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 drug – I’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!