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NHS pain relief, lack of it

83 replies

brahelper · 26/03/2016 21:52

Ladies I have read a fair few threads on here of similar stories so thought I would post my issue even tho I am not a mum I hope you can offer opinion's.

I have numerous times in the past had fallout's with the NHS refusing to give me prescription strength painkillers for tooth ache, luckily tho in those case co codamel and ibuprofen (or naproxen) would at least take the edge off.

Well Starting Tuesday last week I started having almost constant head pain and extreme tiredness, even tho was tired I couldnt really sleep for anything more than an hour at a time. Iniotially the main problem was the sleep as headache was mild.

Then Thursday morning I managed 6 hours sleep for the first time in about 3 days, but the tiredness wasnt gone neither the headache. At about 2PM I went to try and have a nap due to the tiredness then suddenly liker a switch was flicked I had extreme headache, easily the worst pain I have ever had. I was already under naproxen as I take it for other health problems so took paracetomal but both of these had absolutely no affect.

My GP surgery refused to give me time to talk to a GP, not even over the phone, their policy? goto A&E.

According to NHS guidelines I qualified for 999 help but rang 111, and they arranged an out of hours gp appointment at my hospital. That doctor examined me and said I needed further help from A&E, after another hour wait the A&E doc seen me and then tried to transfer me to a neurologist but someone overuled him and I was to be transferred to A&E majors instead, I waited 6 hours for this transfer with no pain relief given, in absolute agony. I did observe sitting up vs lieing down the pain eased slightly but only a bit, it was still unbearable.

When I got to majors they did their usual routine (which seems the same no matter what the issue as if its scripted), which was blood tests and blood pressure tests. Was told to wait 90 mins for blood test results, still given no pain relief. After about 40 mins a doc came to see me and asked me questions, he asked the same questions at this point asked 4 times as if these people dont talk to each other. I was then finally given plain relief, but even tho I told them I had already hit the max dosage for 24 hours and it had no affect, guess what they gave me? you guessed it paracetomal and ibuprofen, one wonders what one has to do to get things like morphine. The dosage wasnt higher than over the counter stregth either was 1gram of paracetomal and 2 tablets of ibuprofen. Result no affect.

I ended up having a CT scan which was clean, and after that point (now about 6am) I heard some kind of ward manager pestering my doctor to discharge me, he didnt for another 90 mins whilst also asking me more questions and examining my head, but eventually he got overuled as she sent another doc to discharge me, she was shouting about me so everyone could here almost every 5 minutes "is he gone yet?". He then told to wait whilst he gets some powerful painkillers, I forgot the name but it wasnt the paracteomal or ibuprofen. The other doc came back to ask why I wasnt gone yet (following another shout from the manager) and I said waiting for painkillers. About 30 secs later I heard thi smanager shout "what!!! tell him to go home and take paracetomal, if he doesnt do what you say call security".

At that point I left.

Now is saturday night, pain is still severe, almost constant, and now I keep feeling faint as well. I already complained to the laison service although I expect them to backup their own colleagues.

So I left with no diagnosis other than what was ruled out with CT, and no pain relief.

The NHS is aweful.

I have been thinking given I was there on my own looking rough, unshaven etc. maybe they thought I was some kind fo addict after drugs, but if thats the case they should give people the benefit of the doubt.

OP posts:
Wolpertinger · 27/03/2016 16:27

For a headache you need a diagnosis. So migraine the treatment might be sumatriptan other triptans are available, cluster headache the treatment is different, tension headache the treatment is pretty much co-codamol but try to avoid it and lump it because if you take too much you can rapidly start getting headaches caused by the co-codamol... and so on.

And I don't even diagnose headache! It's a very complex area. Much much more complex than just 'it's bad, I need some morphine'. And for some people the treatments are excellent and for some people they aren't very good and largely boil down to put up with your headache.

Can I ask, was your headache on one side of your head or both?

Both sides at the front of your head would make you think of tension headache in which case bad luck, it's a bad headache but what most people think of as a headache. They don't respond well to any painkillers really but most sufferers have their favourites. These are by far the commonest headaches but are still horrible.

One side only would make you think of migraine, especially if light or sound bothered you or you felt sick. It's a long time for a migraine to go on for but not impossible. Sometimes they switch sides mine do

As you are a man, if it was a sudden onset of the worst headache of your life, but only on one side of your head, you may have had a cluster headache. They are supposed to be phenomenally awful. Have a read and see if this sounds like your headache:
www.nhs.uk/conditions/cluster-headaches/Pages/Introduction.aspx

If your headache has got better by Tuesday it's still worth seeing your GP, especially if it was one of the 'one side of your head' headaches as they need specific treatment.

You have now exhausted my entire knowledge of headache I think.

tempname12 · 27/03/2016 22:11

They've done pretty well to be honest in getting you seen at A&E and CT'd so quickly (I work in neuro).

I agree with paracetomal and ibuprofen , codeine can cause rebound headaches for some reason. Morphine and other strong painkillers (oxycontin/norm, MST, sevredol, fentanyl) are very powerful in the right doses and side effects (vomiting, hallucinations, drowsiness and respiratory depression) would probably have massively outweighed any benefit to you.

If it carries on I'd see your GP, possibly worth seeing neurology as an outpatient. Keep a wee headache diary in the meantime and try to identify a trigger - caffeine, lack of sleep, alcohol, prescription medication etc..

BeaufortBelle · 27/03/2016 22:42

I sort of sympathise having attended A&E a few months ago with a fractured vertebrae. The triage nurse and reception were generally unhelpful. The nurse forgot to give me pain relief. The doctor was OK and got me Xrayed and lying flat and was quite irritated that the nurse had given me nothing. I think I was given co-codamol and naproxen it certainly hit the pain. However, I was told very brusquely that I had broken my back and they got a bit arsy when I asked for the orthopaedic registrar to come and discuss his findings with me. It wasn't very helpful and I was sent home advised to see my GP for further management.

There was little information about the extent of the fracture except that it was stable and I had to be assertive with the GP to refer me to a neurologist but he did.

The GP however did send me home with a huge bag of pills: naproxen 500s, co-codamol 30/500, omeprazole and laxatives and subsequently the wrote me a prescription for 150 more 15/500 co-cocodamol, whilst the neurologist offered me surgery that I decided against. So, in summary I was quite shocked at the quantity and strength of the pain relief I was given and I don't think there'd have been an issue if I'd needed something stronger.

Yes, I did have to be assertive at the hospital and the GP but neither suggested calling security.

I'm sorry you aren't well but is there perhaps some history that you aren't sharing with us. It's quite unusual I think to have been stabbed; could we help you deal with the circumstances around that.

triballeader · 27/03/2016 22:53

I have not seen your other threads but I am posting just in case you might be darn unlucky and have one of the rarer primary headache disorders.

It was your comment of the worst pain ever and a headache that keeps you from sleeping that makes me go maybe...I have TAC and its the most horrible uncontrolled severe pain think a 9-10 that makes childbirth, kidney stones and broken major bones seem insignficant. For some the pain is so severe and disabling they present as if they have had a bleed and look as if they have had a stroke from Horners Syndrome that normally occurs with TAC headaches.
Please have a look at OUCH UK's website on Trigeminal Autonomic Cephaligias and check if any of the descriptions might fit your experience. [SUNCT, Hypnic, Cluster aka suicide headache et al]

The bad news: if you might have TAC none of the opiods, NSAIDs and all will NOT work and should NOT be prescribed. You would also need to be seen and formally diaognosed and managed by a neurologist.

A headache diary is a good idea, Migraine Buddy app is well rated by others I know who have very frequent severe headaches. The Migriane Clinic and many of the Migraine charities also offer a headache diary that you can print off. Detail drugs taken, symptoms, timing, location and type of pain. Anything that eased the pain or makes it worse and so on. The info your gather will help your doctors to help you.

Another real and more likely possibility is rebound headaches [medication over-use headaches]. These are very common if your using pain releif for other conditions and would need to be first ruled out. The British Association for the Study of Headaches [BASH] have produced guidelines on how rebound headaches should be managed.

longdays · 28/03/2016 00:44

LP is lumbar puncture.

longdays · 28/03/2016 00:49

Cocodamol has helped though?

CockacidalManiac · 28/03/2016 00:52

Its the same reason I find it stupid that certian drugs no longer get prescribed due to "fear of addiction" such as diazepam which is an amazing drug for certian conditions, I never got addicted to it. Co codamel has warnings about addiction as well, but to me the lesser evil of pain or addiction? the latter easily.

I disagree, Diazepam is highly addictive and used only for short periods for certain problems; severe muscle spasm for example. It doesn't tend to be used for longer than a week, because it's so addictive. Codeine addiction is a pretty nasty thing too.

CockacidalManiac · 28/03/2016 00:58

Has anyone ever gone down the Amitriptyline route with you?

CockacidalManiac · 28/03/2016 01:37

The NHS is aweful

It really isn't. Pain is complicated, and just because yours couldn't be magicked away isn't a reflection on anyone.

NotnowNigel · 28/03/2016 02:00

I agree the NHS isnt awful BUT I have several times been left waiting for painkillers as an in patient, most recentlt because nurses were about to handover to the new shift. I had to threaten discharging myself for lack of treatment ti get my painkillers. (Was a complete bluff as I couldn't have even got out of bed as I wsa too busy writhing in agony and focusing on breathing, let alone being able to get dressed and leave). At that point I thought the nurses were truly sadistic. Sad

brahelper · 28/03/2016 05:05

thats not middle ground as co codamal is only slughtly more powerful, I meant on a scale of 0 to 100 with morphine been 100 paracetamol been 0. What is there at around 50.
So basically non over the counter and designed for "heavy" pains. Which co codamol isnt.
co codamol is probably about 10 on the scale.

If you trying to say its unreasonable for someone with unbearable pain to get anything more than co codamol then thats insanity. Were soilders on the battlefield who got shot given paracetomal and co codamel?

Update today, I guess you may tell from my mood it isnt good, woke up at 1am, tiredness and heavy pain again, tried to get back to sleep but lieing down was unbearable, I took 2 more of those tablets but this time is no affect.

So maybe I should rephrase the question, what is middleground between co codamal and morphine?

OP posts:
brahelper · 28/03/2016 05:12

Whats the problem with been addicted?

Lets say you need to take a drug regurly (yes I have spasms and diazepam is the only drug that ever fully controlled them), doc was giving me them until the NHS changed their rules some years back and sadly I never had that good improvement since. I am struggling to see how been addicted to a drug you ave to take anyway is good, and just because "some" people may get addicted you cannot assume everyone will, its the same reason just because over the counter tablets work for "some" people, it doesnt mean it will for everyone, the whole basis of treating people based on probability is bad in itself.

Its coming across to me the people who havent sympathised (which sadly seems most replies) think I am either lieing or exaggerating, simply because it doesnt compute in their heads that a headache cannot be controlled by moderate painkillers.

This is no exaggeration, if this doesnt subside whether naturally or via treatment, I can see myself forcing the issue, because I cannot live like this, I hope that drills home how bad it is,

OP posts:
brahelper · 28/03/2016 05:14

Thanks to notnownigel and others who have either seen first hand how unsypmathetic the nhs is to pain or can at least understand what I am going through.

The only reason I have not gone back to a&e is I know I wont achieve anything, with a clean CT scan they believe they have nothing to do and an out of hours GP will only refer me back to A&E, My only hope is my GP been sympathetic.

OP posts:
Sothisishowitfeels · 28/03/2016 05:21

If you are in so much pain I would go back tbh.
Pain is very odd though ! I had pneumonia and really serious pain on breathing a and e couldn't seem to give me morphine fast enough. What difference did it make ? None!.

They gave me paracetamol through an iv and it eased it enough that I could talk again in literally minutes!

I don't think the " strength " of the drug is the issue rather how you react to it and what type of pain you have.

brahelper · 28/03/2016 05:24

Does the MHs disagree with this site?

www.migrainetrust.org/about-migraine/types-of-migraine/chronic-migraine/

triptan suitable for ongoing migraines

maybe this site is wrong as well

www.mayoclinic.org/diseases-conditions/migraine-headache/basics/treatment/con-20026358

They both say the NHS is wrong and that over the counter is only good enough for mild migraines. Or maybe I have a mild migraine and I am imagining things?

Or perhaps what is nearer the truth is the NHS cost cutting has put a block to these sort of treatments.

Another site

www.emedicinehealth.com/migraine_headache/page8_em.htm

NHS is like the odd one out in the block.

Those who say co codamol and paracetomal is suitable for heavy ongoing migraines please provide a source of this information from the internet thank you. As the packaging with these medications and the sources I found disagree with you. I expect if I paid for a private consultation I wouldnt have any loops to jump through.

OP posts:
brahelper · 28/03/2016 05:28

Sothisishowitfeels that is a fair comment, I agree the type of painkiller is enough to make it more effective as well. Of course when I told a&e paracetomal wasnt effective, if they were good at their job then they should have listened to me and tried an alternative, the reason for my anger is I clearly havent been listened to. As well as the pain. Normally I am a more polite person.

I am trying to hold out until tommorow, of course with no guarantuee of even getting a GP appointment, my GP is very good but they are way overloaded with patients, 5 mins after they open all appointments for the day are gone and phone is choco block, I think I will actually walk in instead when they open to avoid the phone congestion.

I suppose i can try a&e once more, would going at say 6-9am yield less waiting it is still a bank holiday so I imagine they will be under intense pressure and as a result be motivated to push me out of the door.

OP posts:
brahelper · 28/03/2016 05:36

Regarding amitriptlyne I am already on for nerve pain.

To give you idea an idea how good my GP is, she sent me to a&e 2 years ago with some pretty serious problems, she told me they will likely try to send me home with no treatment but she will try her best to bulldoze through their resistance and gave me a large letter to hand in to them when getting there. Even with the letter they were going to discharge me until she rang them very angry forcing the issue.

OP posts:
olympicsrock · 28/03/2016 05:49

I sympathise with your awful headache as I have had several myself ending up in A and E. And being given morphine fluids and antisickness medication I am sorry to say that what comes across is that you are clearly angry and I can imagine that this not helping you. The majority of people in awful pain are not able to type long posts attaching links of recommendations etc. I personally was hardly able to speak. Perhaps this is what made you come across as a morphine seeker?
There are various misconceptions in your post. Firstly paracetamol..... Google analgesic ladder. Always start with paracetamol and add in stronger painkillers as required as it IS effective and reduces need for stronger things which have side effects. 4 g in 24 hours is not the maximum dose . It actually goes by weight so 4g is on the packet for non doctors. The 4 hour target is to be treated and or admitted or discharged not for anyone not diagnosed to be discharged. They did not think you warranted admission hence plan to discharge.

My advice is that if you are still in awful pain over the bank holiday go back to A and E and explain this calmly. They should provide pain relief.

CockacidalManiac · 28/03/2016 06:12

Those who say co codamol and paracetomal is suitable for heavy ongoing migraines please provide a source of this information from the internet thank you.

Er..why?
Treatment is based on NICE guidelines, not on the result of random Google searches.

OvariesForgotHerPassword · 28/03/2016 06:50

Sorry but I can see why people aren't rushing to say "oh yes you should have been given morphine". My worst headaches were 8/9 on the pain scale and I couldn't open my eyes let alone look at a screen to post on a forum. None of the painkillers they tried had any effect - you need a neurology appointment arranged by your GP to find a longer term solution. I'll be on propranolol for pretty much the rest of my life but it's worth it for the relief.

Not saying you're lying/exaggerating, it's just that people's definition of pain scale is different. And there are lots of times when whacking someone on morphine isn't the right thing to do. I've been to A&E with dislocations that are almost a 10 and been given naproxen. I've been in with suspected appendicitis and been straight on morphine. The pains were both pretty much a 10, but it wouldn't have been appropriate to give the same drugs in each situation, and I'd assume that's why they started with paracetamol with you, to start building it up.

The NHS don't shy away from prescribing painkillers, but they're generally very good at giving the right ones where they're needed.

I've been addicted to cocodamol. It's awful. Horrendous withdrawal. I'm also now on long term tramadol for endometriosis and that's not something I'd recommend either. Long term pain relief isn't something top just be handed out like smarties.

CockacidalManiac · 28/03/2016 06:51

I am sorry to say that what comes across is that you are clearly angry and I can imagine that this not helping you. The majority of people in awful pain are not able to type long posts attaching links of recommendations etc. I personally was hardly able to speak. Perhaps this is what made you come across as a morphine seeker?

Well, yes. Exactly.

olympicsrock · 28/03/2016 07:12

Cockacidal... great usernameSmile

ohlittlepea · 28/03/2016 07:14

If your notes history has a record of asking and being refused prescription pain relief on afew occasions I wonder if that affected your treatment? Glad they checked you out with ct and examinations and bits. Next time it's probably best to ask for pain relief rather than morphine, as that can make it appear that you are asking for a drug with a street value which may make people suspicious.

Footle · 28/03/2016 08:01

You're already taking Amitriptyline regularly, plus a load of other stuff ? I'm a non-medical person with a long acquaintance with both migraine and tension headaches. To me it sounds as if you need to consider going cold turkey for a week or two, as your already strong medication isn't helping and may now be exacerbating your problem.

Believeitornot · 28/03/2016 08:06

OP

The whole NHS isn't conspiring against you to make sure you suffer from headaches.

You were dealing with medical professionals who have a bit more training than you on these things.

Loads of posters have given sensible reasons as to why you didn't get the drugs you were after. And alternative places to get them.

So why make it into the whole NHS is rubbish?

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