Co-codamol/Codeine

[lil_miffy]

im taking paracetamol now as regular pain management. it seems to help a little with the flu like aching. but the nurse i saw who reffered me to pain management told me to take my codeine 4 times a day too. when im alot of pain yes im taking it up to 4 times a day but its totally messing up my tummy. i dont know what the affect it would have on my tummy if i took it every day 4 times a day. when i mentioned this to the nurse she just said they would give me pills for the affect on my stomach. i really dont want to go down the route of taking 10 meds to combat the effects of one.

what benefit do people get from taking codiene as a pain management drug as regualr med rather than as and when needed?

[Rosie]

Hi lil_miffy

The advantage of taking pain killers regularly is that it maintains the level of the medication in the blood. Also, painkillers are more effective the earlier they are taken at the onset of pain, so a regular dose means they are taken early on.
Occasional painkiller use is not really an issue if it is working for you. If it is not working, or you are taking them more and more often, then the regular dose may be better. Also, on a regular dose you may be able to take the long acting or modified release ones, and this helps to maintain an even level in the blood as well. I wish I could draw you the graphs cos they explain it so much better.
Try having a read through this thread as well, I think there is something about this in there.



Rosie

[Eloise]

As Rosie said, it can be better in pain management to be on top of the pain with regular pain killers rather than continually fighting fire which requires bigger doses and leaves you in agony while they kick in.

Unfortunately with codeine, constipation is a big problem, which gets worse with higher doses and doesn't lessen with time (unlike the drowiness that can lessen with time). Therefore, I find I keep the paracetamol regular and only have the codiene at night (as this is when pain keeps me awake and a bad nights sleep is worse for pain the next day) and then only when needed when pain is bad.

If constipation is bad with codeine then it can be combated with plenty of fluids, fibre & fruit (if can tolerate) but this is not always effective and so often laxatives are needed. The best laxative is senna (or bisacodyl), as codeine acts by sending the gut movement to sleep and senna (and bisacodyl) work by aggrevating the gut and waking it up. However these can cause stomach cramps and for me these set my IBS off big time. Therefore alternatives are lactulose or docusate that work as softeners, by pulling water into the gut, not as effective as you wil still have a slow tranist time, but as long as you are fully hydrated it stops the stools going rock hard.

Unfortunately with you being unable to take NSAIDs the only real option is for you to go through the opioids. All opioids cause constipation and the stronger ones more so, and so it probably does mean that you may have to combat this to be able to get the pain relief. Somepeople say that tramadol causes less constipation, however this was only in theory and doesn't always happen in practice. If you are requiring higher doses then the slow release preparations and patches can minimise the constipation but it still will be there.

Just re-read your post, if you mean by stomach problems you mean nausea and vomiting, then this actually can actually lessen with continued use. Unfortunately nothing can be done other than giving you anti-nausea drugs that are all prescription only. Also, this is the same with all opioids and is worse with the stronger opioids (as withh all the side effects).

OK - hope I have answered your question without TMI.

[Sandy L]

im taking paracetamol now as regular pain management. it seems to help a little with the flu like aching. but the nurse i saw who reffered me to pain management told me to take my codeine 4 times a day too. when im alot of pain yes im taking it up to 4 times a day but its totally messing up my tummy. i dont know what the affect it would have on my tummy if i took it every day 4 times a day. when i mentioned this to the nurse she just said they would give me pills for the affect on my stomach. i really dont want to go down the route of taking 10 meds to combat the effects of one.

what benefit do people get from taking codiene as a pain management drug as regualr med rather than as and when needed?

What does codeine do to your stomach? There is the constipation effect Eloise mentioned, but there may be nausea, too. If nausea, taking half tablets every three hours may work better than whole tablets every six--the high concentrations are lower and the low concentrations are higher. Pain control is usually better with the half-tablet routine, but constipation could be worse, since the gut doesnt have the low periods to move things along. You usually do best to take a full tablet the first dose of the day,

A drug called misoprostol may also work to prevent constipation if the methods Eloise outlined are not sufficient. That is a prescription drug, and can't be used in pregnancy, so try the simple things first.

[lil_miffy]

is there a difference between the two? my gp wont give me amnything other than the phosphat even though it does nothing for me. but when i was taken into hospital alst week i was given dihydrocodeiene, same dose, it made a bit of different. jut want to know before i pster my gp for it incase its the same thing and its just psycholocial affect of a different med thats helping a bit more.

[nonyanomemory]

http://brain.hastypastry.net/forums/sho ... hp?t=44525 copy and paste into your browser I hope it works! (too tired to do proper link sorry) there is the exact same question on hastypastry.net from an hms sufferor.

Caffeine appears to be one difference, not in the Codeine phosphate and in the dihydrocodeine, which is news to me, as I have given up caffeine in my general diet! Eloise would be able to tell you in what form. Or look up in rxx list I think thats the right name for it on line for specifics. Codeine phosphate may have suctrose/fructose, again Eloise would know. Caffeine can affect efficacy I think, so that may be why you felt it worked better? I prefer slow release (M/R) dihydrocodeine personally. Have you asked your gp outright what the reason is, it may be worth a try. Alternatively, your pharmicist especially if you have a regular one would know about all your medications and may be able to give you information also, they are actually better qualified than gp's with regard to medications. Am not a doctor though, or a pharmacist so don't rely on me and my sparse info!!! Cannot remember I am afraid if you have seen a pain management consultant, this may be an option, or as well, attending a pain management course. As with any med of this kind, the effect is has on the bowel needs careful management.

Take care

nonya

[Eloise]

Sorry - this will just be quick as not really got any energy to think much.

The two molecules for codeine and dihydrocodiene are very similar - but the dihydrocodine has two (di) hydrogen (hydro) atoms on it extra to codeine!

Potency wise, dihydrocodeine is probably stronger at equivalent weights. This would be for both pain relief and side-effects. They are both weak opioids and so only really for mild-moderate pain and you get lots of constipation with them.

In theory they are both very similar. But in patients then there can be totally different. i.e. pain relief may be none or great and side-effects can be little or lots and when you swap to the other one it could be pot luck again (as with every other pain killer).

So lil-miffy - I would definitely tell your GP that you found dihydrocodiene is better for your pain - he should also have received something from the hospital saying you had it. (In theory it is a more potent pain killer and he should realise that). I would also suggest you push for a referal to a pain management course or specialist - that way you can show you are willing to learn other ways of dealing with your pain and not just after opiates. It is going to be difficult for you to find pain killers that don't interfer with your other medication so you need to look down the route of as many other pain relieving options as possible.

Nonya - you are right caffiene can enhance the absorption and speed up the benifit of opioids and paracetamol and is the reason it is added to many over-the-counter pain killers. I am not sure which brands of codeine and dihydrocodiene may or maynot contain it - you would have to check each ingredient list. The modified release preparations (MR) can be useful to provide a more level effect of pain relief and side-effects during the day and night. Also - i couldn't have worded the bowel management as well as you

[rockgirl92]

Whenever I take co codamol I feel like my head is disconnected from my body. I can't feel anything and my reactions are awful. This is the only strong painkiller I have, but I feel so bad I can't go to college. Is there something else I can try?

[butterfly81]

Yes! I find the same, I was given it to help the pain so that I can sleep and it does work but it scares me because I feel like I'm not in control and woozy. Like I hear noises and I can't work out what they are (scary because I live alone and don't think my reactions would be good enough if anyone was to break in etc - silly I know but it's one of my biggest paranoias!) I now only take them if I really really need them and don't want to go back and ask for other pain killers because I had to be for those.....my doc isn't sympathetic, he gives me the age old live with it phrase!! Glad its not just me and look forward to other peoples comments and advice.

[Shybushbaby]

Hiya guys
I am on Tramadol for my pain.
It has basically the same negative effect on me.
One tablet normally isnt enough to make a difference and if I take 2, then I am just totally spaced out and it is is really horrible feeling, so I generally dont bother.
I was recently put onto Amitripyline (low dose) as it is good for chronic pain and it also has a muscle relaxant in it, so aids a restful nights sleep.
If your meds aint working, you really need to go back and see your gp. If they aint sympathic to your needs, then you need to see another gp and/or change your practice if need be.
The most important thing is you and your ability to cope with and manage your pain. If you are not helped to do this, then it could develope into drepression.
Luv & stuff
JO. XXX

[paw]

Codeine used to make me sick to my stomach and a bit dizzy. I did not need it often, only after a surgery or a big injury so I never got used to it.

Then a few years ago I had a major shoulder injury that needed a big surgery. After that I had to take pain meds. Over time I got used to them and now I don't get "buzzed" or dizzy and they don't upset my stomach any more. I am on a low dose of pain meds, I take them only at bedtime unless I have a new injury and I might need two doses in a day.

You might get used to them too. Till you do, try to eat something so they don't bother your stomach as much.

[Blaadyblah]

Co-codamol can send me into a complete fug if I take it on an empty stomach, I've found I feel much more human if I take it with a meal. Your GP/Pain Management team may be able to suggest alternatives, or a different dose (please remember the forum rules forbid discussion of dosages).

[Elfy]

I have had a constant headache for over 2 weeks now that is gettign worse each day and I have just discovered that codeine and paracetaol taken combined can cause headaches. I take co codamol for pain and this is apparently causing my headache. Catch 22.

[Eloise]

Yes Elfy - it is very common. It can be either paracetamol alone or with combination with a weak opioid. Some think NSAIDs can cause the same:

http://www.patient.co.uk/showdoc/40002048/

Basically the only way to over come it is a detox (cold turkey) of the pain killers. Therefore get ready with all the other alternative (heat packs), TENS etc for your joints.

Also, only take painkillers for your joint pain. Other alternatives maybe better for headaches, such as drinking water incase it is dehydration, forehead cooling strips, aromotherapy etc.

[nonyanomemory]

Hi Elfy, I used to get rebound headaches and discussed with pain management consultant the whole cycle of them, fortunately I don't get them anymore. Although I take dihydrocodeine slow release now which seems to work much better for me. The only thing I would say is that if your meds are prescribed by your gp it may be politic for you to discuss your discontinuation of your prescription if thats what you feel you need to do with him/her if they were the initial prescriber. You may feel more comfortable, if you do this slowly to avoid stomach cramps etc. or your gp may just say stop as Eloise suggests or may also give you alternatives to try, to avoid unnecessary discomfort. Generally I tend to run by any med changes with my gp even if its over the phone for a quick chat, so thats it on my notes for continuity of care and also from experience I find its better to keep him informed. Codeine can in some cause constipation which bizarrely can cause headaches! I would at least have a chat if this were me to check that they are rebound headaches. Good luck with whatever course of action you decide.

nonya