AIBU to be concerned G.P has prescribed DH co-codamol for long term pain relief

[Hangingwithmygnomies]

Obviously will start by saying I am clearly not a health professional but my DH has a problem with a couple of vertebrae in his neck, something akin to bulging disks. It's a chronic condition and basically he has been told that nothing can be done so it's just long term pain management. He was precribed amitriptyline but he felt they made him an angry person and didn't like it, so he spoke to the G.P and they've now precribed co-codamol. I feel really uneasy about it as whenever I've bought it for migraine, the pharmacist has told me not to take it for more than 3 days so didn't think it was suitable for long term relied. Also I had a friend who became fully addicted to codene after taking co-codamol for an injury and sadly the addiction over took her completely and she took her own life, so I am aware my opinion maybe clouded due to this and would welcome other perspectives to see if IABU or not

Yours is an interesting question OP I often wonder about this as I suffer chronic pain that has no cure and take soluble over the counter Co-codamol. I stick to one or two a day at night to manage my pain so I can sleep. I never feel the need to take more during the day or feel any ‘withdrawal’ if I miss a day or two. I would think it depends on the individual though. The prescription Co-codamol is a stronger dosage I believe. My late DM took prescription strength Co-codamol for many many years as pain relief for severe arthritis. She was never dependent on it and always took only the prescribed dose. This helped her manage her pain quite well. My DM lived very happily and passed away at a good age. I really hope your DH gets some relief from his condition in whatever he way can. Chronic pain is an absolute life draining thing.

I was on them for a while, I have a pancreas disease which causes me a lot of constant pain. Yes they are addictive, but to be honest all pain relief at this kind of level is. I’ve been on some very high doses of fentanyl, a very powerful drug, but managed to wean off it post surgery which helped my pain. I think as long as he’s just taking it for pain, only taking the prescribed dose then he will be ok. I’ve always been told by the pain clinic that yes you will become dependant on them, but to me dependant and addicted are different and the different is as above, taking as prescribed only. Doctors can support in weaning off when the time is right. The thing is if he needs pain relief he needs pain relief.

I'm a GP. YANBU to be concerned. We are trying to steer away from treating chronic pain with medications as they ultimately don't work well and come with their own risks of addiction, dependency and rarely fatal side effects especially if you end up on a cocktail of them that all mix together. I wouldn't be massively concerned about a bit of codeine but I would be explaining to DH that other methods such as distraction techniques and talking therapies are much more likely to provide more long term benefits. I'd be encouraging him to self refer to his local counselling service to access therapy. His current medications are low risk but I would want to be nipping the chronic pain in the bud and starting early finding alternative coping mechanisms to medicine. This is all ultimately your DH's decision though of course x

With all due respect @Cheeseandcrackers86 how is therapy going to help with bulging disk pain?

That’s very interesting @Darbs76 I never really thought about the difference between dependence and addiction. I think you are right. I do worry about the withdrawal of pain relief medications from patients in favour of other methods. I worry it’s just about saving the NHS money. Although saving money is of course understandable. I think maybe alternative methods alongside medication that could be possibly reduced if appropriate.

I'm not even 30 yet and my GP was happy for me to take OTC cocodamol basically indefinitely as long as it's reviewed with them periodically. But I hate how I felt, was like I was halfway to another planet. Ultimately I think if it's a choice of being dependent on pain meds to live a somewhat full life or suffering with pain then I'll take the pain meds.
Interesting about going from amitriptyline to cocodamol though, amitriptyline is usually used for nerve pain whereas cocodamol isn't usually particularly effective for that

Totally. It's bullshit. There comes a point when "mind over matter" isn't enough.

Has he tried Duloxetine?

Exactly this. Mind over matter only works to a certain extent - some conditions really do need long-term pain relief.

Could he ask to be referred to a pain clinic? I was referred for neck pain - they prescribed everything, although not codeine. I didn’t like amitriptiline, because it affected my memory imo. In the end, I had cervical epidurals, one on each side every so often - but that was for slipped discs. I don’t know about bulging discs.

Taking them for a short time won't be a problem but if the condition persists he should look at distraction techniques as the GP says. Pain is not linear and there is good research around using coping mechanisms. There are also medications specifically for nerve pain which may be successful. Different mattresses, stretching exercises, anti depressants etc can all help. Chronic back pain isn't just about whacking it with stronger and stronger painkillers.

I've been prescribed codeine for over ten years now and I only ever take at most two a day. For some people it is addictive but I've never felt the need to take more even if my pain levels get higher because I don't want to become dependent/for them to lose their strength. I hope he feels better soon!

Why wouldn't it work?! All pain comes from your brain whether there's no physical cause or you just had your leg chopped off. When it first happens then yes pain relief medications are good at breaking that cycle. However when it becomes chronic pain it's so hardwired into your brain that it's incredibly difficult for even the strongest painkillers to fix this. Therapy does help more than pain relief. It's been proven. The problem is it's a damn site easier to swallow a couple more tablets a day than put the significant mental effort it takes to engage with therapy....

I suffer from chronic pain and it's absolutely miserable to live with. I've been prescribed cocodamol and tramadol on repeat for years. I'm not addicted or even dependent on either of them. But I feel so, so grateful that my GP's are willing to prescribe them to allow me to get a break from the worst of it. Unless you suffer from chronic pain, you really do not get it.

I think you have to have a certain type of brain chemistry to become addicted in the way that your friend did. Think of it like social drinking vs alcoholism/major binge drinking. We all know that person who cannot stop after one drink but most people can stop after one or two with no problems.

I don't blame you for worrying with your friends history, but don't expect someone to live with pain to ease your anxiety.

I guess it depends on the alternatives. Sometimes patients are just pumped full of meds and sent on their way. That very much happened to me, it took me 5yrs and a lot of pushing myself to get a diagnosis, and another 2 for a surgery that has made my life a whole lot better.

I agree with comments that pain meds are given out too easily but I was living in horrible constant pain. I couldn’t have survived it without pain meds. I was looking after 2 young kids on my own and trying to keep hold of my job. Pancreatitis is a very painful condition and I had 4 acute attacks on top of constant pain and even though my pains under control most of the time now I’m still on what many would consider very high doses of pain meds. But I can’t live my life without them.

The pain clinic was horrified what dosage of fentanyl I was on pre surgery and asked me to repeat it 3 times. He apologised at the end of the call for over reacting but said he had never known anyone on that dose. And I was working in a senior role, raising kids, never ever felt drugged up, my body had just become dependant on the meds. Not sure what else my GP would do though whilst she waited for the specialists to finally work out what was wrong and help (for reference a gallstone must have got trapped at some point in my pancreatic duct causing it to become damaged meaning the bile didn’t flow properly causing my pancreas to be constantly inflamed). Darn stones

At the risk of sounding flippant, and I am not. Buy some prune juice or pineapple (not from concentrate) ditto expensive apple juice. Natural yoghurt and sunflower seeds will also help.

Mmmm. so my pain where it feels like white hot (not red hot, white hot) pokers are ripping through my stomach after it's been cut open with a knife can be cured by changing my thinking. Am guessing you aren't suffering from chronic pain are you although won't be surprised if you come back and say you are. Sometimes CBT really doesn't cut it!

YABU.

it would be wonderful if everyone who experienced chronic pain was able to relieve/alleviate/manage it with non dependency forming drugs such as paracetamol, but unfortunately that isn’t always the case. And when you’re dealing with serious pain, often there aren’t many stronger options that aren’t dependency forming.

he will become physically dependent on them and need to taper off them if such a time comes where he and his doctor decide to give that a try, but that’s not a problem necessarily. It just means he can’t stop taking it cold turkey without feeling like absolute shit. Similar to many other medicines like some antidepressants, anxiety medications, and so forth.

respectfully, you need to leave this decision down to him and his doctor and not share your untrained opinion, you wouldn’t want him feeling bad or being reluctant to follow medical advice because of your own fears.

it’s good that his pain is being treated and taken seriously and I hope this gives him some relief. There is so much misinformation out there about medications and addiction, which can sadly leave some people in a place where they’re experiencing awful unmanaged pain without treatment due to fear of addiction. Your husband and his doctor have to weigh up the pros and cons together as it seems they have done. When you buy it OTC you’re told not to take more than three days worth because it’s not under medical supervision and someone might not realise the chance of becoming physically dependent (which btw isn’t the same thing as addicted). When it’s prescribed it’s safe as the doctor is fully aware this will happen physiologically and won’t stop the medicine out of the blue but the benefits are worth the risks.

Oh and have recently weaned myself of a whole 4 codeine phosphate a day for another condition because I no longer needed it for that condition. CP didn't touch the other one btw.

@Theonewiththecandles from my understanding of what my husband has said the issue in the vertebrae is causing problems with a nerve in his neck and causing peripheral neuropathy also.

@Cheeseandcrackers86 interesting, I'll speak to DH. He's put off taking medication for so long but the pain is becoming quite intense now. With the job he does, he may just start with taking them of a night so he can get some sleep without being woken in pain.

@ArseInTheCoOpWindow no, not heard of that one so will get him to speak to the G.P again, thanks

If amitriptyline worked but he didn't like the side effects, he could ask the doctor to try nortriptyline which is from the same drug family but generally has fewer side effects.

Unfortunately it’s hard for people to understand what it’s like to live with severe chronic pain.

there‘s absolutely a place for psychological therapy that can help with chronic pain, and this should be offered to all patients. But it really isn’t as simple (as you say) as everyone with pain receives therapy and that’s adequate. Sometimes the pain truly is so severe it impacts upon ability to function without being medicated. I’ve sadly known people end their lives due to unmanaged pain. Until you’ve lived with relentless daily excruciating pain with no end in sight it’s difficult to wrap your head around. I think most people who set their hand on fire or wrapped barbed wire tightly around their leg would quickly realise that in order to survive and continue with life you need to stop the pain. And when pain can’t be stopped via treatments for the source, managing the pain the best you can really is sometimes the only option.

I’ve been on pain management courses and had hypnotherapy etc.
In the end, I said to the doctor that I really needed to keep taking co-dydramol and not to make me beg for them.
16 years, I was on them. 8 a day. Highest strength.

(Please do not minimise pain or suggest that you can think it away. That is absolute bullshit. I don’t know how to tag the GP who suggested this but I thank God that my GP was more understanding.)

Of course if the GP has prescribed it, give it a go but generally it's not effective for neuropathy
As others have suggested, nortriptyline and duloxetine are options, but also pregabalin and gabapentin are also used for neuropathy. The "standard" painkillers don't tend to do much and things like amitriptyline etc (antidepressants) or pregabalin/gabapentin (anti epileptics) are generally helpful.
If it's bad enough for him to see a GP about though, try not to worry too much about becoming addicted/dependent. I find GPs are quite stringent on what they offer and always check in regularly eg they don't put my naproxen on repeat and I have to have a phone call every month where they review my dose and explain about potential for gastro problems etc every time.

I think therapy is very helpful for managing one's response chronic pain but it doesn't necessarily take it away. I understand about pain gateways etc. and am not overly convinced. Some relaxation techniques are very helpful, mindfulness useful at times. However, I have a condition that flares up and then I absolutely need pain killers as well as using the techniques I have learnt. So perhaps that leads to lower use of painkillers as I mostly take them in the evening so I can sleep.