Any experts? I hate querying my GP

[Forgetcourgettes]

I’ve had a diagnosis of Rheumatoid Arthritis for 7 years and take methotrexate injections.

I do get breakthrough pain which is absolutely excruciating, impossible to describe. It’s in my hands at the moment so the pain is so severe I am unable to lift a pen, for example.

I take co-codamol 30/500 which can help but with a bad flare does very little. I was prescribed slow release tramadol but the problem was I feel fine when I’m not flaring so didn’t want to be taking pain killers all the time.

I called the GP this morning, explained that I need something that will work quickly to help with the pain. My husband has just come home with a batch of slow release morphine. This is what I said I didn’t want, I need something that works quickly not something that may take 12-24 hours to work. By that time the pain will have gone But getting to that stage is horrendous.

Would I be wrong to query this with the GP? I don’t want to sound like I’m begging for drugs 😔😔

You would be right to query that. He should’ve prescribed fast release opioid that starts working with immediate effect and reaches peak within the hour.
Slow release, you’ll feel some benefit within the first hour or so but it won’t reach peak efficacy quickly enough fir what you want.
We don’t prescribe slow release opioids unless the fast release break through isn’t sufficient on its own. So it’s usually slow release with fast release and it’s an on going long term pain. Considering you want to treat short term flare ups it’s fast release to take as needed you need.
Have you used the codeine/paracetamol and the tramadol together or just one or the other? They are both weak opioids

You need to ask your GP, not randoms on the internet!

She asked for experts not randoms.
(I'm a random so I won't comment)

babytum thank you so much for the reply, I really appreciate it.

When I was prescribed the tramadol I stopped taking the co-codamol, I didn’t think I could use them together.

I just want something to ease the pain immediately not in 12 hours. I feel like a complete drama lama but when a flare hits, I really feel like I’m going out of my mind with pain. I can’t speak to anyone in my family, I have to use all my energy to just cope and even when the pain goes I feel like I’ve a hangover as I’ve used all my energy and reserves trying to cope with dealing with the pain.

So I could ask for fast acting morphine?

What have they actually prescribed you?

5mg extended release morphine

Have you tried regular 50mg tramadol? I take a mixture of 50mg/100mg tramadol during the day, and a 100mg slow-release (Maxitram) at night. The key is to be taking paracetamol too. You might think paracetamol is useless, but alongside others it can have a good effect.

disclaimer; not an expert, just a chronic pain sufferer, also very very reluctant to go down the morphine route.

My understanding is 5mg extended release is less pain relief than the cocodamol you have now.i swapped from 2x 30mg cocodamol to 10mg slow release morphine (MST) and it’s had to be upped to 20mg as 10 mg morphine dose was just the equation of the cocodamol.5mg maybe of liquid oramorph for break through pain would have been better.im not an expert but unfortunately have pain issues and have tried loads of combinations over the years- sorry you are having flare ups

@Mollymalone123 If you are taking 2 co-codamol 30/500 four times daily the equivalent morphine would be 10mg MR twice daily. Usually you divide the daily codeine dose (240mg) by 10 (24mg) then round down (20mg) so 10mg MR morning and night
OP - Current guidance is to avoid immediate release morphine other than for cancer pain or very short term use such as post-op so GP may not want to go down that route. I agree modified release is not ideal so the key is finding a weaker opiate or similar that helps.
First thing is, as JemimaPuddleCat said, to take paracetamol with the tramadol (you are right to stop co-codamol, I don't think they usually recommend more than one opiate at a time). If that doesn't work can you take ibuprofen too? You can take that safely alongside paracetamol and opiates.