Alternative to codine

leilateggie

I am posting because my Gran 82ish suffers really badly with knee and hip pain. She currently takes alot of codine and paracetamol, this has the nasty constipation side effects, so she takes movicol. She has been tried on morphine patches but these made her unable to do anything as she was so spaced out. I am fustrated that there must be something more than codine and morphine patches out there!! I would really like some ideas of what she try, this might mean that they find something which gives much better relief especially at night. I did wonder about fentanyl, but this might make her spaced out aslo? All thoughts gratefully appreciated.

tillytop

How lucky your Gran is to have such a caring granddughter

The issue you describe is a common problem and the balance between effective pain relief (or pain dulling as we tend to call it on here) and being spaced out can be a very difficult one. I had to stop codeine because of my stomach and I now take liquid morphine which I find actually doesn't work as well for me in terms of helping with pain, but is much easier on my stomach. I'm pretty used to the morphine now but I still wouldn't want to drive or make work-related decisions when taking it -but luckily I don't have to do either so it's not a problem for me. I don't have wider experience of other pain meds but from what I have read on here the things your Gran is experiencing are typical of the opiate based pain meds and I'm sorry to say that there may not be an easy answer.

I know there are others on here with far more experience of these meds than me, so I am sure you will get some better (and hopefully more useful) replies soon.

I hope that your Gran can find a reasonable compromise soon.

Tilly xxx

stickywicket

I endorse all that Tillytop has said, Leilatiggie. It does seem to be a fine dividing line between functioning-but-in-pain and spaced-out-and-not-functioning. I hope someone with more experience of the stronger paindullers will be around soon. If she could do some gentle exercises that might help too.

Helenbothknees

Some people find that ibuprofen and paracetamol works well, or other anti-inflammatories such as naproxin. Or she could try tramadol; it's also opiate based (I think) but works better for some people than codeine...but for other people can have horrendous side effects. It's a matter of trial and error really, eg I can take codeine and paracetamol, but none of the other things I've mentioned! However, everyone is different, and if she can find an understanding doctor, he might be willing to let her try a few things until she hopefully finds something which works.

dreamdaisy

Oh dear, bless her and bless you for trying to find an answer. Pain relief is not all it's cracked up to be - I have found over the years that the stronger the relief the more I am removed from the pain, not vice versa. My mum (who is 88) is taking tramadol and is somewhat bewildered by the odd things that 'happen' whilst she is under its influence (which she denies): OK her joints don't hurt but she doesn't really know what she 's doing. There is no easy answer and I think that the older one is the harder it can be to live with extreme discomfort.

These strong meds bring their own problems (as she has found) but I think the best to advise you is her GP - or maybe the pain clinic at her hospital - her GP can refer her to that. There are alternatives but they are the ones to advise. I wish you both well. DD

frogmorton

Hi Leila

Bless her I so agree with her it's horrible being blocked up or spaced out or in agony :roll:

There are lots and lots of different analgesics she can try out there. I use bu-trans patches and they do not send me spaced out. I do howevere drink a small glass of prune juice if the other problem becomes an issue!! Does she try other things like wheatbags to ease the pain a bit?

In your shoes l would accompany her to the GP next time and try to talk to the Gp about pain relief. He/she may even be happy to refer her to a pain clinic - lots of folks have had good help from them as they are the pain experts after all

Good luck
Love

Toni xxx

carole123

Hello, can I join in here? I'm still experimenting with pain relief (sorry, dulling - much better word!). I find paracetamol useless really, except as a placebo - I feel I've done something! Exercise is the best bet for me so far - especially swimming.

I wanted to ask about anti-inflammatories. When I was first diagnosed with OA around 3/4 years ago, my GP prescribed Arthrotec-50. It was great for a bit and then I became habituated (I had to take the pill to feel in my usual state - not great) and after a year or so I decided I had to make a big effort to come off it.

Just at that time the GP wrote to me and said to stop the Arthrotec as it was bad for the stomach, and enclosed a script for Naproxen (with Omeprazole to prtect the tum). I looked up Naproxen and found that it could affect circulation, & as I have poor circulation anyway - and had had a not-brilliant experience with Arthrotec - I decided to not take anything.

This has been OK so far with the help of exercise, but to be honest it is getting worse and there are some days when I need to keep going and not get too tired with the pain. Has anyone had any experience of using these drugs very intermittently - does Naproxen work as a one-off dose or is it cumulative?

Sorry this is rather a long post!
Good wishes, Carole

Soretoe2

Hi, Sorry to hear about your Gran, she is lucky to have you keeping an eye on her.
If she tolerates the codeine I would ask for some plain codeine without the paracetamol. It's risky taking the paracetamol long term, especially for the elderly. She can then add paracetamol on a bad day now and again, much safer.
There is dihydrocodiene, much stronger but can make you spacey and nauseous.
Palexia is a new drug, it is very expensive and gp's are wary of prescribing it because of this. It is supposed to have less side effects but I can't actually comment on it as I've not tried it myself
There is also the Lidocaine patch. This is 12 hour patch that you stick on a particualr area, it is not morphine, it numbs the area and brings pain relief. It's the stuff dentists use to numb our mouths. Quite good for overnight relief if they suit you.
Also a very small amount of amitriptyline taken in the evening helps give a good nights rest. Yes they can make you a bit sleepy first thing but this wears off after a while. The sleepy bit has to be weighed against a good nights sleep.
The Fentanyl patch is much stronger than the Butrans, so is unlikely to be suitable for your Gran, if she found the Butrans didn't suit her.
Also Carole, Naproxen can be taken as and when required, if you are someone who is able to take them, usually with a stomach protector. There is a cumulative effect but they also work if you want to take them now and again.
My husband often takes them for a few days or a week or so, when he's overdone things and his bad knees give him hell. He prefers this to taking them all the time, lessening the long term risk that can happen with anti-inflammatories.
Go back to the gp with your Gran leilateggie and have a good chat about it all. You never know there may be something out there that really helps. Best wishes to you both, Joy

leilateggie

Thanks for all the ideas. I will sit down and write down all the different things that you suggest. It is usually my mum or aunt who goes with her but I may just have to arrange that it will be me that goes next time. I'm looking forward to speaking to the doctor as they have seem to have lost interest in her and the pain that she is in. Atleast I now have more of an idea about what is out there.

Many thanks to you all for taking the time to write. I see my gran most weeks as she is not really able to cook for herself so I make extra of the meals I make and freeze them for her.

Leila xx

kentishlady

Hi Leila. Hope your gran can soon get some pain dulling sorted out. As everyone else has said, this is a very 'hit and miss' subject which many of us on the forum are constantly having a battle with. I have OA with my back badly affected and my GP has tried several different meds to try and help, most of which give me horrendous side effects, including feeling completely 'crashed out'. Have recently started on Butrans patches. My GP suggested we tried to increase the dose from 10 mcg to 15 but the extra 5 proved too much and I was falling asleep every 10 minutes so am back to just the 10mcg. I really don't find they do very much regards the pain. I also take paracetamol (which as my GP keeps telling me is the safest). However, it is also ineffective for severe/chronic pain! I have 2 different pain relieving gels (which don't do a lot either) but I suppose are better than nothing. I find I get most relief from a wheatbag heated in the microwave as someone else suggested earlier. Do hope you can get the dr to help your gran and glad to hear she has such a kind and caring granddaughter. Best wishes to you both. Beryl

carole123

Joy, thank you very much for the tip about Naproxen - very helpful.
And I didn't want to just ignore Leila and her grandmother - sorry! This forum seems so supportive and full of ideas. If I were Leila's grandmother the best thing of all would be having Leila for a grand-daughter!
Carole

Soretoe2

Hi Carole, you are very welcome. I also think that leila's grandmother is a lucky lady.
There is always a great deal of support here - just ask a question!
Joy

barbara12

Hi Leila
How lovey that you are looking out for your gran, I have just started on the morphine patches, and the lower does is doing nothing at the min,so I am having to up it ...like the others have said everyone is different when it comes to pain relief but they all have side effects, its a matter of getting used to them,if your gran lives on her own they will be careful what they give her..or should be .... I do hope your gran will get something that helps her very soon, you take care xx