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Chronic pain

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Original poster

Pain Medication Advice Please

54 replies

Charlock · 21/02/2025 23:45

Hi, I've been suffering from some combination of tennis/golfer's elbow in both arms for a year, and more recently should impingement and I think cubital tunnel syndrome. I've tried various physio exercises via my practice physio, steroid injection (ineffective). I just went back to the doctor again because I don't have decent pain relief as both co-codamol 30/500 and ibuprofen give me a sore stomach and I find paracetamol alone pretty ineffective and I'm getting pretty worn down with it all as it's uncomfortable through the night and affects my sleep. I've also tried ketoprofen gel, not effective. She's referring me for xrays and doing bloods again to rule out inflammatory stuff (done in October, all normal). I was hoping she might prescribe me a different NSAID perhaps with a PPI to protect my stomach but she said that's a no-go because the ibuprofen gave me a sore stomach. So she prescribed me co-codamol 8/500 to see if I could tolerate the lower dose better. Well, I thought I was but on my 3rd dose and my stomach is doing what it did on the higher dose. She said I could try dihydrocodeine next as this can be better tolerated. And then it's tramadol.

I'm confused as to why it's only opiates I'm being offered, esp as you can only take them for short periods and this pain has been bad for a year and showing no signs of let up. Does anyone have any suggestions on what I could try? Can I do anything to help me tolerate these things? I'm 48yo F and on Sertraline 50mg and HRT. Thanks for any input!

OP posts:
CaptainBeanThief · 21/02/2025 23:57

Is this your GP or a pain consultant at the pain clinic.
I see a pain consultant and they are far far more qualified on what works best with what sort of pain you are experiencing.
If it's your GP you are seeing id push for a pain clinic referral.

Crispynoodle · 22/02/2025 00:24

Diclofenic suppositories 100mg (top up another 50mg if necessary) lasts 24 hours ish but it is an idea to take omeprazole 20 mg twice a day with it. You are very welcome!

Anonforthis58 · 22/02/2025 00:29

Do you use any supports for your elbow/wrists?

DottyMilkshake · 22/02/2025 00:34

This is odd Op, tennis elbow in both sides? Do you do a lot of gripping tasks with both hands that’s triggered this? Has central nerve irritation in the neck been explored and ruled out?

Original poster
Charlock · 22/02/2025 07:26

CaptainBeanThief · 21/02/2025 23:57

Is this your GP or a pain consultant at the pain clinic.
I see a pain consultant and they are far far more qualified on what works best with what sort of pain you are experiencing.
If it's your GP you are seeing id push for a pain clinic referral.

@CaptainBeanThief Pain clinic? Never been mentioned by GPs or physio. Not even sure there is such a thing here (Scotland). Thanks for replying.

OP posts:
Original poster
Charlock · 22/02/2025 07:29

Crispynoodle · 22/02/2025 00:24

Diclofenic suppositories 100mg (top up another 50mg if necessary) lasts 24 hours ish but it is an idea to take omeprazole 20 mg twice a day with it. You are very welcome!

Never heard of this as a route. Presumably this avoids the stomach irritation - if so why the need for PPI alongside? I worry about taking a PPI because I have a bit of IBS tendency and suspect I'm low on stomach acid as it is. Unless I'm miss understanding how they work ... thanks for replying - good to hear alternatives exist. Just being advised short term opiates isn't reassuring.

OP posts:
Original poster
Charlock · 22/02/2025 07:31

Anonforthis58 · 22/02/2025 00:29

Do you use any supports for your elbow/wrists?

Yes, in the earlier stages I got the supports for both arms but after a few months gave up as they didn't seem to make any significant difference.

OP posts:
Destiny123 · 22/02/2025 07:40

Charlock · 21/02/2025 23:45

Hi, I've been suffering from some combination of tennis/golfer's elbow in both arms for a year, and more recently should impingement and I think cubital tunnel syndrome. I've tried various physio exercises via my practice physio, steroid injection (ineffective). I just went back to the doctor again because I don't have decent pain relief as both co-codamol 30/500 and ibuprofen give me a sore stomach and I find paracetamol alone pretty ineffective and I'm getting pretty worn down with it all as it's uncomfortable through the night and affects my sleep. I've also tried ketoprofen gel, not effective. She's referring me for xrays and doing bloods again to rule out inflammatory stuff (done in October, all normal). I was hoping she might prescribe me a different NSAID perhaps with a PPI to protect my stomach but she said that's a no-go because the ibuprofen gave me a sore stomach. So she prescribed me co-codamol 8/500 to see if I could tolerate the lower dose better. Well, I thought I was but on my 3rd dose and my stomach is doing what it did on the higher dose. She said I could try dihydrocodeine next as this can be better tolerated. And then it's tramadol.

I'm confused as to why it's only opiates I'm being offered, esp as you can only take them for short periods and this pain has been bad for a year and showing no signs of let up. Does anyone have any suggestions on what I could try? Can I do anything to help me tolerate these things? I'm 48yo F and on Sertraline 50mg and HRT. Thanks for any input!

I've never heard codeine causing stomach ache in many moons of anaesthetics it'll be the ibuprofen.

Omeprazole should improve it

Votarol gel is worth a go. Wear the supports do the physio xx

Destiny123 · 22/02/2025 07:44

Crispynoodle · 22/02/2025 00:24

Diclofenic suppositories 100mg (top up another 50mg if necessary) lasts 24 hours ish but it is an idea to take omeprazole 20 mg twice a day with it. You are very welcome!

Will still give gastritis. Nsaids cause it by their enzyme inhibition not by locally eating them and hurting the stomach

Original poster
Charlock · 22/02/2025 07:45

DottyMilkshake · 22/02/2025 00:34

This is odd Op, tennis elbow in both sides? Do you do a lot of gripping tasks with both hands that’s triggered this? Has central nerve irritation in the neck been explored and ruled out?

It started with some redecorating a year ago which I believe is a classic trigger. I'd already had a bit of elbow pain going on (hypermobile elbow joints) but after the redecorating it got really bad and just hasn't healed. It's maybe 15% better than its worst point, but in some ways it's worse, particularly the left arm which is strange because I'm right handed. My last physio appointment a few weeks ago she said I had shoulder impingement too on the left and just sent me away with exercises for that which are very painful to do because of the elbow pain and it just feels like it's getting worse. I've done several rounds of physio exercises and really tried but eventually give up because it doesn't help or seems to make it worse. I'm not getting numbness and tingling in what I believe is the ulnar nerve area at night time along with the other pain. I feel I'm getting to my wit's end with it. It took me 91 attempts to make a doctor's appointment for it again on Thursday then I ended up being in the peak of a migraine aura during the appointment with a doctor I'd not seen before so was unable to advocate or ask more questions about what she was suggesting as I was just trying to stay upright! Went to bed with a sore stomach last night so no more cocodamol. Starting to think this is me for life. Have given up things I used to do like spin and yoga as they are impossible.

OP posts:
Original poster
Charlock · 22/02/2025 07:49

Destiny123 · 22/02/2025 07:40

I've never heard codeine causing stomach ache in many moons of anaesthetics it'll be the ibuprofen.

Omeprazole should improve it

Votarol gel is worth a go. Wear the supports do the physio xx

Show quote history

Tried voltarol, ketoprofen, no relief. I thought it was weird the cocodamol was irritating, and in the past I have been able to tolerate ibuprofen. I feel my stomach just isn't as tough as it used to be and no idea what to do about that. I have really tried with physio but end up giving up as it doesn't seem to help.

OP posts:
Original poster
Charlock · 22/02/2025 07:51

Destiny123 · 22/02/2025 07:44

Will still give gastritis. Nsaids cause it by their enzyme inhibition not by locally eating them and hurting the stomach

Show quote history

Interesting, thanks. Why bother doing suppository route in that case?

OP posts:
IsItAllMenopause · 22/02/2025 08:00

Hi I had tennis elbow last year from too much gardening. I found a physio that has a machine that does some sort of electric waves treatment. It's worked a treat! I highly recommend it!

Original poster
Charlock · 22/02/2025 08:02

IsItAllMenopause · 22/02/2025 08:00

Hi I had tennis elbow last year from too much gardening. I found a physio that has a machine that does some sort of electric waves treatment. It's worked a treat! I highly recommend it!

Have heard of this. Sick of having to pay privately for things though. Good name btw.

OP posts:
IsItAllMenopause · 22/02/2025 08:07

I know, it is expensive but feels worth it now the pain has gone! I think I paid about £50 per session and it took 3 sessions. Like you I literally could stomach the pain killers!

CerealPosterHere · 22/02/2025 08:09

You say you have hypermobility in both elbows, have you ever considered a connective tissue disorder ie EDS? It affects all your connective tissue including your digestive system so people can have low grade stomach issues. How long were you doing the physio exercises for before you stopped? I have EDS and the only thing which vaguely helps me is weight lifting to strengthen my muscles to counteract my shit ligaments and tendons.

Original poster
Charlock · 22/02/2025 08:10

IsItAllMenopause · 22/02/2025 08:07

I know, it is expensive but feels worth it now the pain has gone! I think I paid about £50 per session and it took 3 sessions. Like you I literally could stomach the pain killers!

If I knew it would work it would be worth it. I feel like this has morphed into something more tricky and because it's both arms plus shoulder ... could end up costing 100s. I'll look into it though.

OP posts:
Original poster
Charlock · 22/02/2025 08:17

CerealPosterHere · 22/02/2025 08:09

You say you have hypermobility in both elbows, have you ever considered a connective tissue disorder ie EDS? It affects all your connective tissue including your digestive system so people can have low grade stomach issues. How long were you doing the physio exercises for before you stopped? I have EDS and the only thing which vaguely helps me is weight lifting to strengthen my muscles to counteract my shit ligaments and tendons.

It's never been mentioned and I've only really read about that more recently when I've been trying to understand what's happening to me. I asked if the hypermobile elbows could be an issue but the physio just sort of shrugged. I can no longer over extend my elbows because I can't even straighten my arms. I've always been able to put my hands on the floor easily, and my legs look like they're on backwards when I straighten them fully. I had started doing strength training a couple of years ago but I've had to stop everything because of this pain. It's so frustrating. How would a person know they had EDS and would knowing help me recover from this? How did you find out? Thanks for replying.

OP posts:
IsItAllMenopause · 22/02/2025 08:17

My physio only used the machine on for about 10 mins then massaged it so you could probably get both arms and a shoulder done in one session. I also had a sore back and plantar fascitis which she also sorted!

Original poster
Charlock · 22/02/2025 08:18

CerealPosterHere · 22/02/2025 08:09

You say you have hypermobility in both elbows, have you ever considered a connective tissue disorder ie EDS? It affects all your connective tissue including your digestive system so people can have low grade stomach issues. How long were you doing the physio exercises for before you stopped? I have EDS and the only thing which vaguely helps me is weight lifting to strengthen my muscles to counteract my shit ligaments and tendons.

When I've attempted physio I've done it for 4 or 5 weeks at a time.

OP posts:
Original poster
Charlock · 22/02/2025 08:19

IsItAllMenopause · 22/02/2025 08:17

My physio only used the machine on for about 10 mins then massaged it so you could probably get both arms and a shoulder done in one session. I also had a sore back and plantar fascitis which she also sorted!

Amazing. Do you happen to know what it was called?

OP posts:
IsItAllMenopause · 22/02/2025 08:25

I've just checked her website and it just says shockwave therapy.

CerealPosterHere · 22/02/2025 08:26

That really does sound like EDS. The thing about stiffening up as it progresses is quite typical. There is a thing called the Beighton score which you can google and score yourself. If you get I think 4 or over then you have EDS. Mine was initially picked up by a decent osteopath within minutes, he says the muscles of someone with it feel very different to someone who doesn’t have it. I should have suspected really as Dd was already officially diagnosed and it often runs in families.

i went to see my GP who referred me to a rheumatologist and I was officially diagnosed. From fb support groups it seems it’s hard to get a diagnosis these days as doctors like to say you have hypermobility rather than EDS…not sure why they’re so reluctant. But I had no problem. In a way the diagnosis makes no difference, there’s no treatment on the nhs but I feel I have answers for all my pain which has been reassuring in some ways. And it’s given me the kick up the butt to realise that my exercise regime needs to be life long .

Original poster
Charlock · 22/02/2025 08:27

@IsItAllMenopause thanks. I have read about that but the evidence base for it isn't solid so didn't want to spend in vain but good hearing that it's worked for you.

OP posts:
CerealPosterHere · 22/02/2025 08:28

Charlock · 22/02/2025 08:18

When I've attempted physio I've done it for 4 or 5 weeks at a time.

Show quote history

You need to be doing it for much longer. Even without EDS physio exercises could take months to fix something. With EDS you need to be doing stuff for life. There’s an arguement even without EDS you should be focusing on movement and mobility exercises for life, especially once you’ve had an issue in a certain area as it will always be a risk of a relapse.

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