Codeine for pain - addiction worries!

[Sasha]

Thanks again, everyone, for all the helpful comments! My doctor phoned late this afternoon and when I refused to continue with the co-codamol as originally prescribed (just had no chance of looking after myself if it was going to completely prostrate me like that) he recommended me to have a single tablet of co-codamol plus one of 500mg paracetomol; so half the codeine but the same amount of paracetomol as before.

He said that paracetomol works very well when given in combination with other things and that I would have to persist with it for a few days before the effects would have a chance to build up (by building up the level of the drug in my body). Because I would be having less codeine I should be less drowsy. I took a dose as he recommended and although again there has been no impact on my pain yet, nor did it zonk me out either so I feel able to persist.

He thought it too soon to go the pain clinic route but I'll review this when I check in with him next week - if I can manage something like TENS (that's a thought about rolling onto the patches!) I might prefer it to being on meds long-term.

I'm in the UK so won't get massage on the NHS and don't think I can afford to have someone come regularly to do it at home (which is what would be necessary) - unless a short course would be beneficial? Or is it the sort of thing you have to keep up long term? I don't know what is actually causing the pain. It isn't symmetrical so I don't know if that disqualifies it from being fibromyalgia (which I don't know anything about). My only diagnosis is ME (postviral).

Anyway, the pain has not been too bad today and I've had a pleasant day overall - I hope you all have had too! Thanks again so much for your help. :Retro smile:

 

[SueJohnPat]

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.

Only 5%of the population gets addicted. I think truly suffering with intractable pain will only make your stress hormones go up and make the illness worse. When my fibromyalgia was at its worst I finally caved and went to pain management. I tried
everything before opiates and I am good with chemicals.

Drugs have to be respected and used properly.A few poor fools , or those with unfortunate brain chemistry get addicted. But the numbers is 5% . Unfortunately media hysteria strikes and people suffer from social stigma or pain for being "weak "and relieving our pain.

I got pushback from people like I was shooting heroin. I was surrounded by drugs for 23 years and if I wanted to get high I would have but , no I was treated like a weak drug seeking female by a few idiots.
I am now using the opiates only on as as needed basis. Ps I was a community pharmacist prior to becoming ill. Did not live in a crack house.

 

[beaker]

Stone has written a very nice bit about opiod use. I will add my personal experience :
I have taken straight codeine for over 20 years daily PRN and have no issues or addiction. My dr. gives an even lower figure for addiction , for those who take it for pain,then Stone does. Codeine is a very old very safe drug.
I tried many many types of opiods ( b/c I need a high dose of codeine and it is not very long acting) and none of them worked for my ME pain. I did get a lot of side effects from many of them.
So back to straight codeine. We nixed the acetaminophen( paracetomol/tylenol) b/c it was way more potential for harm in the doses of codeine I needed and did not help me .

Different meds seem to work for different ME patients. You might need to have someone to work w/ you on finding the best one for you. (Pain clinic sounds like a good idea)

I do have a family member who's oncologist said to take the tylenol on an empty stomach-- something most don't say anything about -- for it to really work well. The codeine might upset your stomach( doesn't for me) but might be worth trying it that way.

I can also attest to the benefits of massage therapy for pain relief. There is a huge difference, as noted in -- sorry forgot name-- post above, between "spa" type massage and medical massage. It does hurt, but the more pain I take on the table the better I feel after. I did have to work up to that. Started out only light massage and every other week. It made me not feel so great at the start if I did more. We gradually went deeper and more frequently. I have been happily working with the same person, who is also an RN, for many years.
Ice and heat packs can also help if you have a target area hurting.

I hope your dose change helps and/or that you can get relief in other ways. It just might take time.
My level of functioning went up when I was finally treated aggressively for my pain.

Best,

 

[Starfive]

Speaking of pushback...while waiting for my prescription to be filled, one of the pharmacists came out into the aisles of the small health food/ pharmacy to find me and bluntly ask quite rudely, "Do you really take all of your pills?". I was quite shocked and gave a simple affirmative reply. I told my pain management MD and there was little surprise. Yep, maybe the pharmacist thought this close to seventy year old might be selling her pills.

Pain apparently is still a very subjective topic. My pain management MD faces huge bias. One day I hope there is a way to diagnose pain objectively by using perhpaps thermodynamic photography or a fit monitor rather than the 1 to 10 cartoon faces.