Doctor won't prescribe effective painkillers?

[27Harper]

Hi I'm new here. I have a beautiful son who was born last February called Leo. I also am currently awaiting a rhematology appointment after a recent referal as I have suspected fibromyalgia. I have taken some of my sister's solpadol (30/500mg cocodamol) in the past which I know is bad and you shouldn't take others medications, but I was in really bad pain. I told my doctor this and he said it's a very strong painkiller and I said I know but it still didn't really work, just took the edge off of the pain a bit. He said he didn't want to prescribe any weak opiods as they can cause dependence and that the solpadol is very strong. Which annoyed me because I know all this bit I'm in pain and they don't work! So he said he was going to prescribe ibuprofen as if I hadn't tried that already, then naproxen, again which I've tried. What logic is it to prescribe an anti inflamitory when there is no inflammation whatsoever? Also even if there was, it's technically a weaker painkiller than the solpadol which doesn't work, so how did he think that would help? So then he gave me ANOTHER NSAID called Etoricoxib, which is for things like arthritis and gout, and it's a once a day pill. I've been on it for a few days and I might as well be eating skittles. My back and legs are killing me and I have a screaming one year old to look after lol
He says he's just trying all options which I guess makes sense of course but anti inflammatory drugs don't work for fibro I've tried tons of them. Can I possibly phone up my doctor in a few more days and say they're not working? Ugh I really need some advice if possible thanks. I'm always paranoid that I seem like some sort of drug seeker lol. Thanks xx

I don't think any doctor will prescribe you an opioid when you ask/demand them like that. It is a warning sign to them that you are an addict looking for drugs. Sorry.

Do you know when your referral to a rheumatologist will come through? There is a medication called pregabalin which is often prescribed, even though it is an epilepsy drug, as it is considered by some to be helpful. Alternatively a low dose antidepressant like amitriptyline may benefit you.

I have a painful rheumatic condition which doctors insist on prescribing nsaids for even though I don't get any inflammation. No surprises, they don't work.
I've tried etoricoxib too and several other drugs (including amitriptyline when they gave up on nsaids!) but the only thing that makes any difference is codeine. Have you tried the otc stuff? 8/500 cocodamol works well enough for me to take the edge of, I dislike the stronger stuff because it makes me fuzzy for ages.

Yes I think the thing is to keep going back saying it is still really hurting. If you don't they won't believe you. Focus on how much it is affecting your ability to perform everyday tasks and care for your ds.

Thanks for the responses so far. Sorry FuzzyOwl I didn't mean to come across as if I demanded them in any way and I did not talk to him the way I wrote in the post, I'm just ruminating out of frustration. I am certainly not an addict looking for drugs, I just want the pain to be gone. It has gotten worse recently and I went to a and e a month ago because my whole body was cramping up and felt like someone set me on fire. I was very well mannered to the doctor and didnt demand anything. I just know that NSAIDS do not work for me and give me stomach problems.

Polite - that's a shame hun I hope you're doing ok. Yes I've tried the OCT cocodamol, didn't really do anything to be fair. I'm just getting frustrated as I've been in pain for over a year now and haven't once asked for pain killers until a few days ago and it's just a bit frustrating. I don't mean to come off rude or drug seeking. I'm also on sertraline if that helps xx

Meh, I've been living with it for around 20 years now, it only occasionally drives me to tears. Mine is not constant, it's sporadic and random but each attack only lasts a day or two so I know if I can grit my teeth long enough it will pass.
To be fair to the gp, even when I saw a rheumatologist they recommended going through lots of different nsaids as it's trial and error, some work for some people but not others. Amytrip was prescribed more to help with the sleeping which is disturbed when the pain is bad but it didn't do much for me. Keep trying.

Okite

Thanks hun, hopefully you also find a treatment that works good for you xx

You too!

Fibro is a long-term condition. Co-codamol is highly addictive and also stops working well if you use it too often. It is not going to be suitable to control your pain long-term.

It might not feel like it, but your doctor is doing you a massive favour by not just writing a co-codamol prescription for an easy life and instead trying to find something that is safer. He wouldn't be doing you a favour if he ended up making you addicted to codeine.

Totally understand why you are frustrated though - it's awful being in pain.

Oh gosh, I didn't mean that you were an addict just that it is a red flag to a doctor when someone asks for an opioid to be prescribed.

My advice would be to tell your rheumatologist that cocodamol is the only thing you have found that takes the edge off the pain and see if they will recommend it in their letter to your GP. Your GP will be much happier to prescribe a medication that is on the sayso of your consultant. Sometimes a combination of cocodamol and a NSAID can work well together. I don't think it is ideal but omeprazole can help to eliminate any stomach problems in the short term if you do find one that helps. Then again, some NSAIDS take a while to build up in your system before you notice an improvement.

Often Fibromyalgia does cause inflammation, which is why so many patients with it had multiple tender spots. What are your particular symptoms?

I'd see another doctor to be honest, I've suffered from chronic pain for over 8 years, I've been prescribed either tramadol or dhydrocodine (sp?) for the whole duration, when I fell pregnant I went down to 30/500 co-codamol. I guess some doctors are more wary than others but if you need it for pain then you need it!

Yes it can be very addictive but as long as you don't abuse it and address it If you feel it's becoming a problem then it should be fine. I'm now pretty much off the co-codamol completely now as they won't let me breastfeed on it, but I haven't had any withdrawal at all.

OP, if you've ever seen someone coming off opiod meds then you would understand... It's horrific.
I totally understand that you want proper pain relief, but your doctor is trying to act on your best interests - really.
Have you spoken to your doctor about what else you can take alongside what has been prescribed, or asked for a medication review? If it's not working, they should be able to suggest other help.

That's true and I totally understand that, the main part that's annoying me is the prescribing NSAIDS which don't work with fibro. I did ask if there was anything non opiod that would help the pain and he said not really apart from NSAIDS, which don't really do much for me and have previously given me stomach ulcers xx

If you have fibromyalgia you're in this for the long haul. You need to get referred to a chronic pain team but you also need to stop assuming nothing will work. Try everything they give you - opiates are not a long term solution. There's plenty to try but nothing is going to fix it over night.

Your GP will be much happier to prescribe a medication that is on the sayso of your consultant

No he won't. The prescriber is responsible for the risks of the prescription. If it's the GP's signature on the prescription, he carries the can if the OP gets addicted or suffers other serious side-effects.

I have Elhers Danlos and Fibro. I don't have swollen joints but Naproxen helps. Or rather, trying to cut out Naproxen from the 11 other daily meds I take doesn't work. The pain increases. So it does something. If you want 30/500 cocodamol then you may as well take the naproxen too.

Rheumatology put be on pregabalin and this really worked for me. Not pain free obviously but more than just taking the edge off. Good luck OP

I second what shiny says - my chronic pain team have suggested a few things my GP has vetoed based on their own thoughts on the drug/my health.

OP- you don't have a diagnosis yet so you don't know it's not going to work. Try everything, if an NSAID worked for me and I was allowed them I'd be much happier as the quality of life witn them is, for me, superior to that on opiates.

Good advice there from lobster

Not good advice to change GPs - it sounds like you've got a good one, OP. Can't believe how many MNetters still think that doctors are uncaring if they don't prescribe opioids. Trust me, it's the easiest thing in the world to write a prescription and get the patient out the room. That's what an uncaring doctor does. A caring one works with the patient to try to find something effective that is also safe.

Good advice there from lobster

Cross-post - I wasn't saying I agree with lobster because she agrees with me!

FuzzyOwl - Ah sorry hun my mistake lol. For the last year or so I've been having cramping pains in my legs and back (both lower and upper), headaches, fatigue, spasms, jerks, twitches, shooting pains in my arms as well as numbness. I did recently visit a neurologist and he did a CT scan and got the all clear, so he suggested I see a rheumatologist. I'm sure some people do get inflammation that have fibro but Its usually accompanied with another condition if I'm correct? Not sure.

Sewingbeatshousework - I have been thinking of moving to another gp entirely as my current gp is impossible to get an appointment unless it's an emergency. They currently have a 2 month waiting list for an appointment. I do agree with what you're saying, we're in pain lol not much we can do about that and I don't think it's a bad thing to want effective relief. I'm so glad to here you haven't had any withdrawals hun that's such a relief I'm guessing. I hope you find an effective treatment plan hun xx

I don't mean to come across as if I'm not willing to give them a try, of course I am! Lol. I just mean I've never found NSAIDS helpful for me. And I really don't necessarily want opiates I just want something for the pain. I have heard of Pregabalin being good for spasms and pain but my gp didn't mention it, so perhaps he's just waiting until after the rhematology referall commences. I can totally understand that, it's just very frustrating at the moment so very sorry if it sounds as if I'm being a bit rigid or dismissive in any way xx

I think once you are diagnosed by rheumatology, they'll look at your medication.

I have fibro and am on Amitriptyline (for sleeping) and Gabapentin (for nerve pain). They are fairly effective for me. But it's a balance of trying to reduce pain but not feel drowsy.

But I think you have to have rheumatology diagnose you really. There are other conditions with similar symptoms. E.g. polymyalgia - where the medication needed is completely different (steroids).

My GP gave me codeine to take with paracetamol when we weren't sure what was wrong. Naproxen gave me the beginnings of a stomach ulcer. Two years of medication it took to fix that. I think they're supposed to give you something to protect your stomach whilst you're taking it.

Hang in there. I think they'll sort out your medication once you have a diagnosis.

Thanks purplecollar. You're probably right and that makes sense. Stomach ulcers are a nightmare. They gave me Omeprazole I think for that. Thanks for the advice hun xx

Have you read about the Pain Ladder? It is in NICE guidance and suggests which order to use painkillers. It starts with paracetamol up to 2 x four times a day, if not effective try anti-inflammatory or two, if not effective try paracetamol with anti-inflammatory then opioids and other drugs according to condition, etc. May be worth reading through
Have you tried paracetamol with the anti-inflammatory?

Agree with others though that stronger opioid products are not something to rush into for long term conditions. There is more and more information surfacing about addiction risks with prescription painkillers

Opiod based painkillers are not indicated as a long term option in chronic non cancer based pain. This is because, basically, they don't work and do not give patient satisfaction.

Something like gabapentin, duloxetine, amitriptyline is usually prescribed instead. But your gp is right, you need to start at the bottom of the pain ladder and work your way up.

Yep lol I actually have! And yes I have. For a while I was taking OTC cocodamol and two naproxen but it really didn't do anything for the pain. I was also on fluoxetine for depression and anxiety at the time (now on Sertraline) which I have heard can help with pain, but I had horrible anxiety with fluoxetine but sertraline has really helped me. Haven't noticed any pain relieving benefits though xx