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AIBU?

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

139 replies

Hangingwithmygnomies · 11/10/2022 18:40

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

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ArseInTheCoOpWindow · 11/10/2022 20:03

Pregabalin and Gabapentin are not as widely prescribed though due to addiction issues. I was on 25mg Pregabalin and had horrific withdrawal issues. And l don’t generally get them.

They we’re good for pain though.

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NotaCoolMum · 11/10/2022 20:03

Cheeseandcrackers86 · 11/10/2022 19:37

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....

thank God you’re not my GP.

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Cheeseandcrackers86 · 11/10/2022 20:03

silverclock222 · 11/10/2022 19:49

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!

And sometimes your GP is going to be reluctant to prescribe you medication that has a literal street value and puts you at a very real risk of dropping dead in your sleep especially when the NICE guidelines clearly tell them not to.... whether you like it or not

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Gifthunter · 11/10/2022 20:06

Some broad thoughts linked to the above replies rather than the OP

The uncomfortable truth is very little works for long term pain relief. Perhaps at best a tenth of patients benefit from long term opiate medication eg. Codeine morphine oxycodone buprenoprhipne fentanly. However there is increasing evidence that less or none do. Amitriptylline and gabapentinoids have benefit in nerve pain. None in chronic lower back pain without nerve root comprise. Anti inflammatory have relatively small improvements and there has been some recent evidence which may suggest they increase the risk of short term pain becoming long term. This is probably only for a small number of people at most.


For most people painkillers have minimal effect on chronic pain and may cause harm.

The nhs now has a website to explain this to people.

painkillersdontexist.com/

There is more evidence for physiotherapy cbt in some conditions but this is by no means a panacea. Sadly once pain becomes chronic it is often limiting in the same way other medical conditions are.

Drug companies and the medical profession have encouraged a mindsets initially that we can "kill pain".

There is now a switch away from this but we should be careful not to minimise people's pain whilst still accepting that painkillers are rarely the right way.

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Aworldofmyown · 11/10/2022 20:07

I disagree with posters who have suggested addiction to this type of medication is similar to alcohol addiction.
I absolutely do not have an addictive personality but ended up with physical withdrawal symptoms after taking co-codomol for an extended period, if you look on the relevant mumsnet board codeine is a real problem and creeps in without realisation.
You only have to watch Dopesick to see how people need more and more opioids to relieve pain.
No one should have to live with excruciating pain but I think it is sensible to try all other options first - they may work and if they don't you still have medication to go for.

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ArseInTheCoOpWindow · 11/10/2022 20:10

I find Amitryptiline works for non nerve pain as well.

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sueelleker · 11/10/2022 20:17

The 3 day rule is for if you haven't been prescribed it, in order to make you see a professional for further examinations. Your DH has had it prescribed, so if he doesn't exceed the stated dose he should be fine. I'll warn you though; codeine can cause constipation-he may need to take stool softeners regularly (NOT laxatives like senna, just something like Dulco-Ease to keep the stools soft.)

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Hangingwithmygnomies · 11/10/2022 20:23

@Miiaaoow @LeningradSymphony I definitely do not want to see him in pain and would never expect him to not take something recommended because I was uneasy. It's not nice to see him in pain and I think it's starting to depress him, so the suggestion of talking therapy is not a bad one but I'm not sure he would agree to it - he's a pretty closed book most of the time. As I said in my op, my only real dealings of codeine based pain killer is not a good one and neither of us know much about other long term pain relief available, so it's good for me to get other alternative ideas to give him. It was a phone consultation and he didn't seem that confident in the G.P he spoke to, which is what prompted me to post

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Hangingwithmygnomies · 11/10/2022 20:27

sueelleker · 11/10/2022 20:17

The 3 day rule is for if you haven't been prescribed it, in order to make you see a professional for further examinations. Your DH has had it prescribed, so if he doesn't exceed the stated dose he should be fine. I'll warn you though; codeine can cause constipation-he may need to take stool softeners regularly (NOT laxatives like senna, just something like Dulco-Ease to keep the stools soft.)

Thanks, I didn't realise that's what the 3 day rule was for, I presumed it was because of the risk of dependancy issues. I only ever take it once in a blue moon for severe migraine and only at night for a severe migraine. I think we have lactulose in the medicine cupboard but will get something if not

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Musicalmistress · 11/10/2022 20:32

My OH has been on cocodamol for over 10 years as a result of an injury to his hand causing nerve damage. He's tried dozens of other things, including amitryptiline which sent him doolally, and the cocodamol has been the best. He has regular checks with the consultant who often says 'why would we ask someone to live with pain if we can offer something to help?'

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PinkPlantCase · 11/10/2022 20:37

Theonewiththecandles · 11/10/2022 19:59

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.

The thing is though if OP is worried about the side effects of co-codamol the side effects and long term impacts of the other drugs you mention will likely be much worse. Yes they help people with chronic pain function day to day but they are very strong and there’s a reason why they aren’t available OTC or in some cases are controlled drugs.

OP YABU, if you’re trying to medicate chronic pain codeine is the least of your worries.

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kateandme · 11/10/2022 20:45

I don’t think many would say you can think it away.but thinking and certain meditation exercise and mindfulness are proven to ease or help you at least cope with certain peaks or lower peaks of pain.
it can help with the emotional and mental side of the pain.it can be an aid to ease and help you cope,not feel so hopeless in the darkest of days which then only ever makes the pain feel worse.
allthough actually people have managed to get rid of pain using it.but this takes age old practices and dedication many rightly couldn’t give to it.

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RobertaFirmino · 11/10/2022 20:54

I can't stand the Pain Police.

If I need to use my Zapain, I bloody well will. I have yet to be offered a suitable alternative (other than stronger painkillers!) and believe me, I've tried everything that has been suggested to me. Including mindfulness and those adult fucking colouring books.

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Bottomofthepileasusual · 11/10/2022 21:03

I was prescribed CC for a broken wrist. The strong dosage. My GP told me I'd only get :
3 repeat prescription due to the risk of addiction. I didn't need all 3 thankfully and started not taking 1 with 1 paracetamol when the pain started easing. I'd recommend your DH goes for them. They really were a godsend

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Notplayingball · 11/10/2022 21:04

I take it occasionally when I have hip pain (osteoarthritis) but at night. I often have several days without it though. Addiction is not something that I worry over as I have discussed with my GP and it's there as a last resort for my pain. I also use exercise to help as advised by the GP too.

I don't think there's anything wrong with looking into alternative ways to manage pain like talking therapies. There's nothing to lose. Use in conjunction with painkillers if they are prescribed for chronic pain. It doesn't have to be either or.

I hope your DH finds the cocodamol helps so he can rest. That's half the battle.

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Hangingwithmygnomies · 11/10/2022 21:08

PinkPlantCase · 11/10/2022 20:37

The thing is though if OP is worried about the side effects of co-codamol the side effects and long term impacts of the other drugs you mention will likely be much worse. Yes they help people with chronic pain function day to day but they are very strong and there’s a reason why they aren’t available OTC or in some cases are controlled drugs.

OP YABU, if you’re trying to medicate chronic pain codeine is the least of your worries.

It's not that I'm worried about the side affects for him from it per se, it's just that our only real experience of longterm use of cocodamol/codeine is from a friend who became addicted to the point it ruined her life and she killed herself. He didn't like the side effects of amitriptylin so was enquiring about alternatives available so the G.P precribed this and my belief was that it was a short term painkiller, not a long term thing but PP's have clarified for me that long term is ok under medical supervision. I absolutely do not want him to be in pain

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Karrots · 11/10/2022 21:12

Just because someone says they are a GP on an anonymous forum does not mean I have to believe them, especially when they suggest ‘talking therapy’ for chronic pain.

Yes we should all be cautious of and very aware of addiction of OTC medications. However, your explanation of ‘pain is in your brain’ and therefore is ‘mind over matter’ is a massive misreading of the intelligence on this forum or a huge question mark on your medical credentials or empathy - or both.

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Karrots · 11/10/2022 21:13

*OTC & prescriptions meds

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MissTrip82 · 11/10/2022 21:13

It’s not ‘mind over matter’. It’s psychological treatment to provide adjunctive strategies to manage pain. It’s a cornerstone of many pain management schemes overseen by pain specialists. It’s necessary because we know pharmacological therapies are quite poor at treating many types of chronic pain. It’s also evidence-based, which ignorant sneering is not.

Codeine is not a great drug for pain management for a variety of reasons.

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WiddlinDiddlin · 11/10/2022 21:15

I wouldn't be too concerned - I mean I wouldn't eat it like smarties wahey and fuck the consequences... but I would use it properly, as intended to, to reduce pain and get pain under control.

Then all the fancy mind over matter, positive mental attitude shit can be helpful, if you're starting from a position of 'manageable pain'.

However that doesn't work if your pain sources and types alter daily and frequently, as chronic pain sufferers may experience.

There is no 'mind over matter' or 'keep busy' that works when your trapped nerves in your spine and neck are causing your hands to feel as if they're alternately being stabbed and then about to explode... whilst you're asleep! Pain to the point of being aware of it in your dreams, and waking in agony multiple times a night.

There is only so busy a person can be, and I can't be busy with distracting things AND sitting trying to concentrate on my work (and concentrating on writing tends not to work well when trying to overcome horrific shoulder/back/leg pain).

Very fortunately my GP is happy to prescribe pain medication - I won't live long enough for the long term side effects to matter more than my other issues, and they know that.

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ProbAmU · 11/10/2022 21:16

I have the same issue with my neck as your partner. I take amitriptyline but vary the dose according to pain levels. Gabapentin was better for pain relief but I had horrific weight gain so went back to amitriptyline. Had codiene for a while when I was pregnant but it wasn't that effective to be honest. Would definitely recommend he tries gabapentin or pregabalin and gets an assessment with a spinal physio, if he hasn't had one already

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Alliswells · 11/10/2022 21:18

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Miiaaoow · 11/10/2022 21:21

Aworldofmyown · 11/10/2022 20:07

I disagree with posters who have suggested addiction to this type of medication is similar to alcohol addiction.
I absolutely do not have an addictive personality but ended up with physical withdrawal symptoms after taking co-codomol for an extended period, if you look on the relevant mumsnet board codeine is a real problem and creeps in without realisation.
You only have to watch Dopesick to see how people need more and more opioids to relieve pain.
No one should have to live with excruciating pain but I think it is sensible to try all other options first - they may work and if they don't you still have medication to go for.

This is physical dependency, which is a world away from addiction when we are talking about opioids.

Most people on opioids, gaba drugs and anti depressants (hell, even caffeine!) will develop physical dependency and thus develop withdrawal when they stop.

People (not you, everyone) need to separate dependency and addiction, they are not the same thing.

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Hangingwithmygnomies · 11/10/2022 21:24

ProbAmU · 11/10/2022 21:16

I have the same issue with my neck as your partner. I take amitriptyline but vary the dose according to pain levels. Gabapentin was better for pain relief but I had horrific weight gain so went back to amitriptyline. Had codiene for a while when I was pregnant but it wasn't that effective to be honest. Would definitely recommend he tries gabapentin or pregabalin and gets an assessment with a spinal physio, if he hasn't had one already

He has seen a physio but I don't believe it was a spinal physio, so will look into that thanks. Yes the amitriptylin worked well for the pain, but Christ on a bike, he was a grumpy bugger on it

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littlepeas · 11/10/2022 21:25

This is interesting reading and it seems different people respond differently to it. I was once prescribed max strength co-codamol for an absolutely horrendous ear infection (pain was the only thing I have experienced that is comparable with labour) and understand completely how people become addicted to it. I took it for the shortest time possible. I think I have quite an addictive personality.

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