Doctor won't prescribe stronger painkillers

[verystressedmum]

I've got really really bad back pain and even worse sciatica, I'm on diclofenac and co codamol at the moment but it's not really touching the pain and I can hardly walk or stand because of the pain.
Called the doctor to see about different pain killers and he said I'm on a really strong combination and he can't prescribe anything else I'll have to go to A&E.
Is that right? He said I must feel woozy because the painkillers are so strong, I said no I feel fine but they don't really help the pain.
I can't help thinking it's such a waste of everyone's time to go to A&E for painkillers.
I've read the threads I know there's other painkillers out there so how did you get them?
I'm in really bad pain so I may have to go to A&E but really....

When my DH had a really bad back spasm I took him to A&E and they gave him something like Valium to force him to relax, it worked wonders. My mum has rheumatoid arthritis, pain killers just weren't helping and GP couldn't prescribe anything stronger so has given her amiltriptyline to take at night. Its made a huge difference. Maybe you need something like that?

Diclofenac & cocodamol (30/500mg) is a pretty strong combination, its the strongest they gave me for a broken bone. My DF also needed diazepam (valium) for a back spasm, although the GP prescribed it over the phone, but his GP does know him pretty well personally - its a potential drug of abuse so I can understand doctors being wary of drug seeking, so would want to make sure its appropriate before prescribing (ie exam the patient), maybe thats why they suggested A&E if theres no more urgent appts today. Although is there not a walk-in/urgent care centre if you're worried about using A&E?

Sorry you're in pain, it sounds miserable

See another gp and cry? Agree A&E for diazepam if in spasm but unfortunately bathe pain and misery of actually going might be worse than not going.

Maybe ask specifically for a med such as amitriptyine or gabapentin which are much better for nerve pain than opiates. It might depend on how long this has been going on because acute episodes do often get better without all this. If it's been a while then you need an MRI. Some GPS need to see a diagnosis before dispensing treatment.mim sure there are heaps of good and concerned GPS who don't want to over medicate but being crippled with back pain is unacceptable. Can you take someone with you for moral support and go along asking for all/some of this?

Come and join the back pain thread for more support.

Co codamol does nothing for me. Tremadol works wonders. Have you got a walk in or out of hours place? Your prescription might be strong but everyone reacts differently and there's no way Co codamol or codeine would be the right thing for me.

Thanks for the replies. It's been going on for about 8 months now, I've been for x ray and am going for an MRI at some point hopefully soon when the appointment comes through.
I know it's a strong combination but it's not taking the pain away, to the point even after I take them I can't walk for long nor stand. It's totally ruining my life.
I'm going to speak to another doctor tomorrow and say I know there are other painkillers I can try instead of these ones which aren't really working.
I don't want to have to go to A&E for painkillers it just seems like such a waste of their time. It was quite late when the doctor called me but he never offered the option of an appointment tomorrow or any other day, he just said there's nothing else HE could prescribe but I have no idea why. I know other people at other surgeries in the local area have been prescribed different strong painkillers.
I'm a actually thinking of changing surgeries if I don't get anywhere, I can't carry on like this the pain is so bad. Just feel so frustrated.

Gabapentin and pregabalin and ami can turn you into a zombie. If you've got a job to hold down or stuff to do don't bother. They haven't really helped my pain and the side effects have been worse.

I have Tramadol at my disposal and that doesn't cut the pain. It's not something I would recommend taking lots of either. Currently hoping that surgery helps.

I've found drs a lot less keen to prescribe Tramadol since it changed to a controlled substance. Mine keeps trying to push me toward codine which is annoying as both give me the same level of pain control but codine makes me woozy, sick and gives me withdrawal symptoms where as Tramadol gives me no side effects

Try asking for different painkillers rather than stronger ones op

Pregablin and amitriptyine have helped me a lot. They don't suit everyone and you do need to ride out the initial side effects but for severe sciatica they may be very helpful. Going to A&E would only be any use to get you out of a very extreme situation. They can't prescribe long term meds so you need to see a sympathetic GP. Maybe do some research and take the evidence with you. Refusing to prescribe meds which might help seems very wrong. Hope your MRI comes through soon.

Interesting I am another one Cocodamol makes me so dozy, yucky and does not help with my knee pain. As soon as I walk the pain comes back. Tramadol is brilliant and no side effects. I think everyone is different.

I've got an appointment with another doctor at the practice so hopefully I get somewhere. I did think that about A&E, that they can't keep prescribing me my painkillers!
If I don't get anywhere with this other other I'm going to have to put in a complaint and look at changing surgeries. I can't actually walk the pain is so bad I just want someone to help me!

What other pain killers have you tried OP ,as pp said it's often that you don't need something stronger you just need to find something that works for you .

Dear OP,
The Dr is not correct when he says there is nothing else he CAN prescribe. He may not WANT to but he certainly can prescribe alternatives such as tramadol instead of co-codomol or add in something like oromorph (oral morphine) for breakthrough pain. Whether or not drugs like gabapentin, pregabalin or amitryptiline would help depends on the cause of your back pain. Hopefully the other GP will be more forthcoming with an effective analgesic regime but I would also be concerned about whether your back pain is being managed properly. Has the underlying cause been identified and if so have you had a referral to an appropriate specialist such as a musculoskeletal or orthopaedic specialist? If no underlying cause can be identified (and that happens sometimes) then I would also ask for a referral to your local chronic pain service as it sounds like your GP lacks knowledge or confidence to manage chronic pain. Good luck x

That's poor form on the part of the GP. A and E are for life threatening illnesses and injuries, not chronic conditions.

Agree that there are plenty of options, I would change GP. Until you know the underlying cause though it can be difficult to find the right drugs, or combo of drugs.

Agree triptyline type meds have been very effective for my nerve pain, but tramadol was more effective than codeine for pain relief. I find it helps to alternate between the two so you don't get a tolerance though.

Back pain is the absolute pits, poor you.

I would definitely see a different GP and maybe ask for a referral to a pain management clinic? They can provide options that aren't medication ie steroid injections, and other treatments.

I hope you get to the bottom of what's causing it.

Thank you I've got an appointment with orthopaedic ICAT in a few weeks so hopefully something will start happening but I just wanted something to help me until then.

I think it's a prolapsed disc as it all started when my back 'went', and this is pressing on the nerve. The x ray showed degeneration and narrowing somewhere, but I can't remember what the doc said in regards to the narrowing. The chiropractor thinks it may be that the prolapsed disc has narrowed the space and it's causing pressure on the nerve which is giving me the most horrific sciatic pain.

I agree that the doctor can prescribe but just doesn't want to for some reason. I'm going to go to out of hours doctor tonight to try and get something as I'm not seeing the other doctor for a few days.
I don't want to go to A&E and arrive there and ask for painkillers! I totally agree that it's for emergencies not for sciatica.

I've only ever been prescribed cocodamol 30/500, naproxen (which I didn't think did anything) and now diclofenac (which I don't think does anything either!).
I'd like something that will take some of the pain away (I know it might not all go) so I can keep mobile and actually get on with my life a bit more.
Thank you for the replies.

Your chiro sounds as if he is talking sense.

Re codeine not working, have a look at This (sorry it's the DM but is available elsewhere) which explains that quite a lot of people cannot benefit from codeine so swallow all they like and it still won't help. Tramadol would be an alternative.

You haven't said exactly what kind of back pain it is, so it's hard to advise. But these are the NICE guidelines for lower back pain.

www.nice.org.uk/guidance/cg88/chapter/1-guidance

Please don't go to A&E as its neither an emergency or urgent (although I'm sorry you are in so much pain). Also you may well be judged as exhibiting drug seeking behaviour and probably be given short shrift.

I'm surprised you haven't been offered tramadol. Makes me hallucinate, but many swear by it. Amitriptyline and slow release dihydrocodeine work for my neuropathic pain.

I have constant upper back and neck pain. Current cocktail is pregabalin and Tramadol. My lovely GP has referred me to a pain clinic, and so should yours.

You could also ask for a referral to the pain clinic.

When my back was bad gP was prescribing me stronger stuff, so I got tramadol. But it still wasn't right. I went and asked about amytriptelene and that helped a lot.

Was it spinal stenosis?

Nerve pain can be horrific. I can understand the GP wanting to keep the strength of opiate type painkillers down, hence trying the lowest strength possible and working their way up. But you really need something specifically for nerve pain, ime, like amitryptyline or pregablin etc. The naproxen and diclofenec I think are just anti inflammatory type.

I take the lowest and weakest possible dosages as a rule, but when it comes to flare ups, my GP
Is very proactive in throwing stronger stuff at it - the sooner it gets under control and you get more mobile, the better it is long term.

Agree with some of the posters above. If you have had the sciatica for 8 months and there is nerve involvement, you probably do need to try some sort of neuropathic medication, such as amitriptylline, gabapentin or pregabalin. They can take a few weeks to take effect and sometimes playing with the dosages (supervised). Yes, some people get side effects from them, but the same could be said of any meds, and they are much more likely to have an effect on nerve pain than diclofenac and cocodamol/tramadol.

In the meantime, you could try a tens machine?

I have a very similar pain. My GP, who is amazing, prescribes Amytriptaline (excuse spelling of that) and also tramadol. She has given me morphine too in the past. What did help me a lot was when I was loaned a wireless TENS machine, it really took the edge off. My GP may be more inclined to give me what I need as I have incurable Cancer too so generally she helps as much as she can. What a waste of A&E time!!!
I second the pain clinic too xx

I spoke to a doctor at the out of hours centre and in picking up a prescription for amiltriptaline very soon.

I have no idea if it will work and am a bit concerned that it may take a few weeks to properly work but it's something positive I think.
He asked about my symptoms and I've got numbness in my foot and very strong pins and needles in my leg (feels like electric current) so he agrees it's most likely nerve. Only concerning thing is I need to get a repeat prescription from my own GP not from from out of hours.

Though it wasn't my own GP that refused the prescription it was the other partner in the practice. I can't get an appointment to see my own GP until next week so I'm seeing some other doctor in the practice earlier.
When I went to my own GP about my back/leg he did tests on me and said there was nerve damage. But I have no idea if he'll prescribe something different either, I called him last week to say the cocodamol/naproxen combination doesn't work I'd like something different and he gave me diclofenac instead.

I did wonder about spinal stenosis as when I read up on it it fits really well with all of my symptoms, but this all started when my back 'went' (prolapse? no idea tbh) so it's probably the disc causing all the problems.

I think I need to go to a pain clinic because this pain doesn't seem to be going away any time soon, in fact it's worse now!
I'm going to look into a tens machine I will do anything to ease this bloody pain!
My leg is the worst but it's coming from my back, so if I got a tens machine would I put it on my back or leg?

Thank you so much for the replies

Thehousewife it puts my little bit of pain into perspective when you have incurable cancer! x

Put the TENS machine on your back, or even buttock if the pain is there too. You're probably doing this already but a hot water bottle can be nice too and try to keep as active as you can manage, taking regular breaks where you can. You could also try a couple of sessions of acupuncture - though if it's going to help, you should notice a definite and ongoing improvement that lasts within 3-4 sessions.

Thanks orange. Some people have said acupuncture worked for them (or someone they know) so I think I'll look into it.

I've taken an amiltriptyline tablet. It's 10mg and I can take 1 or 2, so I've taken 1. Will that be enough pain relief? Can I take other painkillers with it (will I need it?) I have cocodamol, diclofenac, naproxem and ibuprofen- not sure if I can take any of these or if I'll need to.