Pain Relief

Question: What are some forms of pain relief?

Answer 1: I take a considerable number of codeine/paracetamol pain relievers every day. I am a big tough boyo who is quite capable of having bones set without anaesthetic (yes I have had it done by choice). Pain is something that I have experienced every day of my life for 30 years. What worries me is the prevailing attitude amongst some sectors of the population that taking pain RELIEF is always WRONG (This is not a criticism of this group where issues meet open minds). ALWAYS TAKE QUALIFIED MEDICAL ADVICE ABOUT PAIN RELIEF – from a Chemist or Doctor, combinations of ‘safe alternatives’ and prescription drugs can be dangerous! Chemists are usually very good at this. Taking pain relief is not a failure. If YOU find YOUR pain unbearable, it is a sign that something is WRONG. When you have experienced long term pain you will ‘adapt’ to it – when this happens, a good check on whether pain has crossed the line to severe is a disrupted sleep.

Some of the ‘milder’ over the counter drugs are dangerous. Paracetamol in ‘small’ overdose quantities is a KILLER. Codeine does cause constipation – my doctor prescribed a mild laxative. The only side effect that I have now when I ‘take breaks’ from it (other than intense pain) is ‘the runs’. When I am in pain I get depressed – don’t we all. Allowing myself to ‘give in’ and accept that I cannot control my pain without ‘chemical aid’ AND continue to function, has led to a complete change in attitude – I was far more grumpy without pain relief <BIG SMILE>. Codeine has two variants in common use – Codeine Phosphate, the ‘milder’ form and Dihydracodiene the ‘heavier’ drug – both are opiates and addictive. BUT there is evidence that many other safe drugs such as Valium are as, if not more, addictive than opiates! One final point, I had an informal discussion with a ‘ranking’ worker in the drugs rehab field a few months ago. I was concerned about the number of people using ‘alternate’ means of pain relief, she confirmed that there was a very small, but increasing, number of people addicted to HARD drugs that they had started taking to relieve pain. I cannot comment on the use of cannabis as I am sure that most of you are aware of the debate surrounding its use at present, other than to state that its use is not included in the preceding statement. To sum up – I spent many years fighting pain – I can guarantee that there are no medals for being big and tough, in fact it is essential that everyone gives their Doctor a TRUE picture of the pain they experience – it is one of the tools that they use to diagnose the severity of what is wrong. Sorry to carry on a bit but…

Answer 2: Amitryptiline shouldn’t be addictive; anti-depressants of that particular family aren’t. Thank you for alerting me to the fact that they might be. Codeine is an opiate, yes, and can be addictive. Classing it with heroin is a bit odd but different countries/cultures have different experiences of such matters. Luckily I’m unlikely to become addicted to it as I really don’t like it. When I do take it, I take codeine phosphate. Paracetamol is dangerous in overdose, yes, even minor overdose. I take it with great care. I’m fairly sure that addiction resulting from drugs’ physical action has to do in part with the way they are taken – and prescribed, yes — 1-2mg 3 times a day (or whatever) is more likely to lead to addiction than “take them when you feel like taking them”. (Many doctors agree but are unlikely to say so.) I feel quite strongly about this, as muscle relaxants are a fine treatment for bad backs but a lot of doctors are wary of prescribing them now. (That’s mainly what Valium is. The really dangerous tranquillizers are the feel-good ones that are also short-acting.) That isn’t an ad for tranquilizers, simply an observation. I called St John’s Wort a MAOI inhibitor. I learned it’s classed as one but it has no MAOI-type actions in humans. It seems to work like the SSRIs. Finally yes, constant pain is depressing. I’m not entirely sure why it hasn’t made me depressed as opposed to a bit low. I’m certainly not a believer in putting up with pain but I am unhappy about masking it, as it’s a warning signal. I don’t really have any bright ideas about the problem except I suppose to make as much use of “painkillers” like ice as possible.

Answer 3: Valium was and probably still is used in well-managed opiate de-tox. Taken sensibly as prescribed there should be no problems with Valium or other tranks- it is advisable to check on repeat prescriptions etc. There are still ‘problems’ with long-term use in many geographical areas – I think I’ve said as much as I can without being sued. My information comes from the problem end of the use range. I am one of the ‘lucky’ people who does ‘not respond well’ to most tranks, so I don’t have the problem – They seem to have the opposite reaction to that intended!

Answer 4: “Well managed” is I suppose the important point. I don’t usually go along with “as prescribed” when it’s “take 2 every 4 hours” as that is a recipe for addiction (or maybe toleration, habituation) — in the case of Valium, anyway. In this instance, I would. I wouldn’t vary from an “as prescribed” without telling a doctor what I was going to do — or maybe, what I’d already done! — anyway. And by “a doctor” I mean the
prescribing doctor, if possible. I know there are problems. Repeat prescriptions, yes. My London doctors usually insisted on seeing a patient every single time they wanted anything (“<sulk> I want my anti-allergenic eye drops.”) I call that good practice — and they were very good. But it does take a lot of time… I seem to have an opposite reaction to anti-histamines than what they intended — if it is anti-histamines. It’s something in a cold cure called Night Nurse. I took it once, more than 20 years ago. Never again. I don’t know how many people have these “paradoxical reactions”, or why.

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