound concerning though, yes.

I did question the doctor if tramadol really was right and she was most insistent that it is preferable to paracetamol and ibuprofen which she said are damaging to DD at the levels she is taking them (which don't seem THAT excessive to me tbh). She did some blood tests on her and one of them was liver function, apparently because of all the paracetamol DD has been taking over the last month.

@R0tational

Paracetamol every other day doesnt sound healthy. Hope she feels better soon. Do you know what the cause is? Tramadol does sound concerning though, yes.

No, of course not and that's why I took her to the dr - to find out what's causing the headaches (and generally feeling unwell). But 4 paracetamol tabs every other day isn't a crazy amount either (DD is about 60kg so basically adult dosage)

@Lilifer

Is Tramadol the one with codeine in it?

Not being funny but why didn't you question the doctor about this at the time??

Come, on, how many people would be assertive enough to question a doctor in the heat of the moment when you don't know if you're correct or not? Especially in front of the child?

As someone mentioned above jumping to an addictive opioid is not the recommended guidance. Paracetamol is safe as long as within recommended dose and ad hoc ibuprofen is fine too. Is the Dr going to investigate the headaches?

Perfectly legit to have second thoughts after a doctor's appointment surely. I certainly think of Tramadol as a major painkiller.

I would ask for a second opinion before using the Tramadol tbh. In particular, has the doctor suggested any cause, or investigations into the cause? She's surely not sending a teenager off with opiates and saying 'job done, she can stay on those indefinitely' is she?

@babytum

As someone mentioned above jumping to an addictive opioid is not the recommended guidance. Paracetamol is safe as long as within recommended dose and ad hoc ibuprofen is fine too. Is the Dr going to investigate the headaches?

Yes, the headaches are being investigated but it's one of those things which might be something or might be nothing and it could take time to figure out what's going on and eliminate main reasons. Dr was a bit concerned about some things in the blood test and wants DD to see an endocrinologist. And in the meantime prescribed her tramadol!

Not a GP but am a doctor. This would pressure unusual I. the U.K. We’d probably start on a little bit of codeine (8mg) if necessary. And it would be as well as the paracetamol and ibuprofen rather than instead of. Google WHO pain ladder if you want more info/ammunition when you go back to the doctor.

@PermanentTemporary

Perfectly legit to have second thoughts after a doctor's appointment surely. I certainly think of Tramadol as a major painkiller.

I would ask for a second opinion before using the Tramadol tbh. In particular, has the doctor suggested any cause, or investigations into the cause? She's surely not sending a teenager off with opiates and saying 'job done, she can stay on those indefinitely' is she?

No, it's not that crazy! It's all private here so they love doing more and prescribing more. Wouldn't be surprised if DD ends up with an MRI!!

She's only got 10 tramadol tabs and I don't think I'm going to give them to her, it doesn't seem right - the pain isn't that severe. I might do a teleconsult with a GP in the UK as I find the whole medcial culture here not to my taste.

No either where the pressure came from.
This would be unusual in the U.K.

Been watching that show about the opiod crisis in America and how easy it was to get dangerous drugs out via doctors. Awful.

Absolutely not normal here. You can get ‘painkiller’ headaches though so maybe try break the cycle of pain relief and see if she goes a few days without if the headaches subside. I’d also look at keeping a diary and food triggers possibly.

I'm on tramadol for severe back & hip pain and that's only after a lot of other drugs stopped being effective. The BNF says it can be prescribed for 12-17 year olds for 'moderate to severe pain' but it wouldn't be the first choice of most UK doctors.

@Cyclingforcake

Not a GP but am a doctor. This would pressure unusual I. the U.K. We’d probably start on a little bit of codeine (8mg) if necessary. And it would be as well as the paracetamol and ibuprofen rather than instead of. Google WHO pain ladder if you want more info/ammunition when you go back to the doctor.

DD is already taking paracetamol and ibuprofen and the Dr said she should stop and move on to tramadol because of damage to liver and stomach respectively.

I've only seen tramadol used for post operative pain or severe chronic pain in my experience as a nurse. I've never heard of it being prescribed purely for headaches, and prescribing an opioid for a 14 year old seems wrong.

If the headaches are that frequent then they need investigating rather than masked with strong pain relief. Has she had her eyes tested? Does she drink enough water? How much caffeine does she drink? Is she stressed about something? Is she getting enough sleep?

Also Google "medication overuse headaches".

tramadol is very potent stuff. and can be addictive.

your dd needs investigation about her headaches, not more medication.

has she had an eye test?
what's her posture like?
blood pressure?

Wouldn't happen in the UK I am pretty sure
Tramadol is an opiate and as such is addictive and can have major side effects in its own right like severe constipation and confusion

I would certainly have thought that she should keep on taking the paracetamol and ibuprofen as long as it's within safe limits whilst the cause is investigated

It could be migraines, eye strain or rarely something really serious.
If serious causes are excluded then maybe she needs to look at non pharmacological solutions like massage, meditation, relaxation because overuse of painkillers can in itself cause headaches.

My BIL got into that cycle as a teenager/ early 20s and it was very hard for him to break. He took so many painkillers for his recurring migraines that he wound up with a constant daily headache which was actually in many ways worse. He had to go to Queens Square to get sorted out and weaned off all the stuff he was on. In the end having good migraine prophylaxis meds, avoiding dietary triggers and a daily meditation practice were what helped him but he had a lot of wasted and painful time on opiates etc that just made him worse.

That is not normal (in the uk). I don’t practice now but in 8 years as a pharmacist I never saw tramadol prescribed for a child in the community (possibly used in hospital). Paracetamol and ibuprofen plus appropriate investigations (eye test etc).

Paracetamol and Ibuprofen will not be causing major damage if used correctly on a when required basis. Unless the doctor has serious concerns about inappropriate use (which it does not remotely sound like here) then it's perfectly appropriate treatment.

As the doctor above mentioned the next step in the UK would be a weak opiate like codeine with a referral to find out the cause so it can be treated appropriately (for example migraine management is very different to conventional headache).

I would certainly question that prescription if it came to my pharmacy.

I was prescribed tramadol post surgery (3 x CS and one mastectomy). I wouldn't give it to a teen, and it hasn't been prescribed to DS1 (same age as your DD) with chronic pain. It's a really powerful painkiller, I think you're right to question it.

Here’s a group of doctors discussing tramadol. In short: they don’t like it as a drug.

twitter.com/existential_doc/status/1376055811051503616?s=21

I think GPs in the UK avoid prescribing codiene for headaches because long term codiene use is thought to make headaches worse? Antidepressant medications are often prescribed for headaches in the UK.