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

I think the addiction risks are overblown.

I don’t know about that, but DD who worked in a pharmacy in our town, told me I wouldn’t believe how many people are addicted to codeine!

I take dihydrocodeine for chronic pain sometimes 4 a day sometimes 6. Without them I wouldn’t be able to work or function properly. I’ve tried pregabalin, duoxetine, tramadol, amitriptyline and others usually with side effects. I haven’t seen a GP in 3 years just in repeats.

There is no effective treatment for my disability, which causes pain. I've been using codeine and diazepam for over 20 years and its really irritating when people try to use that as 'evidence' I'm addicted.
Its evidence that I manage pain. The dose or frequency hasn't increased. I don't need to take it every day, I sometimes have good days. I have regular breaks to keep my tolerance at a base level. We don't all become addicts.

IME instead of vague warnings about addiction, it would be better to give people precise info about what the early stages of addiction look like. 'Stop taking it if XYZ' would give people more control and perhaps make them less fearful.

I was diagnosed with psoriatic arthritis 30 years ago.

I have taken many many painkillers. I am careful, I an dependent on them to live a vaguely normal life. I cannot afford to get an addiction.

I have regular reviews and have had physio and hydrotherapy. I use a TENS machine and my GP has done acupuncture and steroid injections.

I also have antinflammatories and I'm on amitriptoline.

OP

Think of it like a tool box, depending on how your DH feels he needs to use the appropriate tool, at the moment that is pain killers.

They can be taken long term safely.

The dosage should be monitored.

There is a huge difference between a GP writing a prescription and just renewing it every month for 20 years and a GP monitoring dosage and treating appropriately.

Not quite sure why the person reporting to be a GP is getting so much flack, quite correct advice. They're not in a consultation now so can be more direct in speech, the information would presumably be delivered not quite so bluntly when talking through these plans with most patients.

Using strong painkillers for flair ups/at the point of illness or injury is a sensible approach and good to have some available. Taking them daily for a chronic 'normal' level of pain just doesn't work, it's just feeding dependency, misery and an early death. But people can't see this in themselves and believe it does because they're feeding the dependency, it's much easier to see from the outside. I'm not a GP but do shared working at a practice, it's really really common for patients to die due to these drugs and I see the genuine distress when another one dies they've been trying to get to come down off the medications they've historically been prescribed. It's not some rarity that only happens to homeless drug addict stereotypes.

The evidence is clear and shows when people with debilitating chronic pain can access good pain clinics/therapy/physio/exercise programmes and stop the majority of the pain meds they'd previously insisted they needed to function that their quality of life massively improves and pain affects them much less.

However having access to all that is difficult, it's expensive, it takes time and effort from all involved, the services aren't available in all regions and this is a failing of the health service when the provision is not there.

It's very very easy to prescribe pills - consultation can be over in less than 5minutes, then stick it on repeats and rarely have to see them again, up the dose every when they call to report that it's no longer effective as they've grown tolerant, easy peasy. The GPs having the difficult conversations, trying to help people access pain clinics etc looking to tailor solutions, trying to best understand your pain and the exacerbating factors are not being lazy or poor, they're the ones who are thinking about your future and doing their best to help you have a good one.

A lot of pain is psychological. Therapy can really help with the long term management of chronic pain disorders but you have to buy into it and really throw yourself at it. You can't just turn up and hope it might help.

It's why things like Hypnobirthing are so effective (and it's been scientifically proven to reduce the amount of pain relief required in labour when used correctly)

Medication is only one small piece of pain management

Compare and contrast the posts by people who live with pain and have to manage it, and the anti meds posts.
Telling someone with a bulging disc that a lot of their pain is psychological makes you feel better and does nothing to change reality. FFS give your head a wobble. A woman in late stage labour isn't also trying to get her socks on, or cook the dinner. She's focussing on one thing and that's why hypnotherapy works in that situation. If you suddenly added another type of pain she'd snap out of it.
We already know that managing pain involves multiple strategies. We already know the meds are the last resort. We have to be assessed regularly to keep the prescription active, and the pharmacist hands over the meds with another warning.

As someone who lives with chronic pain I am quite happy to say that I appreciate the psychological aspects of managing my needs so won't be giving my head a wobble thanks.

This.

It also takes a lot of investment from the patient too. It's easier to pop a pill than it is to invest the time and effort required for physical and psychological therapy, and I'm not saying that flippantly because therapy or any kind is fucking hard work so the patient needs to be in a good place to engage with it.

Its not psychological pain if its the result of muscles contracting 120 times a minute. My disability gets worse with PT. Consultants warn us not to have physio unless its with a neurological specialist.

And mine is as a result of my nerves misfiring and my skeleton malfunctioning. I can still engage in lifestyle changes to help ease the psychological impact of my conditions. It's not a one size fits all approach, pain is complex and popping a pill isn't the only way to treat it.

Haven't read everything but my DH had a bulging disc but in his lower back. He was on amitriptyline then got given an epidural injection - not sure if it is the one given in labour but we were sceptical.

But I can say that it did help enormously so maybe worth a referral to someone to see if there's more available.

He was on amitriptyline then got given an epidural injection - not sure if it is the one given in labour but we were sceptical.

I used to have those for slipped discs at C5 and C6. They worked well. (I went to a pain clinic, and tried about every painkiller there is, except the opioids. Epidurals were the best, until they decided dystonia was causing my pain and botox was the way forward!) Not it’s not the same, as the ones in labour, iirc?

I was a chronic pain sufferer following facet joint injury. I had steroid injections, nerves burned, I tried ketamine infusions, medical cannabis, about 10 types of pain relief, eventually settled on 8 coedine a day, I had full time care of a disabled child. I spent thousands on physio, osteopath, pilates. I was so so desperate to be pain free.

What eventually helped me was the curable app and the belief my pain was neuroplastic and through somatic tracking I could reprogramme my brain. I completely U-turned on the Harley St medical route I'd been on which got me nowhere. And I went fully into the alternative route. I managed to switch off my pain within about 6 months and came off all pain medication. It's actually the greatest achievement of my life because it was such a personal and private battle.