The war on pain…

While in hospital I was constantly asked by the nursing staff, at the tedious, every two hours round the goddamned clock “comfy” check, why I claimed to have pain when I was taking “pain killers”. I got very tired, very fast, of explaining to people who should bloody well know already that pain killer is a misnomer. For many, perhaps most, people, most analgesics moderate pain, they don’t stop it in its tracks. Or, at least, if they do for others, they sure as hell don’t for me.

Mind you, my experience wasn’t helped by my GP’s refusal to prescribe anything better than 30/500 Co-codamol. I did, a few years ago, persuade him to prescribe Dihydrocodeine, a little better than Co-codamol, but then he refused to prescribe them in 2011 because they can cause pleural oedema. That’s can, not will, or always do – just the uncertain possibility that they might. Not helpful.

After a couple of weeks I got sick of the thinly-veiled disbelief, grabbed the consultant’s HO as he was passing, and said to him pretty much what I’ve just written. He said hang on, and he’d go and find me some effective analgesia.

Didn’t come back.

I waited a few days then reminded him, and he changed my Co-codamol (2 every 6 hours, some days as effective as Smarties), to 100mg Tramadol every 6 hours  and, eventually, I was as close to pain-free as I’ve been in 30 years.**  Not totally – nothing’s perfect – but it’s tolerable rather than completely dominating, and trashing, my life.

**For those who might not know, I was struck by lightning in 1983. It fried my feet, and damaged many of my joints, leaving me with widespread osteoarthritis and a whole package of other problems (see this post).

Of course, drug delivery in hospital is erratic. In theory, my Tramadol was available on demand – in practice there was one nurse responsible for meds on each shift, and they weren’t always available outside of drug rounds, and sometimes even that didn’t happen, or was delayed, often by an hour or more – a deeply shit and hopelessly inefficient way to medicate anybody.

So, once I got home and set about scheduling old and new meds according to my own timetable (primarily every 6 or 12 hours, 24/7, starting at 06.00, with a few waifs and strays off the main schedule).

Anyway once my Tramadol was on a regular footing things began to improve, and surprisingly – and bear in mind this is a potentially very nasty drugI’m experiencing no side effects at all.** Not even that curse of patients on opioid or opiate drugs, chronic constipation.

**Except that I think it’s the Tramadol that’s shutting my writing down, based on what I’ve read. I need to experiment with a lower dose – maybe 50mg at noon and 18.00, bookended by the full dose first and last. Or – something that’s just occurred to me reading through this – do I need actually being on the ragged edge through uncontrolled pain to be able to write way better than this dross? To find my anger?

It’s a thought…

There is a downside – isn’t there always? Tramadol does absolutely nothing for the pain or interminable itching of my lymphoedema and cellulitis, though my long-term pain is mostly well controlled and that is worth a hell of a lot.

The district nurses recommended Oramorph for my legs (this was dispensed in APH, for a variety of reasons not associated with pain – at times it seems like everyone got it but me), but my GP won’t hear of it. His idea? Take more Amitriptyline, up to 75mg.

Just a couple of snags with that. Sub-psychotherapeutic doses are normally taken for pain, in my case 20mg at night (above 30mg I’m hopelessly hung-over the following day). The major snag, though, and extremely prominent in the Tramadol literature, is that it should NOT be taken in conjunction with antidepressants, either tricyclic or SSRI, because the risk of seizures is too great.

Thanks a bunch!

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11 thoughts on “The war on pain…

    • Actually, Bev, I’m getting no side effects from Tramadol, for a wonder. I did get headaches at first but, like yours, they faded. As far as my normal pain is concerned, they’re very effective.

      I’ve no doubt, either, that if the hospital doc hadn’t come through, my GP would still be prescribing Co-codamol!

      Now if I can just figure out why my appetite has increased day on day until it’s almost off the scale, I could do something about it.

  1. My old GP (who diagnosed me with ME) refused to prescribe me tramadol until I was off all psychiatric meds. And I was only on a tiny dose of them. Having experienced the milder end of serotonin syndrome, it’s not something I want to go through again. He was also worried about seizures.

    He was quite happy to prescribe them once I was off the antidepressants and antipsychotics (which luckily I managed without difficulty and without affecting my mental health) and since then tramadol has been the best painkiller for me other than morphine, and works so long as I’m not really bad. I’m a bit surprised you hadn’t tried them before, as I was first prescribed them for gallstones. I’m really glad they’re helping.

    My current GP (who is soon leaving, which sucks) has told me I can take as many tramadol as I need so long as I don’t exceed the daily limit (8 capsules, 400mg).so I sometimes take 200mg at a time when I would otherwise be thinking of A+E for morphine. Does make me rather out of it and sometimes hallucinate but at that stage it’s worth it (and my hallucinations tend to be pleasant on opiods). I also tend to have doses 4 hours apart (except when I’ve doubled up), but then I sleep on average for 12 hours at a time so it works for me.

    I hope you can find something to help your legs. A cool pillow maybe, if you’re propping them up? Isn’t wet but the coolness may help the itching a little bit. Wheat bags can also go in the freezer.

    Oramorph sounds good if you can get it and tolerate it. I really want you to feel a bit better soon. *Squishes*

    • Thanks Danni.

      Trouble is, when it comes to applying anything cold, my legs are swathed in absorbent pads (they leak), plus yards of cotton wool and bandages so the cold doesn’t really get through.

      My opioid hallucinations tend to the horrendous, and often feature spiders!

      Ron.

  2. Hi Ron, it’s been a long time. I haven’t been here because I went from bad pain to 24/7 chronic pain and a bunch of new diagnoses in only a year. Ahhh yes, hospitals have strange ideas about pain and medications. But we have the EXPERIENCE. I’ve been down the codiene road all to no avail. I am now on Norco and a bunch of other meds. I’ve been through the back injections, cauterizing nerves and this week we’re doing a nerve block. Ummm, no offense but can you choose a different GP? I have to go to a pain management specialist, along with my other doctors. Just a thought… :)

    • I’m at the best practise ion the area, plus it’s only a few minutes away if I need them urgently. Buggers have a blind spot when it comes to pain management though!

      I was referred to a pain clinic about 20 years ago, and was firmly told that unless I accepted that my pain was psychological (I’d been struck by lightning – sod all psychological about THAT!), I wouldn’t be admitted to the programme. I came close to murder that day.

  3. Like you, I’m never totally pain free. Pain killers take the edge off the pain. I take slow release Tramadol 100mg morning and night. If either my Endo or Fibro flare up, I can take ordinary Tramadol 50mg plus 300/50 Co-Codamol. Taking the extra Tramadol makes me itch like mad. Could that be contributing to your itching Ron?

    I would try the Pain Clinic again Ron. 20 years is a long time ago and attitudes have changed. Anything is worth a try. I found our Pain Clinic to be really good and understanding.

    • I’ve taken 100mg ordinary Tramadol plus 2 30/500 Co-codamol. Got a nice buzz but did nothing extra for pain.

      I don’t understand the logic of slow-release Tramadol. With DHC the overall dose is the same with either version. With Tramadol I take 400mg a day, but that could be replaced with 200mg slow release. Whichever way you slice it, that’s half the dose.

      Pretty sure the itching is due to the cellulitis infection – I don’t itch anywhere else, and it’s worse where the infection is worst. The infection’s spreading too, the antibiotics have done nothing. This paper http://www.lymphoedema.org/Menu3/Revised%20Cellulitis%20Consensus%202013.pdf says that Amoxycillin is the best antibiotic for cellulitis- and I’ve got plenty so I’ll give it a try.

  4. Hi Ron,
    Have you ever tried any of the morphine patches directly onto the site of the pain in your legs? My GP has recently upped my dose to 30 micro grams per hour in two patches applied over the upper arm and shoulder, and it’s been the first time in years that I’ve woken up without pain there. The trouble is that you can’t put patches everywhere it hurts, but it does give some break from all over pain.
    Having said that, I’ve currently got bronchitis and am chucking down Co-Amoxiclav and more Co-Codamol, and they won’t let me put the morphine patch over the bronchial tubes for some unknown reason.

  5. The patches can only be applied to the upper body and Im sure you know Ron that they cant be applied to wet or inflamed/infected areas.
    I wouldnt think applying them directly to bronchial tubes would do any good.

    • Quite so.

      I had intended to reply today – well, yesterday now – but between the district nurses and it being laundry day, I completely forgot.

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