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

Also: GPs aren’t pain specialists. Pain consultants are. There’s a reason pain patients should be referred to pain clinics for help instead of being treated solely by their GP in the first instance.

friendly reminder that anyone who pops up claiming to be a pain consultant might or might not be...

I've been on co-codamol for years now for a chronic pain condition, having tried multiple different options its the only one to work consistently. I would agree with earlier points on dependency v addiction. If I'm having a good day I will forget to take a dose, sometimes 2 until my pain levels rise and remind me. On a bad day it the only thing that enables me to get out of bed and do the bare minimum to keep everybody alive and safe.

Obviously long term painkillers are never the ideal but often they're still better than the alternative.

Can't they do anything to help like physio, exercise, diet or a minor op? Long term pain relief should be a last resort. (Disclaimer, I can't tolerate codeine at all and just go around grumpy instead).

I would suggest a more empathetic response than your first post. I have not suggested that alternative therapies do not work, ( I acknowledged their potential clinical ‘correctness’ )but that simply telling a patient to try distraction and counselling needs to be done with awareness of how that is going to make the person feel. I do continue to question how practical a suggestion of counselling is given how difficult it can be to access. Your first post suggested a confidence in alternative therapies which came across, from a patient point of view, as having no understanding. I accept this might not have been your intention.

Its good to avoid painkillers if you can but sometimes you need them. I’m on long term painkillers. Ones that are classed as addictive. Without them my life was miserable and no amount of mind over matter or meditation techniques could help. With them, I still have pain but I can live with it (along with stretching, heat packs and other things which help). They transform my life and give me a good quality of life. My body is currently dependant on them but I’ve never needed to increase my dose (I’ve been on the same dose for over a decade) and I don’t feel I have an emotional addiction or anything. Sometimes people need pain killers and shouldn’t be denied them just as some people have addictions. They shouldn’t be handed out like sweets but they rarely are.

@Cheeseandcrackers86 with zero respect that is absolute bullshit and I'm glad you're not my gp. Get a clue.

Haven't RTFT (got annoyed with the GP upthread!)
I have a pain condition and have been on cocodamol for 15 years. I'm a nurse. I have never taken over the prescribed dose and take 8 tablets daily pretty much.
I probably am dependent but certainly not addicted.

I think it largely depends on the individual just keep an eye on him x

@Cheeseandcrackers86 is not a real GP.
Real GP's don't pop up on forums offering advice and arguing with posters on Mumsnet. Real GPs don't be on Mumsnet entrenched in one particular view and being so dismissive of posters serious experiences of pain.

Giving advice without seeing and assessing someone is actually quite dangerous..... But hey GPs have been doing that for over two years because of Covid 🙄 so maybe they are a GP after all. But an unprofessional one.

GPs aren't pain specialists and pain is definitely a specialist area as it complex and debilitating.

@Cheeseandcrackers86 for another perspective I actually wish my GPs had worked with me on the source of my pain rather than keep prescribing codeine. I'm off it now with a lot of Pilates and some weight training. I still have some pain and take paracetamol etc but I prefer it to dependency. Which I had. Because mammals will get dependent on opiates if they take them long enough. Even my vet would only give a short course after my cats ankle fusion. That said people are different. OP Yanbu to be worried but its up to him and his doctor.

Not sure how this is going to help to be honest. My husband has been on co-codamol for years due to having to have 4 hip replacements on the same side due to MRSA contracted in the hospital (he was only 54). As a result, the last hip will never be as good as it should and has had a real bad affect on his lower back. He now has to walk with a stick. He has tried to do without but the pain deems it necessary to start again. He also has to take anti gastric tablets alongside the co-codamol and I think this is an important thing to note - make sure you get anti-gastric tablets if you are on co-codamol long term. No amount of talking will make this pain go away.

You can definitely tell the people on here who’ve had chronic pain and those who havent

You can also tell the people who are pretending they are GPs...

I was diagnosed with arthritis at 26, I'm about to turn 56. I am on an array of pills for this and other health issues.

The big difference, IMHO is that I cannot afford not become addicted because then I would have no pain relief.

If he needs pain relief then he needs it.

They showed their hand when they tried to portray people with chronic pain as 'people who are trying to turn their doctor into their drug dealer and think doctors should hand out whatever they ask for'.

I'm very sorry that they're in so much pain that they feel the need to pretend to be a GP online to put their point across, but I feel more sorry for people who might read it and be really upset by their words. There's a reason MN make it clear at the top of the page that they haven't checked the qualifications of anyone posting here!

Form what I've seen people take this, become basically addicted to it, and then get issues from the drug itself, but it's okay, because they have more drugs to treat that, and so on and so on until pharmaceutical companies are even more well off and can afford the million pound fines for fraud they get frequently.

I'd look into ways to replenish synovial fluid and reduce inflammation if it were me.

Some people have a genetic disposition for opiates not working. This article is very interesting. www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwit2dGzs9r6AhWVTUEAHVdFCG04ChAWegQICRAB&url=https%3A%2F%2Fwww.practicalpainmanagement.com%2Fresources%2Fnews-and-research%2Fgenetic-marker-helps-explain-opioid-sensitivity&usg=AOvVaw3nrSsdaSjgaOVyAgycMFUQ

I think if what happened to our friend had not happened, I wouldn't be so wary. I've certainly used cocodamol myself for migraines when nothing else has worked but I've only ever needed to use it once at at a time as I've taken it once at night, as often I can feel the migraine in my sleep.

Thanks everyone for the different perspectives. Lots for him to think about. He said he may just use it when the pain is particularly bad as, like a few of you, some days the pain is manageable and other days it's not. Will look into alternative routes also to see if there is any non medication things that might help but at the end of the day, all we want is for him to be as pain free as possible

I’m with you cheese.
I’m also a doctor and completely understand what you’re talking about.
It’s very much a multi-disciplinary treatment approach and just taking pain relief really doesn’t solve much.

But of course everybody on here will know better than you. That’s just how MN is.

She didn’t say you could think it away!
Didn’t even intimate it.

Dr Michael Moseley did a very interesting documentary on pain relief and how it only works for a short period of time.

I've got a long term back condition (crumbling disks), and went through the diazepam/tramadol phase before realising that it was just making me feel worse. A course of sessions with an osteopath, gentle daily exercise and stretching exercises have had far more long term impact.

Personally I think it's not just about widening the approaches to pain relief it's about

1. not just pushing everyone who has chronic pain into alternative approaches where not relevant (as my pain for example is not muscular skeletal at all so the recommendations are limited although I've explored dietary and lifestyle changes)

2. acknowledging that alternative approaches whilst they may make sense on paper are extremely hard to put in practise in real life. For example on a pain management course I was on we practiced distraction techniques. I would ask who would have the mental energy to do this constantly whilst working which I have to do and living a somewhat normal life? I was not the only one attending the group who reported back it is incredibly draining to do. If I was in a position to have to work I'm sure I could explore it further but it's not possible everyday

3. also properly funding alternative approaches to painkillers. A lot of recommendations have not been funded at all such such as acupuncture. I've been with the pain management team for over a year but contact is sporadic and very limited. Ive only been on one course in that time. I've been recommended counselling and ended up paying myself because the waiting list were too long

4. accepting alternative medication (antidepressants, pregabalin etc) have potentially significant side effects especially when beginning to take them and often if taken only when absolutely necessary pain killers do not have these so there are considerations about the impact on balancing patients' work and life pressures

I feel like some medical doctors I've encountered suggest the link between brain receptors and pain can be broken by alternative processes do not appreciate that this has to be delivered in a very sensitive manner (I really appreciate there are time constraints) as it can come across as if the whole of your life is not considered in why you may wish to continue taking painkillers, as if it's easy to access or to utilise the alternatives when it often really isn't.

Great post @Toomanybooks22

This thread has made me resolve to find a way to see an osteopath as I'm sure it will make a difference

It is absolutely true that "pain is on the brain" - but that does not mean that revamping your brain in the form of counselling to reframe the pain is a cure all. It tinkers around the edges. I speak as someone living with chronic pain. One aspect of it has been cured by a microdiscectomy and I am now out of pain from that source and I can feel my foot again and walk - no amount of counselling could have achieved this result.

OP - please ensure your partner is careful with the 'only when necessary' pain meds.

Whilst it is of course important he doesn't take pain killers he doesn't need, it can also be a very poor, ineffective way to use pain meds if he is waiting til he is in utter agony before he takes them.

Some conditions are better treated at the first sign of pain getting worse/beyond what you can manage and then continue dosing at the safe/suggested intervals for a while (a day or two) before trying to back off them again.

I did try to post the other day but got distracted by some glitch (reported to MN) - the talking therapies and mind over matter stuff does have its place.

If you sit about moaning and groaning or just generally focussing on how painful it all is and doom and gloom... then you will feel significantly worse than if you are pro-active about doing what you can, staying busy, distracting yourself etc etc.

But its useful up to a point. It's useful, alongside pain medication. It's useful alongside understanding how various pain medications work, what your pain is telling you, what your body can do/not do etc etc.

As part of the whole thing, it has its place.

As a replacement for pain meds entirely, for everyone across the board - no, it really doesn't.

I take prescription co-codamol for a chronic knee condition and can stop whenever without withdrawel symptoms (not that I like to, my knees bloody hurt). I think the addiction risks are overblown.