GP trying to prescribe wrong/unhelpful things and getting cross with me

[OnceThereWasThisGirlWho]

I just want to check I'm not barking up the wrong tree here.

Have endometriosis. Pain very severe first day of period, lessens afterwards. Currently take codeine on the first and sometimes second day, which helps a fair bit. Gynaecologist suggested Tramadol, for the first hours/day when the pain is extreme, and said he'd include a note in his letter to GP to say I should be given it if I need it.

He didn't do this. Also, had a brain freeze during my GP appt. that meant I couldn't remember the name of the drug either. Fair enough, GP can't/won't prescribe (although I'd assume he would be able to work it out himself or prescibe some other suitable strong painkiller, but nevermind).

GP then offered tranexamic acid. Had issue with previous GP giving this to me; it's for heavy bleeding (which I don't have) and apparently you're not supposed to take it if you don't have this symptom. Plus, I can't find anything that suggests its intended for pain. I explained that I don't have heavy bleeding, blah blah, and GP just acted like I was making it up, telling me it relaxed the muscles (or something) and would help the pain. I again repeated that on the patient info leaflet it specifically says: do not take if you do not have heavy bleeding! He got all huffy, saying he was the one with the medical degree, what did I know, and looked it up and patronisingly read it out to me. Of course, it was all about menorrhagia, no mention of pain. He still acted like I was the one being awkward though.

Then he offered me mefanaemic acid, which some people swear by, but for me it doesn't touch the pain. Think it's because it's best of you take it before the pain starts but my period isn't predictabe enough to do this (and when it starts pain goes from 0 - ARGH in 20mins). Explained this, and that I'd tried it. He again acted like I was being awkward, almost as if he didn't believe me it didn't work.

Finally - and bearing in mind I'd explained I currently use codeine - he offered me co-codomol. Was more unsure of my ground here, but I have been prescibed co-codomol before and it didn't touch the pain. I can't take enough for the codeine to work without overdosing on the parcetamol element (explained both these things to GP). However, I'm not sure if they are in theory supposed to work together in a way that is better than a higher dose of codeine alone..? It felt a bit insulting tbh, being fobbed off with paracetamol as if i'm too stupid to have tried that before, or he thinks I'm exaggerating the severity of the pain.

Ended up in tears, speaking through gritted teeth trying not to completely lose it, trying to explain to him that prescribing me something for heavy bleeding, which I dont have, is not helpful, and no it's not me being awkward. And that surely co-codomol wasn't as strong as paracetamol. Had to keep repeating the same basic sentences again and again.

It reminded me of abusive ex(es) - the way their whole manner is acting outraged at you being so difficult and like you're doing something dreadfully wrong; an argument that you are provoking and they are innocent. Doesn't matter how much logic or cold hard truth you can politely supply, or how irrational they are being, they still act as if youre the one in the wrong. The actions and manner doesn't add up with the actual conversation being had.

I'm sorry, just really upset by this. And so frustrated. Have contaced gynae's office to hopefully get a letter sent and get painkillers. (FWIW gynae is awesome, explains everything simply and efficiently.)

Oh, also he went on to offer me the pill. Explained hormonal contraception makes me really lethargic and depressed - even the mirena coil did - so for now I don't want to take it. Other half of appt was for mental health reasons and I had to spell it out that as I'm currently hanging on by my fingernails, taking something that's likely to upset the balance isn't a good idea. He then said "what about the implant?" As if (a) that doesn't contain hormones, and (b) isn't the one form of contraception that seems to cause the worse side effects.

You can get co-codamol which is 500mg paracetamol/30mg codeine per tablet so 60mg codeine per dose. Would this help?

I think he's trying to help you. Obviously, some of his suggestions have upset you. The tranexamic acid will have been because it's the shedding of the womb lining that causes the pain - he wouldn't have known that you don't bleed heavily. The mefenamic acid is also very sensible and he wouldn't have known that it isn't effective for you.

The co-codamol is stronger than paracetamol alone. You didn't say whether he was thinking of giving you the 8/500 16/500 or 30/500 strength, but either way you can take two at a time which gives 1g of paracetamol along with 16mg/32mg/60mg codeine.

The pill doses are very low dose now, so less likely to cause mood swings and the implants/mittens mirena are localised so even lower dose.

I don't think he was in any way abusive and I'm not sure what else he could suggest.

What painkillers did you want. Why didn't you just say 'can you prescribe me X drug, please?'

Think Tramadol can be quite addictive and has a fair few side effects that make you feel out of it. So maybe the GP would prefer you to try other things first. Maybe if you started a thread asking about Tramadol you might get better answers from those who have used it.

What your GP has suggested is all stuff that normally would be tried before getting to a consultant, let alone before tramadol.
Prescribing codeine separately can be helpful as if you have taken 1g of paracetamol (standard dose) then you can't take any more for 4 hours, but could add codeine if necessary (I have 15mg tablets so often take 1 with paracetamol, then up to 3 more if the need for pain relief trumps the need to be sentient).

Though if the consultant suggested tramadol then the GP should prescribe it. It makes me more spaced than codeine but works well for joint pain, so I take it routinely before bed.

I think your anger would be better directed at the gynae consultant not sending the information and treatment plan through to your GP.

I can understand you're frustrated and upset but what your GP offered is fairly standard response to very painful periods and those drugs do help a lot of people

Tramadol is addictive and has a lot of side effects so shouldn't be given out unless the doctor prescribing is confident other avenues have been explored first.

lougle The tranexamic acid will have been because it's the shedding of the womb lining that causes the pain - he wouldn't have known that you don't bleed heavily.
He did know, because I told him. It was the way he got all arsey about it, not that he assumed I had heavy bleeding. Although surely he should check that anyway before giving me something for heavy bleeding?

The mefenamic acid is also very sensible and he wouldn't have known that it isn't effective for you.

Again, I explained that I'd tried this and it hadn't touched the pain. But he acted like I must be making it up or was just being difficult.

I take 60mg codeine but have to take another 60mg a couple of hours later. He didn't explain the doses or suggest I try some paracetamol alongside the codeine. That's the thing, he just expected me to go away happily with a prescription for something inapproriate without actually explaining anything, checking what my problem actually is, or what I've tried before.

I didnt say he was abusive, I said his behaviour reminded me of abusive ex. The "you must believe and obey my word at all costs and if it doesnt make sense you mustn't query it and I will not explain anything" attitude. Bearing in mind I had three years of being fobbed off and told my pain was "normal", that I should have a baby, that it was menopause, etc etc.

I recently tried the pill again (for 3 months) and it was horrendous. I dont mind him suggesting it, it was the fact that he then suggested the implant which also obviously has hormones in, and seems to have much worse side effects.

sadie and NotCitrus Yes I heard tramadol was like that. I figure I might as well be completely out of it for a few hours as completely incapable anyway but in immense pain!

I might try supplementing the codeine with paracetamol, if I haven't got tramadol by my next period. I'm aware of the addictive nature of these drugs, but only use them one day a month (possibly two for codeine). I imagine I'd only need tramadol for part of the first day, too.

Both codeine and tramadol are opioids (codeine derived from the poppy and tramadol is synthetic). I've taken high doses of both and side effects are pretty much identical. Tramadol has an added feature of binding to serotonin and norepinephrine receptors too to help inhibit pain further, and is the stronger drug.

BTW - I take 60mg codeine but have to take another 60mg a couple of hours later

You are technically overdosing. You should wait four hours before taking another dose. That said, so long as you're watching your daily dosage and not going above 300 240mg daily you'll be fine.

It's the gynae consultant who has failed to send his recommendation to the GP so if the GP then goes through the usual suggestions it's not really his fault. It is very frustrating to feel not listened to, though and many people with chronic medical conditions are better informed than their GPS especially if there are new products or treatments available.

Don't pin too much hope on Tramadol being a magic bullet here. I take both cocodamol and Tramadol and switch them around but don't see a great deal of difference in the level of pain relief, especially once you begin to develop some tolerance.

On a really bad day I take full dose cocodamol plus a slow release Tramadol 150mg and that can help. Not ideal but there you go. My GP is fine with prescribing, I'm surprised he would find it more worrying to give you Tramadol than cocodamol, both are addictive but for 1-2 days a month should be fine.

Hope you get some help soon, I hear the pain is awful.

Thank you. Sorry I missed the last two replies until now.

I don't take more than 240mg of codeine for the day. My ex had some after a series of operations; I realise now he must have been abusing the stuff considering how much he was taking.

I will hold out for 4hrs before taking the second dose from now on then... Gah it's horrible! I always write down the times of taking pills cos I can't remember through the pain, and because I feel so horrendous I vaguely imagine the paramedics will need to know later..! By the evening I'm sane again.

Sound very frustrating. I have endo too and was fobbed off for years

Some people get more relief from tramadol, and some from codeine. Some people lack a hormone that converts codeine to a more effective painkiller in the body (non scientific explanation but it's true!). I find tramadol more effective than codeine. My DH and mother find codeine more effective. Your GP should prescribe what the consultant suggested. It could be useful to add an anti inflammatory to the mix - the mef. acid, diclofenic or ibuprofen are the ones most usually prescribed.

Have you had/been offered treatment surgery (ie not just a diagnostic laparoscopy?) This is often the most effective treatment. Painkillers alone without hormonal treatment will only manage the pain while the condition is likely worsening. I had two surgeries and after the second was able to halve my painkillers. Now with gnrh treatment I have reduced them by 75%.

The laparoscopy I had was both diagnostic and treatment (at a recognised centre for endo hospital). The spread of the endo wasn't bad - one main patch fusing ovary and bowel. Bowel symptoms have improved since surgery but pain is the same...

Once, could you give your gynae a ring and ask her to send a script to your dr?

The GP sounds condescending and unable to listen/see when he is wrong. This kind of thing is very upsetting when you are already feeling crappy.

Some doctors are just used to assuming that patients are a bit thick, or a bit delusional, or eager for more and stronger unnecessary drugs. It is very frustrating, and I doubt you will see his attitude change. Is there a better GP in your practice?

You need to get back in touch with your gynaecologist and get them to prescribe better painkillers. I was in a similar situation to you (couldn't take anything hormonal, had 3 laps, pain horrific for the first 24 hours). I was prescribed quick release oxycodone which was a godsend. I only took it one day a month but it meant I could get some sleep and actually go to work. I couldn't take it in the day though as it spaced me out too much. Zoladex was wonderful for me (other than the hot flushes), not sure if you've tried that yet? Thankfully my symptoms are a lot better since having DS. I found my GP was reluctant to prescribe anything stronger than codeine but did reluctantly do so after the gynae had given me the first lot.

I think claraschu has nailed it and that you would benefit from seeing a more grown-up GP who doesn't react badly to being told they are not in possession of all the facts. Also, you might need to ask your gynae for a clear letter explaining all this so you can show that letter to GPs in future.

I hope you get the treatment you need soon

God yes ask for another appointment with a different GP, this one sunds like a knob! Poor you

Have come back to thread to vent as GP has reached new levels on wankerishness. Sorry.

He phoned me re. mental health issues and assessment follow up etc. (I only have GP now). First off he brought up the endometriosis/tramadol issue, asking if I'd managed to get it sorted. I thought it was a genuine query but now I'm wondering if he was being purposely goady (surely not?) I asked if the gynaecologist had sent the letter through with the painkiller recommendation. Apprently not, so I said I'd get in touch with him again.

Oh no, said GP, and started going on about the gynae referring me to another doctor (entirely different department) and saying I should wait to see him. I explained that was regarding a separate issue; that when I saw the gynae he's a) recommended a different painkiller, and b) felt there were some issues that might need investigating elsewhere.

Again, no, GP repeats the gynae has referred me to another doctor and I should await my appointment.

Again, I explain that it's two separate issues. One, gynae recommneded a different painkiller, and two, he felt certain symptoms needed more investigation in an entirely different department. Separate issues.

Again, GP went on that I should wait to see this other doctor.

I said "Ok, I'm going to try to explain again, for the third time. Please try to understand". I was hopping mad by this stage because people not hearing really winds me up, and was trying to stay calm but obviously sounded frustrated.

He said "this is abuse, I'm going to have to end the call". And just kept on talking over me, nonstop. I was begging him to just listen, asking how I was supposed to explain and why wouldn't he listen, trying to stay calm, and he just kept on talking over me then hung up.

Of course it was last thing on a Friday so I have no one to discuss the mental health things with, as well as feeling so wound up and upset by him. I'm trying not to think about it but it's bringing up memories of my horrible ex who used to make me feel so trapped like this - literally just talking over me and refusing to understand anything and wielding power. He's done this the last couple of times I've seen/spoken to him to - just shutting off, shuttig down anything, literally talking over me and refusing to listen if he's made a mistake/assumption (which he also does a lot).

I've been waiting for these painkillers since December.

Will be trying to change GP surgery this week as well as contacting gynae, and practice manager at current GP. Not that the latter will do much good as have already tried.

On reflection I might stay at this practice until the painkiller are sorted, it would be satisfying for him to have to write the prescription.

Sorry, needed to get that out.

ps. I know I shouldn't have sounded sarcastic when I tried to explain for the third time, but god I've been dealing with this man for a while now and he'd have just talked over me and refused to listen on explaining it for a third time anyway.

Feel sorry for you OP, its very frustrating when doctors won't listen. Hope you get things sorted soon.

I've had issues getting painkillers too. Went to the emergency doctor when I was in severe pain and he wanted to prescribe me tramadol but the e-prescription system was down so he couldn't so he told me to call the health centre the next day and ask a doctor to prescribe it. All written down in my notes. Called the next day, told the doctor what the emergency doctor had said and she told me she won't prescribe it because "young people need to just handle pain". Was too shocked to say anything beyond that I was going to complain about her awful attitude, which I did and she got a good telling off

The amount of codein you take seems excessive. Codeine is actually more effective when it's taken as co-codamol. You seem to have been on these a while which isn't recommended, do you think you could have an addiction?

I would change gp, but tramadol is a class 3 controlled drug and I know in my ccg they really really don't like prescribing it. We've seen prescriptions cut by 50% in the last year

Can't be an addiction if she's only taking it a couple of days a month.

I had tramodol for a few days after a c-section. I wouldn't recommend it long term. I was particularly high and also very dozy. It is also addictive.

You can't tell a doctor he's wrong you know. I had a broken arm once for Two weeks that no doctor would believe, I had to insist on an x ray in the end