What pain relief options are available for chronic back pain?

[13062804DT]

I have chronic back pain and I’m currently under rheumatology, my last MRI showed tears in my hips, arthritis and hyperintense signals, (I’m 31) I’m currently waiting on another MRI. I had codeine on my repeats and I had been taking them since 2018, I fell pregnant last year and obviously stopped ordering/taking them, some point in my pregnancy they were removed from my repeats list, which I assume was down to me not ordering them for months. I went back to my GP after my son was born for a medication review she refused to reissue, she said I was far too young to be on that kind of medication and It should have never been approved in the first place, she prescribed me Naproxen instead. Fair enough, I was happy to give it ago, I don’t particularly care what I take, I just care about relieving my back pain and making my day to day easier.

It’s not working. And since having my son my back pain is becoming unbearable, the stiffness in the morning, lugging his car seat around and getting it in and out of the car, putting his pram up and down and putting it in the boot, bathing him, slowly putting him down in his cot after rocking him to sleep, it’s safe to say my back feels shattered. I have a telephone call with a rheumatology nurse in a few weeks, the soonest they could fit me in. My question here is, if the doctors are uncomfortable with prescribing opioids/strong pain killers long term… What on earth is available? What do people take to make day to day easier?

I cannot help with painkillers but Have you seen an osteo privately? I was suprised at how quick they fixed an issue I had. However I do not have tears as far as I’m aware. My friend has ankylosing spondylitis and exercise and diet (very little sugar and following the AS London diet - I believe that’s what it’s called) has taken their pain from 8 to 2. If they don’t exercise or eat badly (on holiday or at a party/wedding for example) it returns the next day.

It may be worth exploring whether something similar would work for you. I find the lighter I am and the more I move the less pain I am in. Personally I’d research and explore food and movement and combine it with an osteo appointment and if that didn’t work I’d try a Chinese acupuncture person. The NHS just takes too long and pain is debilitating.

My shoulder and neck was giving me grief - physio was useless. I found a few exercises helped but an osteo fixed it and now I find exercise keeps it away.

I keep getting prescribed physios too - all well and good, most of us need to work on core muscles because frankly if you back is FUBAR you do not have a gym membership! I really wish they would take it seriously and do DEXA scans rather than send in some 20 year old with a 6 pack and abs to tut over how I can't balance on my toes and elbows on a bed 2 meters off the floor...

Following for DH
no solutions I’m afraid
he is very fit and healthy, does all the physio stuff but has a physical job that flares up his back at least 1/2 a year.
Osteo could be a good idea

I use ice packs on my back or heat pads. They distract from the pain.

However, I am fortunate in that I am also prescribed weekly Butrans pain patches, a muscle relaxant to ease the spasms and prescription strength codeine . I questioned addiction but was told to ask for more if I needed it. I would be inclined to see a different GP as I only manage my leg and back pain by not lifting stuff and that must be impossible for you with childcare.

I have chronic back pain (Spinal Stenosis and it's also in my entire neck) and it has been so difficult to get adequate pain relief!

The only drug that actually REALLY works for me is Zapain but my GP and consultants refuse to put that on repeat prescription because it's addictive, so literally I have to beg for it when I'm having a bad flare up and they prescribe it in small doses.

I'm on Amitriptyline every night but it does make you very sleepy and I'm not 100% convinced it works.

I do find that Piroxicam gel helps as does "swaying" when I'm stood and bending forward to open up the spaces between my vertebrae. Heat pads are also quite effective.

I'm currently with my 5th physio and awaiting a referral to Neuro.

I did try Pregablin but it did nothing for my pain and really made my temper horrendous.

Worth being aware that if you’re breastfeeding codeine is not advised - it can cause real problems for babies. Other opioids are ok for breastfeeding but not sure what the usual guidelines are for. Ack pain. Physio’s probably a good idea even if the rheumatology team come up with a good drug plan - the can probably help with safer manual handling techniques for whatever your back problem is.

Butrans is not a muscle relaxant it's a slow release opiate medication
https://www.nhs.uk/medicines/buprenorphine-for-pain/how-and-when-to-use-buprenorphine/

Both in combination are addictive and shouldn't really be prescribed for this reason according to national guidance

https://cks.nice.org.uk/topics/back-pain-low-without-radiculopathy/

Would highly recommend tens machines they were life changing for my chronic pain

(Anaesthetist)

Ask if you can be referred to a pain management consultant/ clinic. I have major issues with my back and gone down the physio/ meds/ surgery route.
I now have a spinal cord stimulator for pain, it's like a permanent tens machine in your spine with a little battery pack inserted under your skin. Not a guaranteed result but for lots of people it is life changing.

I'd see a physio/sports physio.

It’s worth trying. Ask for local recommendations. It took three sessions, I was still not 100% (say 75% but another two weeks of doing basic exercises I was at 90%. Which meant no painkillers, 90% movement back. Weightlifting okay. Exercise okay.

I was told initially it would take 5 sessions but he was pleased with my progress. He said we could keep going but normally at 75% you can manage it on your own to save the cost.

I had an idea it was working when different parts of me started hurting after seeing the him 😂 it was as if it had moved the problem.

If you end up on any anti inflammatory medication for a long period please ask for a proton pump inhibitor like omeprazole. They wreck your stomach over time.

Also look at things like amitriptyline which can be good for nerve pain.

dihydrocodeine is better than codeine phosphate