Some thoughts about controlling pain from WebMD…

According to WebMD, some ways to reduce chronic pain include exercise, meditation, avoiding alcohol, cutting smoking, practicing (sic) better eating habits, keeping a pain journal for doctors, scheduling relaxation and distraction. (source:- ThirdAge.com ).

Let’s look at those a little more closely, from my perspective, because some are nonsensical, and not just for me.

Exercise – Simply not possible, as it causes excruciating pain. I know exercise is officially recommended for those of us with arthritis, but for that to be possible, most of us need better drugs.

Meditation – Possible for me,** but not for everyone, and not wildly reliable.

**I can’t tell you how I do it, whether it’s an acquired skill or something innate, but in the right circumstances – not always – I can tune out my pain, and much else. I’m not asleep – though I sometimes slip over into sleep – and I’m aware, more or less, of what’s going on around me, but pain is reduced to a sort of irritating background buzz.

Avoiding alcohol – Simply wrong. I mainly drink in the pub rather than at home, which, because it makes me sleep afterwards, will get me 8 hours or so free of pain (Pain is present even when I sleep, intruding into my dreams, my subconscious generating horrendously violent night mares as it attempts to rationalise the pain). However, while I never got the habit of drinking at home, I have, of late, started to. Not a lot – six bottle of beer lasted 3 months, a bottle of Jack Daniel’s 3 months – but I’ve found having a drink on seriously bad days, when pain and depression are at their worst, to be beneficial (I’m not depressed all the time, mercifully, just occasionally – I think most chronically sick people are depressed to some degree, it would be hard not to be). I’ve taken to drinking Jack with Stone’s Ginger Wine, which go together quite well, and about 2oz of each, just the one, will mellow me out nicely (my ex, who, along with a load of other MH problems, suffered from depression, always said that she felt best about one-third drunk). So on the worst of days, Jack & Stone’s are a regular feature, to lighten the darkness just enough. And an occasional bottle of beer in the evening, just for the hell of it!

Cutting smoking – Don’t smoke, never smoked, so irrelevant. Not convinced of efficacy anyway.

Practising better eating habits – Rubbish.  Eating habits have no effect on pain whatsoever. Gourmet food has exactly the same analgesic properties as cheese on toast, which is to say, none. Eating the food you like rather than that which is supposed to be good for you will make you feel generally better – won’t make you hurt any less though it just might make it more tolerable.

Keeping a pain journal for doctors – What? How will that lessen my pain? The only way I could get even moderately effective analgesia from my GP was to tell him I was very close to killing myself because of the pain. And, to be honest, I don’t know how if that was a lie or not.

Scheduling relaxation – You try relaxing while in constant severe pain – there is no position in which I can sit or lie that doesn’t hurt. A lot. And for many people, especially with young children, being able to schedule anything is a miracle.

Distraction – Finally! Yes, this does work, and distraction is, along with drugs,** my most useful tool in dealing with pain. It generally takes the form of losing myself in a book, or in that very rare beast, a totally engrossing TV programme, though constantly being jolted out of the zone by ad breaks isn’t that great. **Sorry to be boring, but that’s prescription drugs, Dihydrocodeine  (60mg every 6 hours, Paracetamol (with DHC), and occasionally, Naproxen (those, I bought).

By the way, Codeine is officially considered to be as efficacious as DHC. It’s not. DHC has no cough-suppressant effect, though, and for those who need it, Codeine Linctus will need to be continued. I find DHC far less constipating than Codeine, though.

Music can help too, on headphones, turned up to 11. Just try concentrating on anything else!

Yeah, I know, some bugger is likely to comment and tell me I’ll go deaf. That would be the least of my worries and, frankly, I don’t care.

The question is, though, why isn’t “Effective Medication” right at the top of that list, instead of not being there at all?

7 thoughts on “Some thoughts about controlling pain from WebMD…

  1. hmmmm. Interesting reading. Im on 2 x 30mg codeine which is not too good stomach wise and I alternate with tramedol. Im not looking forward to mini heatwave wont be able to breathe.(bronchestasis).
    What I wanted to ask was about inhalers. Was given 2 last week. Ventolin and other one to use at night.
    Have stopped using (after two days only), coz didnt seem to have any effect. Should I feel improvement immediately? or does it take time

    Going to hospital on Tuesday for 6 minute walk test and totally dreading the walk from roadside of hospital to clinic.

    • OK, Ventolin takes 20 minutes to reach its full effect. GPs won’t tell you, but the Pulmonary Function Lab told me, though I’d figured it out already, as hospitals doing before and after spirometry tests wait 20 minutes after administering Ventolin. Two days though – it means nothing. Give it a couple of weeks. And the effect is quite subtle – it’s not like throwing a switch and, magically, you can breathe normally again – life’s not that simple. There’s no cure for bronchiectasis, just management, but you have to do your part and take your meds properly. And if you smoke, stop, unless you want to die nastily.

      And it does need to be genuine Ventolin, not generic Salbutamol. The quality of the generic inhalers is uniformly poor. If the prescribed dose is ineffective, take more – the PFL told me it’s impossible to overdose using the inhaler, so take as much as you need, preferably using a Volumatic spacer device (get a scrip from your GP – all inhalers are better for using a spacer). I often take 10 or 12 puffs if I can’t be bothered setting up my nebuliser.

      It’s also possible – in fact based on comments I’ve had on my COPD posts it’s almost certain – that you are undermedicated. Personally, I believe that inhalers should be adjuncts to the baseline medication – in my case Phyllocontin Continus – not baseline themselves.

      To the best of my knowledge, there is no inhaler specifically for use at night – normally you’d just take Ventolin at bedtime. What’s the name of it?

      It’s not good to alternate analgesics – it just screws up your system.Many drugs have a cumulative effect, too, and by keeping changing you won’t get that Probably best to add plain Paracetamol to the codeine and carry on with that. You really shouldn’t be getting side effects on such a low dose, but sticking to codeine will allow you to adjust to it and they should stop. If they don’t taking them with milk can help or, of you have nausea, taking ginger in some form – I favour ginger wine as if I buy crystallised ginger it just gets eaten!

      And is that 2 x 30mg doses or one 60mg? Because 30mg won’t be much benefit.

      This is my list of meds for COPD https://ronsrants.wordpress.com/2008/06/06/drugs-for-copd/ it’s the same as I took when it was just bronchiectasis and asthma.

  2. wow thx for that Ron. My full meds are 2 x 30mg codeine 4 days a day, Ventolin for day and night inhaler is one capsule 18mg Spiriva. (Leaflet says) The capsule contain sthe inactive ingrediants lactose monhydrate , gelatin and black printing ink! Also at least once every 6 weeks in summer and almost every month in winter 100mg doxcycline (antibiotic).

    As I said earlier 6 minute walk on Tuesday at hospital and then see consultant mid August. Your post has been a lot more help than any doctors so far.
    funnily enough in winter I’ve taken to chewing raw ginger.

    • Add two Paracetamol to each codeine dose (making it effectively Co-codamol), and it’ll be more effective.

      The problem I have with dry-powder inhalers is I cough the stuff right out again. And even if you don’t a lot of the dose is lost in the throat and mouth. Better is the Atrovent inhaler – a virtually identical drug in a conventional inhaler. No reason to take it at night, but if it’s convenient no reason not to either.

      Doxycycline is a potent antibiotic, but it’s overkill to use it routinely for respiratory infections – it should be a drug of last resort. And it’s not actually indicated for respiratory infections anyway (source – British National Formulary, No. 61 (latest edition) ). The big problem taking as potent a drug as doxycycline routinely is that if it doesn’t work you’re at a loss for an alternative, whereas taking a broad-spectrum drug like Amoxycillin, if that doesn’t work there are a number of alternatives, including doxy.

      I rely on Amoxycillin, I take 500mg daily as prophylaxis,** increasing the dose if/when needed. I buy my own and have needed a doctor only 4 times in 7 years whereas, before, I was there at least once a month. And having my own supply I can treat an infection as soon as it appears – which is several days before a doctor could see it – which means I can usually knock it down in less than a week. Get used to the taste of your sputum. Yes, I know it’s gross but it’s a great diagnostic aid, as is the colour. It should be white and taste fairly bland, if it gets sweet-salty or just plain offensive, and yellow or green, it’s infected (but by the time you start to wheeze and crackle so your GP can detect it, the infection is well-established and harder to get rid of).

      **But then I have stage 4 COPD, and since my pneumonia and empyema in January, I’ve been increasingly prone to infections – you could probably get buy with 250mg.

      If you’re prone to bouts of coughing, the only cough medicine that actually works is codeine linctus. Alternatively, I find sucking a strongly-flavoured sweet, like Hacks (hard to find, try the chemist), very effective, but taking that much codeine should also suppress the cough reflex quite well, though there’s always “break-through” coughing to deal with. Inhalers won’t fix coughing, btw.

      “Your post has been a lot more help than any doctors so far.” You know, the number of people who have said that is positively scary – it reflects badly on the standard of medical care. Everything I’ve written about COPD is equally applicable to bronchiectasis, which I’ve had since I was 2, along with asthma.

      It was my work on COPD that got me invited to join Wellsphere (see sidebar), normally you have to apply.

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