Friday, 17 February 2017

Pain killers

I have been quite lucky in my life in that I have not needed pain killers in general. The main reason I have ever had to take such is if I had a headache. There are many possible reasons for a headache (including the occasional hangover) and paracetamol has always been an effective way to tackle a headache, and/or reduce my temperature if I have some infection.

Of course there have been occasions where I have injured myself by way of a cut or a bruise but the pain is not usually a big issue, and I don't really recall having ever taken pain killers for such cases in general.

However, over the last few weeks, things have been somewhat different. I have never had a broken bone before. However, with this cough/cold "virus from hell" that has lasted a couple of months (and is finally diminishing) I did manage to cough hard enough to "do in" my ribs, somehow. I cannot really tell if I just "pulled a muscle" or actually cracked a rib, and I don't have much of a reference to know. All I do know is I was in absolute agony when it happened, could not move, had problems breathing or talking, and (as it was at the office) staff called an ambulance. This was about a month ago.

They put me on gas and air, and said I would feel somewhat "high" or "drunk". Well, it worked to diminish the pain. They gave me ibuprofen as well and that helped. I was prescribed co-codamol (codeine and paracetamol), and so was on pain killers for a while. I also had Valium as a muscle relaxant. A couple of weeks later I managed to do the same on the other side of my chest (no ambulance this time).

So I have been on pain killers for a few weeks now, and had the chance to experiment a bit on how they work. For a start, the codeine does bugger all. I was told I'll be "high as a kite", but to be honest it is no different to just taking the paracetamol, which is what I am now doing, with ibuprofen, every 6 hours.

The pain killers do work - they make the pain in my ribs bearable, now. When this started they helped, but I still could not lie down and so ended up sleeping on the sofa partly sitting up. If I don't take them, then it starts to get very unbearable, so they clearly do work. Overall it is gradually getting less painful, thankfully. Interestingly, the ibuprofen seems to suppress my cough - just taking paracetamol does not. Yes, the scientist in me means I have tried taking one or the other only and even not taking either for a while, just to see how it goes. I am not really that happy being on pain killers, and will be glad when I am back to normal (which is happening slowly).

What struck me today was that this is quite unusual for me - pain killers for such "conventional" pain, as opposed to something like a headache. It seems wrong somehow - the pain is telling me something - not to lie in that particular way, for example. If I don't feel the pain as much, I may be doing myself more harm than necessary and not realising it. This seems wrong. However, I cannot do a lot to avoid a cough, and avoiding the pain from a cough is a good thing! It just seems wrong to avoid pain from "doing something wrong" in terms of my position or movement if that means I "do something wrong", if you see what I mean. Pain is there to tell you that you are "doing something wrong", after all.

There are those that spend much of their lives on pain killers for something, and they have my sympathy. This is a strange state to be in, and one, for me, that is very much temporary.

However, having wondered if things were better enough to stop taking pain killers, and now realised that is definitely not the case, writing this blog has given me time for the pain killers to "kick in" again and I can perhaps get back to sleep.

Good night!

15 comments:

  1. I'm on constant multiple pain killers. I take regular paracetamol, which is fantastic, ibuprofen and dihydrocodeine, and I am on fentanyl patches (which is an opiate, I believe) together with duloxetin and pregabalin, only I have had to stop the latter because it was making me very sick. I have a whole lot of other regular medicines just to try to counter the many side-effects of the aforementioned list. You do not want to be on these, it's a bad thing, My recommendation is to not have pain, it isn't good.

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  2. Luckily I have a really good ISP that allows me to triple the speed of the pipe to the internet by using DSL line bonding and so brings me entertainment to my bed and thus takes my mind off it all and brings the world to me.

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  3. Co-codamol vary in strength quite wildly. The non-prescription ones available from chemists top out at 8/500, so 8mg of codiene and 500mg paracetamol.

    Prescription only there are 15/500 and 30/500.

    Codiene is metabolised into Morphine, it's an opiate painkiller and as such you can't really overdose on it but it is very addictive, as such one of the reasons it's paired with paracetamol is to stop you taking high doses - take too much paracetamol and you'll throw up/be in hospital anyway.

    You can take paracetamol alongside non steroidal anti inflammatory drugs (NSAIDs) such as Asprin and Ibuprofen (although you can't take two NSAIDs at once), and you can get "Co-Ibuprofen" at 12.8/200 from the chemist.

    As such you can, mix co-codamol over the counter with co-ibuprofen and hit effectively 20.8/500/200 without prescription, obviously 2 of each tablet so 41.6/1000/400 which is only slightly less than the 60/1000 of taking two prescription only max dose co-codamol.

    Of course, I am not a doctor, please don't take this as medical advice! Consult your doctor before becoming addicted to painkillers!

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    1. Interesting - what I had was prescription... 30/500

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    2. It affects everyone differently, you must have an impressive natural tolerance then!

      My other half gets migraines and takes co-codamol for them, it doesn't seem to hit her too hard, but anything more than the 8/500 ones make me loopy! I'd certainly not drive on anything more than those, whereas she functions normally even on the 30/500s.

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    3. Hmmm, rtho782 is correct about codeine being metabolised to morphine, which is why it is not effective in some people as they can't do the conversion due to a faulty CYP2D6 enzyme. CYP2D6 is also affected by other drugs and either reason might be why Adrian did not find it effective. A small number of people metabolise it faster than normal and are more prone to toxicity.

      However, paracetamol is not combined with codeine "to stop you taking high doses" but because the combination is better than paracetamol alone for most people. The 8mg in the "over the counter" preparation is a bit homeopathic though and you'd need 30 tablets to get up to the maximum recommended dose of codeine at 240mg/day. By that time the 15g of paracetamol that you ingested could be fatal in its own right.

      Codeine is perfectly easy to overdose on and like all opiates can cause fatal respiratory depression. Paracetamol is a very toxic drug itself in overdose potentially leading to fatal liver failure.

      Co-Ibuprofen is a new one on me (although the combination makes sense) and it is *not* listed in the BNF unless I've missed it. Co-codaprin is listed (codeine+aspirin) but I've never used that in anger. Co-didramol (paracetamol+dihydrocodeine) is the other paracetamol based compound combination.

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    4. Oh, sorry - I should have said that codeine+paracetamol is more effective than paracetamol alone (which is itself an effective analgesic) but codeine *alone* is really quite a rubbish pain killer. It does have some use as an anti diarrhoeal drug though.

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    5. Nurofen Plus contains ibuprofen and codeine and I think caffeine so the combination is not exactly new

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    6. Yup, Nurofen Plus are the ones in our drawer at the moment. Solphadine also do a similar one. The pharmacy near us does do an off brand equivalent as well.

      http://www.boots.com/nurofen-plus-32-tablets-10060148

      https://www.chemistdirect.co.uk/solpadeine-migraine-ibuprofen-codeine-tablets-200mg/prd-gu9

      There is not much evidence that combining the drugs significantly increases the therapeutic effect, as mentioned here:

      https://www.evidence.nhs.uk/formulary/bnf/current/4-central-nervous-system/47-analgesics/471-non-opioid-analgesics-and-compound-analgesic-preparations/compound-analgesic-preparations

      As you mention, the maximum recommended dose of Codeine is 240mg/day, this level is unlikely to be fatal however, fatal levels are generally significantly over the max recommended dose. Whereas as you rightly point out, the 15g of paracetamol likely will be.

      Given the poor benefits from the 8/500 tablets, and the prescription only status of the 15/500 and 30/500 variants, it does seem that, even if not intended, part of the benefit of this is to try to avoid addiction. As you try to ramp up your 8/500 dosage due to developing a dependency, you'll feel pretty awful due to high doses of paracetamol long before you hit the daily maximum recommended codiene.

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    7. I'll definitely add Neurofen Plus to the mental vault.

      The low dose of codeine in OTC preparations is, I agree, based on fears of possible addiction but there is certainly some evidence that codeine+paracetamol is more effective than paracetamol alone - eg http://www.cochrane.org/CD001547/SYMPT_single-dose-oral-paracetamol-acetaminophen-plus-codeine-postoperative-pain-relief-adults. As I said 8mg borders on homeopathic but I'm actually surprised at 12mg in Neurofen plus.

      The main advantage of combining, say, paracetamol and ibuprofen is that yu can stagger the doses to provide more even analgesia through the day.

      The generic name probably would not be co-ibuprofen, co-codofen would be more appropriate. The first "co" mens compound" and then there is a portmanteau word made from the names of the constituents.

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  4. I can't take codeine, it makes me feel more ill than the pain. Being in agony minus whatever ibuprofen can do for it is preferrable.

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  5. When I had agonising back pain, I saw various doctors who were incredibly reluctant to offer me pain killers. Instead they kept prescribing anti-depressants, which did nothing at all.

    Only when I was completely incapacitated and my own doctor came to see me did he let me have some co-codamol (30/500) which did the trick. Interestingly, he prescribed 100 tablets for me - far more than I needed.

    I can appreciate why they are cautious with them - they have quite a kick and blissed me out, but they were just what I needed. Although I took them for only a few days, I kept them around for a very long time after that just in case. It's nice to know you have access to them, even if you aren't taking them.

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    1. RevK: "For a start, the codeine does bugger all."

      Some % of the population (10% I read somewhere?) lack the liver enzyme which converts codeine into morphine, so it has literally no effect whatsoever.

      John: "When I had agonising back pain, I saw various doctors who were incredibly reluctant to offer me pain killers. Instead they kept prescribing anti-depressants, which did nothing at all."

      I had very severe back pain in 2015 (spinal cord injury). Given the severity, getting painkillers wasn't a problem (max dose morphine, tramadol, naproxen, paracetamol, gabapentin then pregabalin) - but an antidepressant, amitriptyline, turned out to be very effective.

      For nerve pain (neuropathic), opiates have little effect - gabapentin and pregabalin (which are both anti-epileptic drugs) and amitriptyline (an anti-depressant) all happen to have quite powerful painkilling effects on neuropathic pain, much more so than any opiate. It sounds to me as if your back pain hadn't been properly diagnosed, you probably had a "normal" injury (torn something?) but they were treating it as a nerve problem?

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  6. The stronger codeine type drugs esp dihydrocodeine can make you throw up, very horrible. I always take prochlorperazine with them to protect against instant nausea. And they don't seem to work for some types of pain. I've found it really important to get the right painkiller for the right pain type. One tip: take ibuprofen and paracetamol together, it seems to be a very powerful combination, there's something about this pairing. Another tip: always take ibuprofen with food so that you don't burn a hole in your stomache (too late for me).

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    1. I find paracetamol to be completely useless, it does nothing for me.

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