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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

OP posts:
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Am I being unreasonable?

248 votes. Final results.

POLL
You are being unreasonable
66%
You are NOT being unreasonable
34%
IndianSummer78 · 11/10/2022 22:48

how do you know if someone is becoming addicted

They like the mental effects/ feeling of being on whatever it is and start looking forward to the next dose.

the medicals have told him nothing futher can be done

they would possibly have been more accurate to say there's nothing more they personally can do. Whether this is down to their expertise, waiting lists being closed, NHS protocol, budgets, beliefs (eg believing alternative medicine/complementary therapies are all useless for everything) etc. It's not the same thing as saying there are zero other options. It means they're telling you "this is what you're getting, so take it and go away"

we don't have copies of the xrays. I'd love to see a chiro and have a good cracking session

x-rays of one specific area aren't that expensive for animals, I don't know about humans.

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ItsStardustBackAgain · 11/10/2022 22:52

I’m confused, I had a spine hernia and was told to take cocodamol for 3 days max and the GP said if I take it longer then it would start causing headaches (as well as the addiction).

Your poor partner 😭 keep asking questions and definitely get a private opinion if you can.

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Justgorgeous · 11/10/2022 22:52

Talking therapy for chronic pain ? ?

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paintitallover · 11/10/2022 22:57

@Cheeseandcrackers86 that's a very good point, and one which out to be made on the health board more often.

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PeloFondo · 11/10/2022 22:59

I was on a lot of drugs for about 6 months - diazepam, oramorph, dihydrocodeine etc constantly. No issues coming off them
I still take dihydrocodeine once a day and have done since 2017. I've stopped them before/missed days and it's been fine but yeah, it's something to be aware of

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RosesAndHellebores · 11/10/2022 23:04

@ItsStardustBackAgain I think some GPs are clueless. It didn't give me a headache after 2 weeks. Thankfully my GP hasn't suggested I try therapy instead of pain relief. Fortunately my pain is minimal - because I can pay for healthcare.

GP nonsense:

"Your nipples are sore because you are feeding on demand. Babies need 10 minutes on each side every four hours".

"You are exhausted and hyper because you need to moderate your lifestyle." Turned out to be Graves Disease.

"Did you want it?" After we lost our first baby.

"There is nothing wrong with your back except some muscular pain" it was broken - GP refused to refer me so I paid.

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BaskingInTheSun · 11/10/2022 23:04

Cheeseandcrackers86 · 11/10/2022 19:05

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

Surely a combination of medicinal pain control, maybe nerve blocks/Botox etc, psychological support, listening therapy, physio input etc is what's really needed. Distraction and taking therapy have their place but as someone with intractable neck pain, and the resulting nerve pain, I'm afraid that the idea of 'nipping chronic pain' in the bud with taking therapies is frankly laughable for many of us, not to mention insulting.

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PineCone74 · 11/10/2022 23:08

Cheeseandcrackers86 · 11/10/2022 21:41

I can 100% guarantee that the people on here basically stating that their GP should prescribe them basically any drug they ask for despite it being totally against the current evidence would be the first to absolutely destroy that same GP if a loved one just stopped breathing one night because of the cocktail of medication they're on.... or had a massive seizure and crashed their car..... or ended up in a coma with seratonin syndrome. It really doesn't matter what your beliefs are btw. No doctor is under any obligation to do something if there's a high risk of doing harm. That isn't being an uncaring or unprofessional doctor it's the absolute opposite

This may be clinically correct, but surely part of being a GP is to have the sensitivity towards patients to know how telling someone in constant agony to try distracting techniques and talking therapies is going to make them feel? And, as other people have said, how is anyone supposed to even access counselling these days without a very very long wait? I’d imagine the emotional and psychological impact of hearing this sort of advice from a GP to whom they have turned for help could be very negative indeed.

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FixTheBone · 11/10/2022 23:12

Despite already convincing, and increasingly powerful evidence that opiates don't work for chronic pain...

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mauveskies · 11/10/2022 23:15

I don't understand the moral panic about codeine. I also don't understand how codeine is said to have been shown to "not work" when it works very well for most. Obviously, some people will abuse codeine and similar drugs. But we don't shut down all outlets for alcohol because some/many people are alcoholics.

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BaskingInTheSun · 11/10/2022 23:19

I have a family member who works in a specialised chronic pain team (and I worked in one of the first chronic pain services services set up years ago). The point of chronic pain management is to offer a holistic service provided by a multi disciplinary team to get patients' pain under as much control at possible and improve their quality of life. Honestly, I've never heard anything so ridiculous at nipping chronic pain in the bud, it shows such a lack of understanding. Many pain, and particularly disc, conditions are degenerative and will never be nipped in the bud. I'd give anything for an hour of life with no pain.

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Colourmeclear · 11/10/2022 23:22

Therapy and physio are great ideas especially with the neck (as long as guided by a professional). Maybe therapy/physio won't cure the discs but can help with the muscles that are used to support his neck.

I feel stress in my neck and shoulders and then when I think ah my neck and shoulders are tense they get more tense and so it repeats, pain gets worse, then I have a migraine. Therapy and physio might not cure the disc issue but if for example I take my leg (I have a condition) a lot of the pain is in the muscles that are compensating for the original issue. Gentle exercises on those muscles (not directly the original issue) has worked really well and I've also had counseling on accepting my limitations and listening to what my body needs, when to rest etc that doesn't come naturally to me at all.

I'm sure it's person specific, condition specific and treatment specific. Some people wil need more painkillers, some more emotional support, some physio etc in different proportions and at different times.

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FixTheBone · 11/10/2022 23:28

Justgorgeous · 11/10/2022 22:52

Talking therapy for chronic pain ? ?

Evidence based, most effective treatment.

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BaskingInTheSun · 11/10/2022 23:38

FixTheBone · 11/10/2022 23:28

Evidence based, most effective treatment.

NICE guidance for chronic pain is a bit more multi faceted that that though, as I'm sure you're aware

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MrsRuggles · 12/10/2022 00:08

Hi OP. I'm sorry to hear of your DH's pain. Within my own family there have been different experiences of co-codamol use. I've had occasion to need them for sciatica and gallstones and the other person had lots of back problems.

I used them fine, and yet the other person developed long term, lifelong even, problems with them.

Something that no-one seems to have mentioned is that the body develops a tolerance and the pain killing properties are lessened. The best course of action is to stop taking them for three or four days when this happens and then they will work again as the tolerance level drops. When first taking them, most people have a fair bit of nausea for the first few days and them the body gets used to them.

Some people try and increase the dose, which is where the problems really start. Some people are more predisposed to having addiction problems than others. Your GP should be keeping an eye on this. Hence why prescriptions are needed for this sort of medication.

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StudentMumTo3 · 12/10/2022 00:39

Your DH really should ask his GP about input from a pain specialist, if that's possible.

I'm a chronic pain sufferer and co-codamol isn't usually considered an alternative to amitriptyline as they work in different ways for different types of pain.

And as for the so-called GP - what condescending arrogant nonsense from someone who clearly neither specialises in pain management nor lives with chronic pain.

Distraction works for relatively "low levels" of pain. Talking therapy can help with the psychological and emotional impact of living with chronic pain. Physio and Occupational therapy may help with physical aspects of living with chronic pain.

No amount of distraction or talking therapy is going to genuinely and effectively alleviate moderate to severe chronic pain by themselves. They have their place still, for some, but as part of a package of treatment not in place of all other options!

The last GP I saw like you (thankfully a while ago), ended up with a clear and firm communication from my pain specialist. I needed my meds & my outpatient clinic treatments!

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katmeouws · 12/10/2022 00:48

Why not scrap the NHS and the Courts and replace them with MUMSNET boards? No need to got to your GP, just ask MUMSNET. Trial by jury, barristers on strike. Much simpler to just let MUMSNET be the judge (and jury), complete with a voting buttons Guilty/Not guilty.

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Cheeseandcrackers86 · 12/10/2022 05:03

PineCone74 · 11/10/2022 23:08

This may be clinically correct, but surely part of being a GP is to have the sensitivity towards patients to know how telling someone in constant agony to try distracting techniques and talking therapies is going to make them feel? And, as other people have said, how is anyone supposed to even access counselling these days without a very very long wait? I’d imagine the emotional and psychological impact of hearing this sort of advice from a GP to whom they have turned for help could be very negative indeed.

So what exactly would you like your GP to say then? Because no decent GP us going to keep upping your pain meds until they're basically your drug dealer. So really the options are they look at it more holistically and talk to you about the things that have been shown to work (whether you accept that they work or not) or they tell you there's nothing they can do. So which would you prefer? It's crappy I know but what exactly do you expect them to offer when there is nothing else that works and nothing else that the guidelines recommend?

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PlantDoctor · 12/10/2022 05:27

MIL was taking them and ended up with very very bad constipation, to the point where she needed fairly urgent medical care. She let the problem progress without saying/doing anything, so definitely not only the fault of the meds, but also that's what the Dr said caused it and it hasn't been a problem since switching to another med (unfortunately less effective for pain relief)

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Toomanybooks22 · 12/10/2022 05:44

I'm sorry but as someone with chronic pain I find comments about alternative therapies to be incredibly problematic, somewhat lacking understanding of the impact chronic pain and borderline lacking empathy. I find it completely ridiculous to assume anyone can use "distraction" techniques to cope with chronic pain for any significant period of time (I've tried it whilst guided by pain management team).

I mean seriously it's all good saying in an ideal world we'd all do "mind over matter" but have you considered the amount of mental energy this takes on top of managing a semi-normal life? In addition are you aware of how long it takes to get access to talking therapies on the NHS? Even the dedicated pain management team I've been referred to doesn't offer any form counselling specifically and the best you get is a couple of group sessions about breathing / visualisation which at best can be said to have limitations if you're in pain whenever you're moving.

So yes whilst I limit it pain medication to what is absolutely necessary for me to move and concentrate and I plan my daily activities so I know when best to take it pain medication is absolutely necessary for me to work and have anything close to a normal life in my opinion at least for now whilst under 30.

I am worried about a move towards alternative therapies being a cost saving device packaged as what's best for patients but in reality severely underfunded and of limited benefit at best.

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I6344 · 12/10/2022 06:06

I've been on 30/500mg of cocodamol for six years and haven't had any adverse effects yet. That's not to say your DH won't so maybe just see how he gets on?

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BaskingInTheSun · 12/10/2022 06:43

Cheeseandcrackers86 · 12/10/2022 05:03

So what exactly would you like your GP to say then? Because no decent GP us going to keep upping your pain meds until they're basically your drug dealer. So really the options are they look at it more holistically and talk to you about the things that have been shown to work (whether you accept that they work or not) or they tell you there's nothing they can do. So which would you prefer? It's crappy I know but what exactly do you expect them to offer when there is nothing else that works and nothing else that the guidelines recommend?

To answer your question,I'd like the GP to refer me to a chronic pain management service, particularly if my GP is someone who thinks my chronic pain can be nipped in the bud.

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LeningradSymphony · 12/10/2022 06:44

Musti · 11/10/2022 21:45

I have found GPs tending to offer pain relief instead of treating the cause. I’ve just had surgery for something they suggested just taking pain relief for the rest of my life. I had to ask for a specialist referral, and I was looking into private.

A friend had to have private surgery after a c-section left her in agony as the nerves had knitted all wrong. She went from not being able to carry a bag and having to sit on a ring cushion to being able to lift weights heavier than her.

I don’t know anything about your husband’s condition but I would get a few different opinions from specialists, also look at acupuncture and other non drug methods of healing and pain relief. You lose nothing by researching and trying some other methods.

Gosh, I wish GPs I’ve worked with as a patient had that attitude. From the start of my pain to actually being given the first step painkillers on the pain ladder was six years. Six years of unmedicated pain while they tried to find the root cause. Lost jobs, relationships, went bankrupt. Because living with unmanaged pain was just unspeakably awful. I’m glad they tried to find the cause but I wish they had recognised and understood that you can’t go months, years, in agony day after day until the physical cause is ruled out or identified, you need help with the pain NOW.

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BaskingInTheSun · 12/10/2022 06:45

Also, your might want to take a look at the NICE gudelines again - there are options other than distraction techniques, talking therapies and opioids.

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LeningradSymphony · 12/10/2022 06:48

Cheese and crackers reads like someone who has perhaps lost a loved one to addiction (as have I) or maybe experienced it themselves and is now desperately trying to inform others to stop it happening again. There’s absolutely no way they’re an actual GP with what they’re saying on here. I hope their Ignorance hasn’t upset anyone.

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