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Codeine for pain - addiction worries!

Discussion in 'General Treatment' started by Sasha, Jul 28, 2010.

  1. Sasha

    Sasha Fine, thank you

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    I've just been prescribed co-codamol for inflammatory back pain associated with my ME which has got worse over the last few months (the pain, that is). I've just had an X-ray in case there is something else wrong so my doctor is clearly taking the pain seriously.

    The info leaflet in the packet warns that people can become dependent on co-codamol and this has scared me. Apparently it is an opiate! :eek:

    I don't want to get hooked and add to my problems. The pain is intermittent and somewhat debilitating but I could continue to survive without painkillers - I am already so disabled by fatigue that another hour or two lying down isn't going to make much difference to my lifestyle.

    The dose is two tablets containing 500mg of paracetomol and 8mg of codeine phosphate four times a day.

    I took the first dose 90 minutes ago and it has had zero effect on my back pain (but I now have a slight headache!).

    Any advice/experience? Are there any pain drugs that have good evidence behind them for being effective in ME that I should ask for instead? :confused:
  2. Stone

    Stone Senior Member

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    There is a lot of misunderstanding about opiate pain meds. Statistically, the chances of a person who is actually in pain becoming addicted to opioid pain meds are surprisingly very low. People are far more likely to become addicted when they use opioids recreationally. Secondly, there is a difference between dependence and addiction. Dependence may occur with long term use, but this is NOT addiction. Dependence is basically having side effects or some withdrawal symptoms when the drug is abruptly stopped. With many drugs, they must be tapered off when it is time to discontinue it. This is true with many non-opioid medications as well, even laxatives, and does not indicate addiction, or a weakness in character or anything negative about the person. A person may also develop a tolerance for a medication over time and require adjustment of their dose. This is a natural side effect of many medications, not just opioids, and again, does not indicate anything negative about a person, and does not indicate addiction either. Addiction on the other hand is suspected when a person does illogical or dangerous things to obtain more and more medication in excess of their medical needs. Lying, stealing, exceeding the limits of your prescription would be signs of addiction. Addiction is treatable, and many people who do become addicted to opioid medications recover quite well if they seek treatment and comply with their treatment protocol. Addiction is a danger in any opioid medication, and all medications carry an element of risk. A good physician will weigh the risks against the benefits and prescribe accordingly. It should also be clearly understood that pain in and of itself is not a benign condition. Continued pain can be a more serious threat to health than opioid medication. Pain causes blood pressure and pulse to rise, and causes chemical changes in the brain that can adversely affect your health, both physical and mental, in ways that are far worse than opiate pain treatment. As long as you do not take your pain medication in excess of your physical pain requirements, and do not exceed your prescription, and pay attention to your actions, you should not worry too much. You should always be open and honest with your doctor and your pharmacist about your medication use, and if you find yourself tempted to lie about how you are using your medication, or exceeding your true pain treatment needs, do not be ashamed or embarrassed to call this to the attention of your health care provider. There is no shame in pain, nor are there any points awarded for unnecessary suffering. Pain is a potentially serious medical condition that should be treated appropriately. But just use a little common sense, and try not to worry. It is very rare for people to become addicted if they follow instructions and only use the medication for it's intended purpose. There is a lot of information about pain, opioid treatment, dependence, tolerance and addiction out there. Educating yourself on these matters will alleviate your fears and help you protect yourself against unintended negative outcomes in your pain treatment. Best of luck to you, and I hope you get to feeling better soon. Oh, and about the lack of relief with your first dose, check with your pharmacist about it. It may be that it takes a while or several doses before it works at it's fullest potential, but I'm not sure. I am not familiar with that particular medication, but I'm sure your pharmacist can help, and yes, opioids can cause a headache, especially when you first start them. In some people this side effect goes away, in others it does not. Do not be alarmed if your doctor changes you to a different medication as some are more prone to cause headaches than others. Many people say that Trammadol (Ultram) works well for their ME, but I can not tolerate because it gives me headaches, as does plain codeine. I hope this helps.
  3. Sasha

    Sasha Fine, thank you

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    Thanks so much, Stone - this is such an informative and useful reply. You obviously know what you are talking about! What you say is very reassuring.

    I phoned my pharmacist, who said that some consultants are now prescribing some painkillers long- rather than short-term because they need to build up and he suggested I give the co-codamol a few days to get going. I've also arranged for a phone call with my GP (who prescribed it) later today to make sure he understood that my pain, though intermittent, is intermittent throughout the entire day, every day, so that I need something that I can take on a long-term, steady basis. I'm not sure if he thought he was prescribing for occasional pain.

    Thanks again for taking the time to write such a well-considered and knowledgable reply. I didn't know about the adverse effects of pain in and of itself - I thought that if you just put up with pain whose cause can't be cured, although you were suffering you were also avoiding the risk of adverse effects from pain medications and protecting your body from further damage. Oops! Still, now I know!
  4. heapsreal

    heapsreal iherb 10% discount code OPA989,

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    thats quite a low dosage of codeine, in australia u can buy 15mg strength tablets without a prescription, and if your using it for pain u have a legitimate reason to use it, theres no high in that sort of dosage. if its inflammatory type pain u might be better off with an anti-inflammatory like celebrex, i use tramal with good success for my chronic back problems although its classed as a sort of opiate analgesia. Remember pain can also increase fatigue as well.

    cheers!!!
  5. Stone

    Stone Senior Member

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    Not a problem and I'm glad you were reassured. I think sometimes we have the mistaken idea that there is some sort of merit in enduring suffering. We wait for hours before taking a simple aspirin or tylenol for an awful headache. Why? What does that accomplish in the end? We put value in keeping 'a stiff upper lip' and all that, but I've never paid a single bill with unnecessary suffering, and there's nothing truly admirable about enduring needless pain endlessly. Once the pain has served the initial purpose of alerting you to a problem, and you have addressed the cause of the pain to the fullest extent possible, it is unnecessary in this day and age to put up with it if it can be controlled safely. If you have the energy, take some time to 'google around' on chronic pain. You will quickly see from medical sources that chronic pain is considered a disease state, and it's treatment is considered a basic human right. Take good care of yourself.
  6. Otis

    Otis Señor Mumbler

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    No pain = no pain

    Sasha,

    So much good advice, that I'll just add that if pain begins to encroach on sleep, everything else will get worse, including pain. Not sure how your sleep is but we all must fight to maintain as much sleep quality and quantity as we can.

    My pain doc is very much in favor of getting ahead of the pain, which means learning what it takes to stop the pain and then taking it proactivly, before the pain is too bad to reach.

    Best wishes,
    Otis
  7. Sasha

    Sasha Fine, thank you

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    Thanks, all! I agree there's zero merit in unnecessary suffering. I really did think I was protecting my body from damage from painkillers and didn't know that pain might actually do me damage (doh! Stone has fixed my thinking there) and until recently, the pain hasn't been bad enough for me to want to medicate. I've treated pain as a useful warning flag that I'm overdoing it and as a signal that I should rest; and when I have rested, it has quickly gone away. However, now that it has got worse for some reason I agree that it is probably making me tired in and of itself so I should treat it. It's no longer a "useful" symptom, just a symptom (and it hurts!).

    Fortunately it doesn't affect my sleep.

    I think you're right, people do sometimes see merit in suffering - I think people often feel so guilty for taking time off work etc. that they feel that suffering is the "work" they can do - at least they are not enjoying their leisure time so that people won't think badly of them for being off sick.

    Thanks again guys - this is such a great board for advice and everyone is so helpful!:D
  8. Stone

    Stone Senior Member

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    Yes! here here Otis! I second that motion on sleep. It's a biggie if not THE biggest thing to take care of when you are in pain.
  9. LaurelW

    LaurelW Senior Member

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    "The chances of a person who is actually in pain becoming addicted to opioid pain meds are surprisingly very low."

    I agree with a lot of what you say, Stone, but opiates should be used with extreme caution. My CFS doctors say that everybody's different. If you are the one person out of 20 that suffers the ill side effects, it doesn't matter what the statistics say. Many people with CFS are very sensitive to medications. I speak from personal experience. I was put on oxycodone for pain when it took the doctors a surprisingly long time to figure out that I had a gall bladder problem. I was taking around 30-50 milligrams a day and developed a chemical dependency after only too weeks. Getting off the drugs after I had surgery was the most difficult, horrifying experience of my life. I thought I was going to die. In the end, I couldn't get off the drugs myself and had to go through inpatient detox for nine days, which thankfully Medicare paid for. It took me over a year after that to get back to normal.

    I agree about chronic pain causing more problems than most of us realize, and it needs to be addressed, but I'm in favor of trying the least invasive techniques before pulling out the big guns. I also have chronic inflammatory back pain, which is tolerable if I do 15 minutes of stretches and strengthening exercises given to me by my chiropractor every day. I also agree that anti-inflammatories might be a better option if inflammation is the main cause of the pain.

    In the end, it's true that you need to balance the risks and benefits of any given therapy. The best course is to educate yourself thoroughly. I would have chosen differently had I been aware of what could happen to me.
  10. Sasha

    Sasha Fine, thank you

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    Hi LaurelW - so sorry to hear about your awful experience with oxycodone. A whole year! That's really dreadful. I'm glad you're out of the woods with it now but it sounds horrific.

    Although my back pain is inflammatory I use an anti-inflammatory medication for period pain once a month for five days (mefanamic acid, 250mg four times a day) and it doesn't touch the back pain, even if I add in some paracetomol. I told my GP (who hasn't phoned me back, great) this so presumably that's why he's skipped anti-inflammatories - or is it possible that others might work?

    Took the second dose five hours ago and still nothing happening... just taken another... :worried:
  11. LaurelW

    LaurelW Senior Member

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    Thanks, Sasha. I really hope you find something that works for you. Living with pain is extremely trying in the best of times. :headache:
  12. Sean

    Sean Senior Member

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    Codeine is pretty safe and 8 mg is a pretty small dose. We can buy it over the counter here (Australia), and we have very strict controls on drugs of addiction, so it can't be that bad. I have used it sparingly in the form you have (paracetamol 500 mg, codeine 10 mg) for many years, mainly for sleep, and never had any trouble with it at all. It can make you a bit drowsy, which is good for sleeping, but be aware of that if you are going to drive or anything like that.

    Though, as LaurelW points out, some are more susceptible to problems with it than others. Same as with all drugs.

    The paracetamol is probably as much of a potential problem if you take it every day for a long time. Not addictive but it can mess your liver up in large doses.

    Pain is something that you need to get on top of as soon as possible. It can cause serious long term problems on its own if not managed well from early on.
  13. glenp

    glenp "and this too shall pass"

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    I was prescribed arthrotec, took it but noticed nothing. I decided to take it continuously for awhile and it did help, i took it for about 6 weeks. There was no immediate affect but seemed to really help over time with taking it every day. I chose this over steroid injections.
    Over the years i have taken various anti inflammatories for about 6 weeks and they seemed to settle the pain down for awhile. My gp feels that arthrotec is safer on the stomach

    glen
  14. Sasha

    Sasha Fine, thank you

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    Thanks for the helpful comments, everybody! I don't seem to be doing well on co-codamol so far, though. I took three doses yesterday it didn't help the pain, plus it drugged me up so much I spent most of the day lying down and too stunned to think straight. I can't have a repetition of this today or I won't be able to care for myself.

    I don't know whether to persist with it in the expectation that the side effects will diminish and some positive effects kick in or whether to phone my GP and ask for something else.

    It's only in the last few months that the pain has started to build up to be so bad. I'm interested that you tried a 6-week session with your pain med, glenp, and came off it and found that it settled your pain for a while.

    I'm curious about the effects on the brain that have been mentioned (by Stone, notably) - does anyone have more detail? I'm interested in neuroplasticity and don't want my brain rewiring itself to be in pain, if that's what goes on!
  15. judderwocky

    judderwocky Senior Member

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    So my random thoughts...

    Do you take vitamin d? I think there are some good studies on how vitamin d effects chronic pain... it might not cure it... but it might make you need less pain medication.
    I've had some success reducing my muscle and joint pain by taking vitamin d, calcium, (and recently diatomaceous earth which has silica)...
    I'm not throwing it out there to suggest you should go all natural or forgo the pain meds... but whenever you are dealing with a substance that is going to give you withdrawal side effects, my personal philosophy has been to attempt to reduce it , and if this even allows you to knock a little bit off your dose... imo thats better for your liver, brain, body etc...

    Before I got CFS I had a gym related injury in my upper back... it actually tore the muscle and i never went to therapy and just tried to deal with it. I was in college, and this was incredibly stupid, as it healed wrong. Since the CFS started, the pain sometimes has become really bad... but i've noticed some moderate improvements with really good supplementation... natural anti inflammatories

    I've heard really really good things from some retirees in the city (ocala) that Cherry juice and Elderberries are really good for joint pain... I ran into some other people looking for elderberry bushes when I was and heard that a bunch of them eat elderberry jam for that reason... Elderberries have some really curious properties... mine haven't gotten large enough to start harvesting (this is the first year and they got confused about blooming). they have already grown about 8 feet though, so i imagine i will have crazy amounts next year. the antioxidants in them are really powerful and can help reduce swelling...

    :)
  16. brenda

    brenda Senior Member

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    Have you a pain clinic nearby? I would ask for an appointment there. They have TENS units you can try. I bought one myself for 20 euros but there are other ways to alleviate pain before turning to the big cosh.

    I have been experimenting with acupressure since I found acupuncture too expensive though it works very well on the pain in my hands which has been there for a year. It is helping. And also there is rife which alleviates pain using the special frequencies.
  17. Sasha

    Sasha Fine, thank you

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    Thanks, Brenda and Judderwocky - I've been taking a good-quality Vit D for a long time because I don't get out of doors much but thanks for the suggestion.

    I didn't take any more co-codamol this morning because I was waiting for my GP to phone me back and I had to go back to bed without any breakfast, I was so dopey - have been asleep for about an hour and a half. His secretary just phoned to say that he'd said to persist with it but I told her what had happened and that I couldn't take care of myself if I kept taking it so had stopped. I'm hoping he'll phone me back. No point relieving the pain if I have starved to death in the meantime! :D

    There must be a pain clinic here so I will ask for a referral. The pain, though, is in my spine level with my shoulder blades and then in areas around that, all of which I can't reach. Does that mean I couldn't use a TENS machine? I live alone and don't have anyone who could help me put pads on.

    I can't physically get out reliably enough to visit a practioner of any kind so wouldn't want to go the acupuncture route. What is "rife", brenda? I haven't heard of that.
  18. brenda

    brenda Senior Member

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    I guess you can try it while at the clinic and if it works, sort out the how to from there. My pads are small and I can reach over my shoulder and so far up by back but maybe there is a way if one cannot - I `m not sure - roll over onto them or something :Retro smile:

    People use frequency generators - rife machines also for pain - it is the same principle, electrical impulses but more poerful. Did you try going gluten free to reduce inflamation?
  19. Stone

    Stone Senior Member

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    You might also try a good massage therapist if you can find one. They are rare birds though. I'm not talking about Swedish massage, which is fine if you're merely stressed-out and need help relaxing. I'm talking about myotherapy, trigger point therapy or therapeutic massage. This has to be done by a knowledgeable and experienced practitioner. It's not the most pleasant experience while it's being done, but I find it indispensable, particularly for that pain that is in the thoracic area of the spine, between the shoulder blades. Sadly, insurance usually does not cover this but if done by the right therapist it is worth the out-of-pocket expenditure. I'm sorry your pain medication is making you feel dopey, and I'm more sorry that it isn't helping your pain. Just like any other medication, you might have to either give it some time, try taking it with food, or try different things until you hit on what works for a while. This is the case with blood pressure medicines, cholesterol medicines, antidepressants and many other types of medications. With opioid pain meds, the dopey feeling usually does go away after a while, but if it's not helping your pain then your doctor might decide to put you on something else. Sometimes people find that taking their medication ahead of the pain works better than waiting until the pain is really bad. They say it's better to stay ahead of it than trying to chase it. I don't really know if just staying ahead of the pain is what's called for, as it could very well be that this just isn't the best medication for your particular chemistry and your particular pain. At one time they had me on a pain medication that was considered very strong but it didn't do anything at all for my pain, made me feel awful and knocked me out for 1-2 hours after I took it. They changed the dosage several times but to no avail. They then put me on a different medication which was considered much milder but it worked much better (to the doctors' utter amazement) as long as I stayed ahead of the pain and didn't wait till the pain was too severe before taking it. I did have a little dopey feeling with it at first but that went away eventually. For me, it was a matter of finding out which chemical reached my pain the best and agreed with my system. Don't give up, these things can take some time. It's not a 'one size fits all' thing; that's why there are so many different types. Try to look at it (finding what works for you) as a process more than an event. And yes, it's true that we (with ME/CFS and related disorders) often react oddly to many if not most meds, which is precisely why this process calls for patience and 'thinking outside the box'. It may be that something else entirely could be the answer, but more likely you will end up with a combination of different things. With the TENS unit and the problem of getting the patches in the right spot yourself, I think there exists a kind of tongs-like device that will enable you to place and remove them yourself without twisting yourself into worse pain than you're already in. If not, perhaps a neighbor or even someone at your pharmacy would be willing to help you with it on a regular basis if that's convenient for you. Just a thought. Where there's a will, there's a way. :) Feel better soon.
  20. maryb

    maryb Senior Member

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    Sasha I actually got addicted to aspirin and codeine - had to take it every day, realised after reading about rebound headaches what it was and weaned myself off it, we are all different and others haven't had this experience but one needs to be aware it can happen. The patches (But>>>something) are popular with UK GPs at the moment, what about trying those, anything that by-passes the stomach is good for MEers I think. It doesn't sound like the P/Codeine are doing anything for you. good luck with finding something that works.

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