To ask for medication advice

[lilytuckerpritchet]

Hi anyone with knowledge of acute back pain and painkillers please advise.

I have a prolapsed disc and arthritis in my lower spine in November I was admitted to hospital in extreme pain.

Since November I've been taking 2 x 150mg tapentadol (opiate painkiller stronger than tramadol not as strong as oxymorphine )
8 paracetamol a day
My pain was at a ten when I was put on these meds over two months it's has gone to a much more manageable 2-4.

Saw a orthopaedic consultant 3 weeks ago who said to reduce tapentadol by 50 mg and continue reducing and also bring in ibuprofen. I started the ibuprofen which seemed to have a positive effect. Then about 10 days later I reduce tapentadol. My pain got worse going up to between a 6-8.

I saw a different consultant at my next appointment who said to stop ibuprofen as I shouldn't take it for more than 3 weeks. And to see gp about taking a different opiate alongside tapentadol with a view to dropping tapentadol eventually.

From experience my gp doesn't seem to know much about my meds and I have to wait two weeks to see someone. I've tried asking GP reception for someone knowledgeable but they just say no one is a specialist.

Anyone have any experience of long term opiate use and reduction. ? I'm shocked at how quickly my pain level has risen so naturally I'm reluctant to reduce further but equally I'm aware of the dangers of staying on opiates long teen.

Side note I'm also accessing physio therapy through hospital.

Thanks for your response. When I was discharged from hospital ibuprofen wasn't on my medication letter (apparently they had stopped it in hospital but didn't say why) but asprin was so I took two asprin a day. I saw a consultant a few weeks ago who said as I was fairly mobile I didn't need asprin but try ibuprofen. I started talking ibuprofen every four hours (alternating with paracetamol) and pain went from a 4 out of 10 to a 2 . He also said to reduce tapentadol by 50mg, which I did a couple weeks later and pain shot up to an 8 but has now settled around a 6. Then at my next appointment I saw a different consultant who said he didn’t think ibuprofen would help (I have 2 dehydrated prolapsed discs L4 and5 plus arthritis in lumbar area) .

I'm 45 no previous stomach issues. I'm currently trying to manage on the tapentadol and paracetamol but taking ibuprofen if pain goes above a 6. It does seem to help.

I'm also doing hot and cold and ibuprofen gel

For what it's worth I kept my pain meds high for the first two years after my accident as it meant I could access physio and was able to really build my mobility back up.

It was only when my mobility plateaued that I started reducing pain meds.

I have been on pain meds for ten years and have slowly reduced them in that time so while I understand other people ask for more and more pain meds this is not my experience and I have been able to reduce significantly over time.

Hello, sorry to hear you're struggling. I'll share my situation in case it's helpful.

I'm on a cocktail of meds for back, hip, knee and ankle pain, mostly accident related. I need an ankle replacement. I've been on regular opiates for 15 years. I was initially on a much higher dose but since then some problems have been improved by surgery.

I have been stable on the same dose for the last 5 years. I am on a slow release type of med so it's always in my system. I also have a 'rescue' version of the same med, which is fast acting if I need a top up. I hardly ever use that at the moment.

I also take a slow release version of ibuprofen (I'm not in the U.K. so not sure if it's available there). I'd tried various NSAIDS in the past but OTC ibuprofen seemed to help the most. The doctor suggested a slow release version as apparently it works better. Adding it in made a big difference to me, so I'm not surprised it helps you. I take 1600mg once a day, which sounds a lot, but is only the same as 2x200mg 4 times a day. I take it with dinner, and it's great not to have to worry about timing doses to take them with meals. I've tried to halve it but it's tough pain wise. I take Esomeprazole to protect my stomach. To be honest most doctors I see are more worried about the effects of ibuprofen on my kidneys than me being on the opiates. I take paracetamol as well and pregabalin, for nerve pain. Have you tried this type of med? It might help.

I'm sure I am dependent on the opiates but I don't feel any need to increase the dose. I do physio as well but the thing that has helped my back most in the last few years is my brilliant osteopath, who I've been seeing since 2018. I used to only go in a crisis but I now go every 4-6 weeks for maintenance. I have fewer crises and they tend to last less time.

During my time on the opiates I have worked on and off from home. It's been tough working full time, even for a couple of weeks, so I haven't done that for a while. I am tired but mostly not unmanageably so. I can drive short distances (up to half an hour). After that I'm in too much pain.

I have tried cortisone and PRP injections without success, and infusions of ketamine and lidocaine at a pain clinic. The infusions helped a bit but in the end I felt the hassle of going wasn't worth the benefit.

@AltitudeCheck I tried a tens machine but unfortunately it aggravated it - maybe too soon?. Heat and cold helps. I do meditation although it's hard. I've got CBT starting next week.

Thank you for sharing your stories I had no idea so many people are suffering like this ❤️

As I said, he's not considered addicted nor does he describe himself as such, he would stop taking them in an instant if he didn't need them. Hence described as dependent, there is no other medication that works and no surgical solution left. His medication is prescribed to him, not sure how else you think he'd get it .

Also, are you searching me from the other thread to randomly reply to this? Weird.

Nope I'm afraid you're wrong. For a number of weeks he stopped taking them cold turkey when he had a spinal chord stimulator fitted. It worked brilliantly and no he didn't feel the desire you mention. Unfortunately the SCS was removed due to a serious infection he developed.and it was not possible to reinsert.

Correct on all points. I am unsure why you're choosing to doubt me.

That is the guidance yes but when you have severe nerve damage and spinal damage, having had multiple surgeries, as well as the SCS I mention earlier there are few, if any, other options left. Not sure what your problem is?

Hope you’re improving @lilytuckerpritchet?
I’m taking Naproxen which is a similar drug to Ibuprofen but with Amitriptyline for the nerve pain.
Has this ever been suggested for you?

Have you tried adding yoga into the walking you are doing? I tried Pilates but it aggravated my sciatica. I've been regularly doing yoga for the past year and it really helps with the pain and stiffness. I don't need any pain meds as long as I do this and cardio too. If I miss a week, I'm in pain and struggle. I also do my physio exercises daily which are pretty much yoga stretches. When I was really bad I paid for weekly physio sessions and he was amazing. I'm more flexible and stronger which has made a really big difference

I'm doing better thank you. I'm doing physio and Pilates at the hospital. I'm tapering off the opiates at 50mg every two weeks. Should be off them in a month. My pain is much lower overall but the stiffness and nerve pain have got worse. I've been offered the steroid injection if i want it .

I saw a private consultant in the end which helped massively.

I'm still building up movement and still needing to lay down several times a day. I'm still off sick from work think it will be at least another month or two before I can go back .

But compared to where I was I'm definitely better