going private in the uk , is it worth it?

[bloodred1889]

hi all
swim is seriosly considering going to a private doctor to get the painkillers swim wants that will help with swims back pain.
swim has chronic back pain for 6 years now, its a long story, basically swims doctor is reluctant to give painkillers stonger then remadine and today said im not giving you anymore because exercise is all you need to do and your problem will go away.

well swim has done everything, exercise, rumatology, gone to chiropractor, but nothing works, remidine only eases the pain a little.

so swim is thinking of going private.
if swim pays to see a doctor do you think the doctor will prescribe what swim wants and not say no becuase there being payed?

does anyone else see a private doctor?
swim has asked for hydrocodiene(vicodin) but has been refused it so do you think a private doctor would prescribe it or somthing like tramadol.

thanks all.

[jerbles]

tramadol, probably. Im not sure how doctors work in the uk, probably basically the same as the US, but just because you're paying the guy doesn't mean he'll prescribe you what you need/want. I'd say due to your chronic back pain, you should definatly be able to find a doctor who would do at least vicodin, but thats the hard part, finding a doctor who isn't a dick that thinks everyone's out to get fucked up.

[thewomaninagreenhat]

Swim cant really give an answer, but wanted to share her USA experience anyway. Swim has no insurance, so she pays out the butt to her doctor for everything needed. Her doctor still will not prescribe her what she needs, and will only give her half of the tramadol dose that works. On this side of the river, it doesnt always matter if you pay or not. It is the individual doctor that matters most, and I suspect it is the same where you are.

In Swims town, most doctors wont even see a person without health insurance, so finding one that would was a miracle in itself. Swim had cancer though, so she was pretty desperate to get in with someone, anyone, and feels pretty lucky to have the doctor that she has, even though he is a jerk with the meds.

Yes, in Swims town, even someone with cancer gets turned away without insurance. When swim finally found someone that would see her, the doctor said a few more weeks might have been too long and swim probably would have died.

Swim would recommend trying to get on Tramadol first. There is less chance of becoming addicted, and they are easier to get. To top it off, they really do help with pain, at least for her. Swim gets to take 200 mg each day. If she takes them one at a time, 6 hours apart, then they dont take the pain away. BUT, if she suffers through for a while, and then takes 2 or 3 at once, she gets some relief for awhile. Its not total relief, but its the difference between moaning around in pain and being able to push the pain away in order to think of other things.

Swim really hopes that Swiy will find a doctor that will help!

[Jatelka]

Rather than going private, you need to insist on referral to a specialist pain clinic, who will then evaluate your pain and prescribe appropriately, as well as enabling access to specialised physiotherapy services and specialised techniques such as nerve blocks and facet joint injections (which most GP's know nothing about and have no interest in).

You need to be prepared to think laterally regarding your pain (I don't mean to be harsh or unsympathetic when I say this), and be prepared to consider alternatives that are not opiates, perhaps Amitryptiline, Carbamazepine or similar if there's a neuropathic component.

Chronic pain is a complex condition, and requires specialist input. Just paying to "go private" wouldn't necessarily achieve this. You could end up paying for the same kind of service that you are already getting.

[bloodred1889]

well swim went to the doctor and was refured to hospital where she saw a back doctor, he proded around abit and then decided that its rumatic pain and needs anti inflamatories, even though swim told him that she was on dictofenic and that caused mood changes and sickness, but anyway after giving swim these anti-inflamation tablets swim tried them again and nothing happened.
so when swim went back to her doctor today she just said well what did you expect? your pain is caused due to posture and if you do exercises then the pain will stop.
she then gave me remadine and said these are the last im giving you, after you go to the rumatology apointment then all you need to do is exercise and nothing more, now goodbye and have a nice day.

swim was not pleased atall.
swim has tried everything, bowen, rumatology, chiropody, exersise, paracetamol, codiene, paracetamol+codiene, paramol, co-proxamol, co-codamol, co-dydramol and now remadine, nothing has worked exept when swim takes 4 of the remadine only then does the pain subside a little.

but now its on swims record that all is wrong is posture, and exersise is all thats needed, so swim is worried that if she goes to another doctor they will just read swims record and say the same thing.

swim was beat up when she was 14 and kicked in the ribs and her spine, 6 years later swim hasnt even been offered a scan or anything because aparently nothing would show up.

swim is fed up and upset, no one listens, they think oh your 20 it cant be anything more then posture, or oh your just trying to get a fix.

swim dosnt know what to do anymore exept take overdoses of remadine.

[FuBai]

If you want specific medication then you have to be far more subtle about it. For a start if the substance is one that is commonly used recreationally like most powerful analgesics are then don't ask for it specifically. Simply complain of pain, allow the doctor to try what he wants and keep saying that the pain is still too great. If you ask for specific medication the doctor will suspect you of wanting it for recreational purposes. If you feel hard done by there are ways to appeal - all doctors are regulated by NICE so complain that the medication you are being given has done nothing for you, that exercise regimes have not worked and that your doctor is allowing you to continue to suffer simply because you are young. It is arguably an example of age discrimination so you also have legal recourse if you think it's worth it. Also make sure you have no traces of drug use in your blood stream or hair because then you will never get the medication you need. If worst comes to the worst illicit analgesics may be your only option - diamorphine is the most common illicit opiate analgesic in Britain, but morphine and hydrocodone are quite common too. Cannabis may be of some use. However this is a last recourse and one you should avoid using as much as possible. As for using a private doctor - it is a) likley to be very expensive and b) unlikely to change much. If you are really willing to fork out then there are some exclusive private doctors in London who will do as much as possible to give you the medication you ask for, but their price tags will be pretty massive and there is still no guarantee.

[bloodred1889]

thankyou that does help alot, swim is just worried about the fact my doctor sent me to hospital and they said they couldnt find any efidence of anything, so they just presume its rumatic and anti inflamatories are the answer.
and that if swim does exercise the pain will stop, how can swim get painkillers if the doctors all think all swim has to do is exercise?

swim is just thinking of not asking for stroinger painkillers because this seems to be impossible but instead just staying with the ones swim has now but putting up with taking 4 or 5 at a time just to ease the pain a little.

[AceOvArts]

SWIM wonders when the "miracle" drug Diclofenac will turn and bite doctors on the ass. They seem all to quick to prescribe that shit for anything from gout to a headache (SWIM knows from experience). Has SWIY tried Kratom yet ? Its not a bad opiate like substitute and can help pain management.
SWIM has used it recreationally and the other night SWIMs wife said it really helped with her back pain. Just a thought.
Unfortunately you have to pay for it which is probably not the way you want to go.

[repmobile]

Hi, SWIM (in UK) suffers severe back pain coupled with severe Sciatica in right leg. MRI scan shoows abnormalities at all lumbar spine levels.

SWIM initially prescribed NSAIDS (Voltarol) which did nothing. SWIM's Doctor then prescribed DI-Hydrocodeine (DF118's) which worked fine for a while then ceased to work.

SWIM went back to GP and explained that DF118's had lost effect, so was then prescibed Tramadol as well as NSAID. Again this worked for 6 months or so but again began to lose effect.

SWIM then prescribed OxyContin 10mg with NSAID and also Amitriptyline 50mg for the nerve pain. This worked for about a year before SWIM became tolerant to the 10mg OxyContin. GP then prescribed 20mg OxyContin.

A year later SWIM also became tolerant to the 20mg Oxy's, so GP now prescribing 40mg Oxycontin. Also prescribed 10mg Oxynorm (immediate release version of Oxycontin) for breakthrough pain as well. SWIM still takes a NSAID, Amitriptyline and also 5mg Diazepam for muscle spasms.

So, do be persistant with your GP, but it does take time to work up to something decent at controlling the pain like the OxyContin/Oxynorm combination does.

rep

[Zaprenz]

Originally Posted by bloodred1889

swim has asked for hydrocodiene(vicodin) but has been refused it so do you think a private doctor would prescribe it or somthing like tramadol.

^That might be your problem there.

Vicodin (hydrocodone) is not available on the NHS in the UK, it's automatic alarm bells for any UK GP. [You can thank american TV series like HOUSE for that amongst other reasons]

On the NHS: Only dihydrocodeine is available which is more on a par with codeine than hydrocodone / vicodin in terms of strength.

hydrocodone/Vicodin is possible on a private RX in the UK, still very unlikely.

The opiate part of the UK pain ladder usually goes something like this...

codeine - dihydrocodeine - tramadol - then the strong ones:

morphine/oxycodone/hydrocodone/diamorphine/fentanyl also hydromorphone (which is the demethylated version of hydrocodone) [all these are usually reserved for palliative care though]

http://en.wikipedia.org/wiki/Dihydrocodeine

http://en.wikipedia.org/wiki/Hydrocodone [vicodin]

[bloodred1889]

well swim currently takes remadine which is dihydrocodeine and paracetamol 20mg/500mg

it dosnt work unless swim takes 4 at a time, even then it only eases it for a while, leg and shoulder pain still are bad though.
talking about diclofenic swim totally agrees the doctors were all like yeah this WILL work.
but it didnt, swim just got neerly all the side effects off it, mostly mood change.

swims problem at the moment is swim has had no xray or mri, doctor refused, so thus swim has no hard evidence that anything is wrong.
so doctors are just hay its rumatic, exersise will work!!

so what can swim do, exept complain?
swim thinks she has one more chance, swim was given a letter head adressed to the doctor at the hospital. he said if these anti-inflamatories and the exersise dont work, then write to me as to why they dont work and what i can do next.

swim wants to write to him to get this sorted once and for all, but swim wants to be tactfull and say the right things, swim also wants to sound grown up and responsible and not make him think in anyway swim is an addict, any suggestions as to what swim shopuld write.?

[bjarkii]

yes, private doctors are a LOT more sympathetic to your needs in my opinion. I have private healthcare and although i fully support the NHS, for the relatively small cost, it really makes a massive difference. while the NHS are reluctant to help you if you're not dying, private doctors are keen to assist you any way they can.

[bjarkii]

sorry to double post but i'd also suggest that you buy tramadol online. it's legal and easy if you have a credit card. it's also great recreationally, and for general pain.

[Zaprenz]

Originally Posted by bloodred1889

well swim currently takes remadine which is dihydrocodeine and paracetamol 20mg/500mg

it dosnt work unless swim takes 4 at a time, even then it only eases it for a while, leg and shoulder pain still are bad though.

Please don't take four tablets at once. Thats 2g/2000mg of paracetamol/acetaminophen. That will not help ones general state of health.

Paracetamol 1g/1000mg no more than fours times a day [each dose seperated by at least four hours]. Anything larger is risking toxicity problems especially as it sounds like one will be taking this regularly. [Kidney pain will definately not help back pain!]

As has been mentioned tramadol is easy to obtain and ideally better obtained from the GP [be careful with dose though - there is a risk of seizures & any other drugs your taking, it can interact with quite a few: e.g SSRI's & tramadol have been known to cause serotonin sydrome; can also interact with many recreational drugs], cold water extraction on the remedeine is possible but it is going to exhaust the supply of remedeine before the next refil & be a pain to do every month.

Temgesic (200mcg buprenorphine) or buprenorphine patches are licensed for pain management.

If there is a real chronic back problem be open to suggestions by the doctor. Yes unfortunately some are unsympathetic but even a pain specialist will be aware that treating a chronic pain problem with opioids will require an ever increasing dose to maintain a specific level of analgesia due to tolerance. Be open to other possibilities they recommend not only because this will be the only way to convince them one is not an addict but also what they are offering may actually help.

[bloodred1889]

yeah swim knows its bad to take 4 at a time, but its the only way to get relief at present.

but swim will push getting a new doctor.

[AceOvArts]

bloodred, SWIY really needs to do a CWE on those if he/she is taking more than two

[rocksmokinmachine]

I know this is an old one, but a doctor should prescribe tramadol on the NHS, but they don't. I think this is really sad as patients are not getting the treatment they need.

The prefered painkiller in the UK A&E and GP surgeries is codeine phosphate. The only reason for this is that codeine is 20p by the bucketfull and tramadol is a little more expensive. It is all about penny-pinching.

SWIY should consider going private if SWIY can afford it.

[Jatelka]

I'd disagree that the prescription of codeine instead of tramadol is primarily a cost issue.

Tramadol has a not inconsiderable adverse effect profile, and also a hefty potential for interaction with other drugs, while codeine has fewer interactions.

Both are classified as "weak opiates" and are judged by the WHO as roughly equi-analgesic, so the lower interaction potential for codeine makes it (in SWIJ's experience) the first line.

[Zaprenz]

^Exactly the reason above - interactions with other drugs makes tramadol a potentially more risky drug for individuals taking certain drugs. Codeine has it's side effects too but tramadol requires more checking for suitability.

Zydol (brand name) tramadol hydrochloride 50 mg, net price 30-cap pack = £3.35

Generic tramadol hydrochloride 50 mg. Net price 30-cap pack =
£2.98

codeine phosphate 15 mg, net price 28 = £2.10; 30 mg, 28 = £2.29; 60 mg, 28 = £4.29

Considering some asthma inhalers (a common condition) are very expensive. E.g Seretide 250 evohaler => £62.29 , not to mention some specialised drugs on the NHS which can go for £500 just for one dose. The money (for once) would not be the factor holding a prescriber back from prescribing it.

Tramadol belongs to Analgesics and has the following interaction information:
Antidepressants, SSRIincreased risk of CNS toxicity when tramadol given with SSRIs Antidepressants, Tricyclicincreased risk of CNS toxicity when tramadol given with tricyclics Antipsychoticsincreased risk of convulsions when tramadol given with antipsychotics Increased risk of toxicity with myelosuppressive drugs
Atomoxetinepossible increased risk of convulsions when tramadol given with atomoxetine Carbamazepineeffects of tramadol reduced by carbamazepine Coumarinstramadol enhances anticoagulant effect of coumarins Change in patient's clinical condition, particularly associated with liver disease, intercurrent illness, or drug administration, necessitates more frequent testing. Major changes in diet (especially involving salads and vegetables) and in alcohol consumption may also affect anticoagulant control
Duloxetinepossible increased serotonergic effects when tramadol given with duloxetine Ondansetroneffects of tramadol possibly antagonised by ondansetron Selegilinecaution with tramadol advised by manufacturer of selegiline

BNF

[bloodred1889]

the point is swim is in real pain, if tramadol is a weak opiod, then do you think swim can ask for somthing stronger then tramadol?
or do you think if swim acts like she dosnt know anything and leaves it to the doctor to decide, they will try tramadol next?

[rocksmokinmachine]

This is the analgesic ladder for the UK medical proffesion. Analgesics such as dihydrocodeine (the UK equivelent of hydrocodone) may be prescribed, but it is doubtful. UK doctors are very careful in what they prescribe, and the PCT clamped down a couple of years ago on doctors "over prescribing opiate painkillers and benzodiazepines" so your doctor may well be very reluctant to do this. The ladder follows.

Step One
The first step of the analgesic ladder is to use a non-opioid analgesic, for example paracetamol. Adjuvant drugs to enhance analgesic efficacy, treat concurrent symptoms that exacerbate pain, and provide independent analgesic activity for specific types of pain may be used at any step (eg NSAIDS).


Step Two
If the pain is persisting or worsening despite step one then a mild opioid such as codeine should be added (not substituted). Examples are combination preparations including co-proxamol and co-codamol.

Step Three
When higher doses of opioid are necessary, the third step is used. At this step an opioid for moderate to severe pain is used, eg morphine. The dose of the stronger opioid can then be titrated upwards, according to the patient's pain as there is no ceiling dose for morphine.

[FuBai]

I still think your best move is to appeal to the medical trust where you live or to appeal to NICE. I think a really important question is - do you have a known or demonstrable history of illegal drug use? If you don't then I would threaten legal action in your position on any of the two following grounds a) age discrimination b) compensation required for medical malpractice . Once a threat of legal action is made then the importance of your case will become greater in the eyes of the trust. The reason they are worried about giving it to you - that they may be proscribing a drug which you will only use recreationally - is not for your safety, but rather because of the worry of legal ramifications. So seek legal counsel in private, if your counsel thinks that there is a case to be made then take that to the trust and say that you have consulted a solicitor who says that there is strong case to be made and that you see legal action as your only recourse against a system that is failing you. I think you should phrase it like that - as a last recourse that you were hoping to avoid but is, regrettably, necessary. This way the obvious course of action is simply to proscribe the medication and those dealing with the issue will feel lucky not to have been sued, and you have successfully shifted the balance of power and hospital sympathy. Don't threaten them with legal action if your solicitor says there is slim chance of victory (because the hospital legal team will know this as well), and really make sure it looks like a last recourse that you feel pressured into by unfortunate circumstance.

[bloodred1889]

ok swim could do that, and thats very helpful advise, but.. a lawer here would cost loads of money that swim dosnt have.
plus swim thinks she hasnt got to that stage, swim will see another doctor and if they still dont prescribe anything, then maybe she will complain, its annoying also because there are loads of opioids prescribed to older ppl, even just a little older like 25, basically i think the fact swim is a student and 20 years old is very much against her.

it also dosnt make sence, if i was 30 and / or lived in america, i would have been given vicodin nearly straight away, even maybe for just saying i had a headache, swim dont know if this is a good or bad thing, but its annoying.

[FuBai]

If you are in a position where you can't afford legal counsel there are state provided counsels that can help you. My knowledge of the mechanisms of the UK legal systems is limited - my main interest is in the conduct of cases, not how they are brought to court, and the latter is an area I should do some research on. However, I am still reasonably sure that there is legal provision for people in your circumstance and it is worth doing your own research on-line. I think it is of the utmost importance that you remember that I am little more than an interested bystander, and you should really find someone more intimately involved with the system - in short, don't necessarily accept what I am saying as fact, do your own research.

[cz-one]

Uk doctors are loathe to prescribe opiates for chronic pain for anything other than terminal illness,and if the back pains been investigated and not shown up as a degenerative disc,or disc prolpase,or trapped nerve,or anything demonstratable,than i doubt you'll get anything stronger than codeine. Uk doctors tend to learn from the usa's mistakes,and so thats why they dont dish out strong painkillers for anyone who goes in saying that they're in pain,as well as why you wont find oxycontin and hydromorphone and fentanyl patches widely available on uk streets,like they've become in the USA,and going private will probably result in you paying a lot of cash only to be told exactly what your own GP has told you,and as for going to NICE,the doctors seem to have probably followed their guidelines anyway regarding analgesia.,sorry to be a misery,but if you think you'll be able to go to a doctor,tell him you've bad back pain,and that he'll turn around and go"ooo,you poor thing,i'll write you a prescription for some morphine sulphate right away,and if it doesnt help,come back and we'll try diamorphine"(!!!!)....not gonna happen.

Reputation Comments on this post:

Spot on analysis