To be worried I might be addicted to painkillers

[Uh0hHereWeGo]

I have rheumatoid arthritis and osteoarthritis, diagnosed about ten years ago. I'm on biologics and methotrexate for the RA but the pain is still unbearable at times, particularly at night. It stops me sleeping and even if I'm relatively fine when I go to bed I'm waiting for the pain to kick in which stops me from getting to sleep in the first place. Most of the time it kicks in at some point during the night which wakes me up anyway.

The GP prescribed me codeine shortly after I was diagnosed which I took as needed, maybe a couple of times a week. However a few years ago I realised that if I took two before bed, not only did it relax me so I could get to sleep but I wasn't waking up in pain anywhere near as often. Most nights now I sleep right through.

On occasions when I haven't taken the codeine, for example if I've had a couple of glasses of wine, I find I hard to get to sleep and if/when I do I'm often woken by pain through the night.

I'm concernes I'm becoming reliant on them, but am I overreacting? Are they just doing the job they need to do and that's fine, even though I take them almost every night? I sometimes take a couple of much lower dose cocodamol in the morning too (the 8/500 OTC ones) if I'm having a particularly bad time, perhaps a few times a week. The GP and my consultant knows what I take and GP is happy to prescribe (I have about five prescriptions filled a year for the codeine, 3 boxes on each). I've been doing this for about four years now.

Is this reasonable use of painkillers for a nasty chronic condition or am I doing myself harm/becoming addicted?

YANBU - I'm right to be concerned

YABU - this is a perfectly acceptable use of pain relief

You're absolutely fine.

Codeine is a strong drug but with your small doses and very limited usage the risk of addiction is minimal. For comparison I'm taking 500mg of just codeine each day, well aware I have a physical dependence which is to be expected after 15 years of taking it although luckily no psychological dependence.

Please don't leave yourself in pain and struggling out of fear of addiction. If you're concerned, perhaps ask your doctor for an alternative medication

Thank you so much for your reassuring words. I'm so sorry you're experiencing pain too. Chronic pain is awful - which is why relief from it is so wonderful, however brief it may be.

I've spoken to my GP about my concerns but he seems absolutely unbothered and said pretty much the same as you - that it's legitimate use and is unlikely to be doing me any harm. I have thorough blood tests every two months because of the RA meds I'm on and my liver/kidney function is always spot on, so he says to just carry on as I am and not to be afraid to take more if I need to.

I think my main concern is that I don't always take them when I'm actually in pain, but as a preventative measure because I know I will be through the night if I don't. And when I don't, I pretty much always am!

Ah it's tough when you live with chronic pain.

Many painkillers are dependency-forming, codeine is one of them. If you're taking it as prescribed by the GP, then it's absolutely fine. It's simply a fact that many of the stronger painkillers people need promote physical dependency. Becoming physically dependent isn't a moral failing, it's a normal expected side effect of the drug. A drug you clearly need to have a quality of life.

Dependency is different to addiction, which some people don't realise. Dependency is when your body gets used to a medicine and begins to need it or you experience withdrawal symptoms. Doctors are very aware of this and should always support weaning off if they/you want to stop them rather than cold turkey. Addiction is very different and is a pattern of behaviours and psychological processes that mean someone starts to crave it for reasons other than as prescribed, find ways to access more and more of it, buys it illicitly in some cases, and takes ever increasing amounts.

You're doing fine OP, you're working with the hand you've been dealt and we are very lucky to have medicines available to relieve terrible chronic pain.

There are people who go without drugs that would bring them a far greater quality of life because they've been scared off them, even in terminal diseases! It's awful.

That seems reasonable. After 10 years you are still on the same dose as opposed to needing more - I guess that would be a problem. I’ve worried about the same thing on a few occasions (after operations related to osteo arthritis). Was prescribed codeine but had the most horrendous constipation after only a couple of tablets so I stopped. Fortunately the operations went well and no ongoing need for pain relief.

If it is helping I wouldn't worry about it. Waking up in pain is very unpleasant and then you have to wait for the painkillers to work before you can get back to sleep.

The only thing is if you take cocodamol regularly you'll probably find it doesn't work as well as your body gets used to it. It's actually not a very good medicine for chronic pain, but there are not a lot of alternatives.

I think you’re right to be concerned. People think because they’re on prescription that all is hunky dory. They are definitely habit forming drugs and many people end up hooked. It must be a difficult balance to strike when managing a painful condition. Best of luck op.

Keeping things vague intentionally.

@Uh0hHereWeGo
I have a (thankfully/hopefully) mid term condition that was causing a lot of pain. Especially at night as you describe.

I was put on painkillers by a palliative care team (they aren’t just for end of life where I’m from 😁) we had a long discussion about what they were prescribing me and long term effects. I was reluctant to really take daily painkillers for a variety of reasons. But I was a wreck without sleep. I’m still on them but hope to be off in the next couple of months. I probably didn’t take enough at its worst and was still waking up. Preventative is actually the right way to use painkillers in our situation… it’s worse to try to catch up. (I got a talking to from my care team that I was taking less than they prescribed).

It is very likely that you become physically dependent on them. That’s ok and absolutely normal. Many drugs have withdrawal effects (google steroid skin withdrawal). You will have to address that if/when you stop taking them. This can and should be managed with your doctor.

It is possible you could become mentally (ughh I feel like this isn’t exactly the word I’m looking for) addicted to them (as in gambling, food, or other addictions). The fact that you’re questioning and afraid of becoming addicted is a strong indicator that you probably won’t. I had the same thoughts as I would take a perfectly reasonable and acceptable ‘rescue’ OxyContin in the middle of the night. (Spoiler alert: when I stopped being woken up with pain I didn’t wake up looking for narcotics just for fun or because I thought I needed it)

I’m still on a low dose of pain killers but don’t feel like they are bringing a whole lot of anything to the party. (There are reasons which have been discussed at length with my care team).

Keep discussing with your doctor but also keep in mind that narcotics are a tool. Nothing more or less. Any tool can be misused or abused. If you find yourself not using them reasonably (as discussed with your doctor) then that is the time to be concerned.

Long story short…nobody wins prizes for being in pain. Sleep well… keep talking to your doctor… hopefully you get to a place where you don’t need them.

I probably should have just said “Yes all of this” you explained better than I did the difference between dependency and addiction.

Oh please don’t worry. Constant pain really drains the life out of well life!
I have CP and also am in different amounts of pain daily
i “ mix and match” mine according to pain levels It’s actually known as the pain ladder
i I take diclofenac 3x daily then either paracetamol, co Codamol 30/500 or Tapentadol( small dose as it makes me nauseous
I have the first 2 on monthly repeat
Do whatever you need for an enjoyable, interesting life.
i also have a drawerful of stuff like heat pads wheat wraps, mini tens, stick on self heating pad things..Well hidden I might add

I've been taking prescription painkillers for 20 years now (mainly dihydrocodeine) and am still not addicted.

I was pregnant when first prescribed them, then had a baby, then pregnant, another baby, then pregnant, then small children, then teens who you really need to be on the ball for… you get the gist! So I have always been really careful with taking them.

Like you it’s always been a worry because who needs a drug addiction on top of all our other problems, eh?! 😆

You're not abusing pain relief, far from it, but it’s hard to be okay with it, I know.

My DC are older now (one's and adult and the other one soon to be!) and I joke about how I’ll finally be able to take my pills when I need them and enjoying drug addiction to the fullest! 😁

If you are on long term codeine then you will be physically addicted and you would experience withdrawal if you stopped suddenly. I’ve had it when I was only taking one dihydrocodiene a day for over a year. I stopped suddenly when I had a bad stomach upset and I got the the full on tremors, it really freaked me out. I’ve also been up to 8 a day and developed such a strong tolerance that they weren’t actually touching the pain, and then had to spend months weaning myself off them. I’m afraid it’s pretty normal with a chronic condition. Doctors will happily prescribe these drugs and just expect you to get on with it but long term they become ineffective anyway so you end up back where you started in terms of pain, but now you’re stuck on strong painkillers too. It’s shit. Don’t panic about it, but I’d advise investigating alternative approaches to managing your condition. I’ve been down the painkiller route. It is a short term fix and leaves you no better off in the long run, eventually they stop working and you have to try to get back off them.

Is this reasonable use of painkillers for a nasty chronic condition or am I doing myself harm/becoming addicted?

Absolutely reasonable use given your chronic condition, responsibly used, and a low dosage as well.

All the people I know who were using codeine and became addicted were using beyond their medical need, using for the feeling, not for pain relief, or rather using them for emotional pain relief, and also using massive doses beyond the recommendations on the pack.

Listen to your doctors on this and don't worry. You're doing nothing wrong.