How do painkillers work; what is the best way to take them?

[KatyMac]

Specifically paracetamol, co-codamol (not at the same time) & diclofenac

Currently I take (Paracetamol or Co-codamol) them when I am in pain; but something the GP said makes me wonder if taking them before I get to that point might be better.

He also intimated that I should take the diclofenac whether or not I have any pain at the time

Does anyone know what I am supposed to be doing; getting understandable info out of my GP is like puling teeth (which may well be my problem as I don't think I am necessarily a 'good' patient)

Depends why you're taking them tbh.

Occasional headache - well you can't really take it until it's sore!

If it's something you know about (like post op pain) don't wait till it gets really bad - paracetamol is more effective if you take it regularly (but I'd only add in the codeine if needed - lots of people will do that with the bedtime dose for eg)

Dicofenac does take a bit more planning as need to take on a full stomach, but I tend to add an NSAID (I usually use ibuprofen though) before codeine-type painkillers myself.

If its something that's been painful for a while and I think will be for another couple of days I'd go for regular paracetamol and see how they suit, adding in the others as you go, but that's just ME

You need to talk to your doctor they really won't mind, even if they seem busy we'd rather you understand your meds properly than get into a pickle with them!

Umm, no I tried talking on Wednesday & it really wasn't working

Apparently being aware that I was:

• possibly taking too many
• in a fair amount of pain
• wished to consider other types of pain relief in the long term

precluded having more now & I needed more now

I am having tests for things like thyroid, diabetes, anaemia, some rhumatoid stuff & some other stuff (& no despite asking I wasn't told what)

I can't have a referral to the CFS clinic or a pain clinic until the results are back (which is fair enough)

It is for muscle (less so), bone (beyond words how painful), hand & feet pain/pins & needles/cold and joint pain (joints in my hand are randomly enormous, red, shiny and bloody painful)

& rather embarrassingly the pain-killers have built up over about 3 years

If you have inflammation then yes you should be taking diclofenac regularly as prescribed. Although it does have pain killing properties, you cant just take it as a magic on-off for inflammation, it has to be done regularly and over time.

I take diclofenac 3x a day and top up with paracetamol (and stronger if necc.) when struggling.

Diclofenac is anti-inflammatory, so depending on your problem could have a use beyond just pain relief, IYSWIM.

There is also a belief that it is easier to stop pain developing than to take it away when it is there, so taking the paracetomol before you 'really' need it might be more useful that waiting till you are in alot of pain.

So how long does the diclofenac take to start helping? & will it affect the result of the tests I am having?

So there something to be said for taking the paracetamol (within it's limits) regularily so I never get to that 'so bad I can't cope' bit?

OK.

Is there another GP in the practice that you might have more of a rapport with?

Getting the test results first makes sense as then can sort you out in clinic rather than sending all the baseline tests from there and then getting you back again.

You really mustn't go over the max.dose for paracetamol - it seems all safe because you can buy it everywhere but in OD it can be really bad (I worked in a liver unit ITU a few years ago, so do twitch a bit about this one, sorry)

If it's all inflammatory (which it sounds like from your description) then regular diclofenac with food sounds well worth a try. Unfortunately pain relief for this sort of thing is always a bit trial and error, but you will get to the rihgt combination.

Do really try to keep moving too - painful joints are bad enough, stiff painful joints are another level you don't need!

Keep us posted, and good luck!

Sorry, a bit of a X post.

yes, regular paracetamol is a good thing up to it's limit.

I know about the moving - getting up in the morning is awful, I cry walking to the bathroom

Paracetmol worries me, I take co-codamol because I can take less paracetamol per hit as 1 co-codamol = 2 paracetamol (& a bit more) for pain relief

& the side effect of co-codamol is that my IBS is wonderful which I worried about but the GP said it was a happy side effect

What will happen if I don't eat with Diclofenac?
& how does eating fit with taking them 8 hrs apart?

They're quite hard on your stomach and have been linked to gastritis and even ulcers if taken on an empty stomach. Even a piece of toast with them is fine, but not nothing.

If they seem to help but it becomes tricky to fit in with your eating habits ask about the modified release ones which are 12 hours apart instead.

Don't mess around with NSAIDs, you can develop a stomach ulcer.
It doesn't have to be solid food, a glass of milk is sufficient.

diclofenac and other NSAIDS like iboprofen are known to cause stomach upsets (ulcers). this risk can be lowered by taking them with food, but you still need to watch out for symptoms like stomach cramps, very dark stools, and stop taking them immediately.

Not milk, but a biscuit or 2 might work if it's that little

That would be difficult to tell as I have fairly constant tummy cramps anyway

It just gets more complicted

I started keeping a medication diary today

I took a diclofenac at 8:30 & have managed with some tears to get through to 10 am - now I will take a co-codamol & based on yesterdays diary - that was exactly what I took yesterday

What that means, I have no idea

But I wonder if I should have taken the co-codamol when I got up

good for you, show that to your gp.
also, ask the receptionist if the nurse makes pain appointments to look at medication.

Diclofenac is an anti-inflammatory which, taken over time (as your GP seems to be suggesting) can lessen inflammation and pain.

Co-codamol, on the other hand, (is it 30/500mg or 8/500mg you're taking) is an opiate and you need to take it as little for adequate pain relief as needed because the codeine can be addictive.

Co-codamol is a very good painkiller if used properly, so please don't take any more than 2 tablets in any 4-6hr period. You could take 1 co-codamol and 1 paracetamol OR 2 co-codamol OR 2 paracetamol, but no more than 8 co-codamol or paracetamol in a 24hr period.

There are other anti-inflammatories/pain relief out there to try, so don't be afraid to ask your GP about that. Sometimes it takes you to keep trying other methods of pain relief to find out which ones suit you and work well and which don't.

FWIW I was on Co-codamol 30/500mg, Lodine 600mg (for severe back pain) and was swapped to Celebrex because the Lodine was really irriataing my stomach. Celebrex is just as good, but more gentle on the stomach.

I had steroid and local anaesthetic injections at the chronic pain clinic, am still on celebrex and I take paracetamol 4 times a day as my back is still pretty horrid most of the time (the injections themselves were quite painful and lasted about 5-6wks when they normally last from 3 months or more).

Hope your pain eases v. soon.

I'm not sure the diclofenac is working positively anyway, it gives me a 'head' feeling

1 co-codamol takes the edge of it, but doesn't last for ever, 2 co-codamol makes everything woosy, paracetamol doesn't get there

I probably only ever take 6 co-codamol over the day, the diclofenac seems to make the co-codamol last longer but I'm not so sure the feeling it gives me is worth taking half as many co-codamol

Some pain relief/anti-inflammatories will work for some people and won't work well for others, so it would be worth your while seeing your GP, explaining the current situation and asking to try another one for a few weeks to see if they help.

Believe me, it took me to be a pain in the arse about adequate medication until there were very few options left except the jabs, morphine patches or surgery. I'm sure the Dr's were saying 'Oh no, here she is again quick, hide' .

Seriously though, don't let up until you have the pain relief you need to get on with everyday life.

Anyway, relax, have a wee and a to dunk and keep posting to let us know how you're doing.

Well I 'forgot' to take the diclofenac last night. This morning I am in a lot of pain; so at least we know it helps, even if it has side effects I don't like

So more co-codamol or more diclfenac

OK took co-codamol because I could barely stand

Do I take the diclfenac as well, I still haven't got this sorted yet

I was prescribed Kapak (another name for co-codamol 30/500mg) and Voltarol (diclofenac) for pain relief when I was sterilised, so yes, both are OK to take together at the same time. You'll probably feel spaced out for a while, but as long as you are in considerably less pain, you should concentrate on your usual daily routine.

Have to go out this morning but should be back around 10.30am.

Kapak should be Kapake

you really should be taking an anti-inflammatory as your regular treatment. As others have said, you can get different sorts if diclofenac upsets your tummy too much, or you could ask whether taking omeprazole alongside it would be helpful. The other pain killers are only for pain relief, not for treating inflammation.
I really think you need to book an appt with a nurse or a gp to go through how to use these treatments most effectively.