Effects - Usefulness of codeine as a pain killer

[dark12]

Hey all.

SWIM has been having constant back over the past few months. It was always bothersome but tolerable; until a few days ago. While at work, the pain suddenly became unbearable. He left work for a bit to lay down in his car. He decided not to go to the ER, but instead to his family doc the next day.

Anyway, he ended up getting a blood test and an x-ray. SWIM's doctor has known SWIM's family for almost 30 years. As some of SWIy may know, SWIM's sister overdosed on heroin about 6 months ago. Because of this, SWIM's doctor seemed to treat him like a drug addict. This really bugged SWIM. SWIM left his office without any pain meds. Later that day SWIM was in pain again and called his doc to ask what he should do, his doc phoned in a script for 4-8 tylenol 3's per day. This equates to 120-240mg of codeine per day.

When SWIM arrived at the pharmacy he immediately took 4 pills for the pain he was feeling. This gave SWIM a pronounced buzz and killed the pain very effectively for about 4 hours. Today SWIM woke up for class and his back was beginning to bother him so he took two Tylenol 3's. Here is the problem: At this dosage, the medication did not provide pain relief. SWIM sat in class feeling miserable and drowsy. SWIM is afraid that he will have to hoard his daily dosage and take them in large amounts to kill his pain.

SWIM knows that most will recommend a new doctor. SWIM is working on this presently. But SWIM would just like to know if any amount of codeine could provide the same kind of pain relief that... let's say 20-30mg of oxycodone could provide? Is the difference between codeine and the more powerful opiates just potency or is there something about the stronger opiates that makes them more effective for pain relief?

[cockney]

Put it this way, in the UK you get 8mg Codiene for back pain to start with, about 64mg codiene over the day and usually end up with dihydrocodiene or tramadol. Anything stronger is generally reserved for people with terminal illness, I would say you are not getting much stronger for back ache.
We dont have Tylenol over here but is it safe to take four at a time ? If they have APAP in them your stressing you liver mate.
Have you tried something like ibuprofen, NSAIDs aint the best thing for you but they do have their uses.

[dark12]

Each Tylenol 3 tablet has 30mg codeine and 300mg APAP. So 4 tablets would be 1200mg APAP. Hardly a dangerous dose. But yes, SWIM does try to stay away from that crap whenever possible.

SWIM has tried aspirin and ibuprofen, but they never helped him much.

SWIM is talking about prescription doses of pain medications. In the UK, the dosages of codeine you listed are easily obtainable over the counter. In the US we can't buy codeine OTC, but higher strength opiates are prescribed quite often.

[AddyCrazy]

SWIM would say indeed there is more analgesia in say hydrocodone or oxycodone than codeine definitely hence why most people get hydrocodone for everything even as little as toothaches from getting them pulled. SWIM is actually quite surprised SWIYou's doctor didn't prescribed hydrocodone/APAP from the get go. Maybe SWIYou should go back and state his pain is still very much present even after 4 tylenol 3's and only wants to be out of pain. If not SWIYou obviously would have to get a new doctor or maybe get referred to a specialist.

[dark12]

I agree with you SWIaddy.
The reason he didn't prescribe a stronger opiate is because SWIM's little sister recently OD'd on heroin and he thinks SWIM uses illicit drugs too.

[AddyCrazy]

While from the doc's stand point it is understandable SWIYou should definitely be upfront with him and say while addiction does run in families that was my sister. SWIYou should say you have no history of substance abuse(assuming he doesn't otherwise this is invalid) and that if the doctor isn't willing to actual help and treat SWIYou than he will gladly move onto a new doctor who worries about his patients more than his own business as the Hippocratic Oath says.

[dark12]

Yea. Couldn't have said it better myself.
SWIM has absolutely no history of substance abuse and this doctor has never even prescribed him any CIII or CII substances in the 21 years that SWIM has known him. So obviously SWIM isn't doctor shopping or whatever.

SWIy inspired SWIM to look for a new doctor right now. This is just unacceptable.

[RoboCodeine7610]

Try taking NSAIDs with the T#3 and it should provide some more pain relieve.

[dark12]

SWIM went to another doctor just now and he was given a script for an NSAID.
The doctor said SWIM should take it once a day and tell him how he feels in 4 weeks. SWIM replied that he has been taking anti-inflammatory pain killers for months with little effect and that SWIM needs something for breakthrough pain. The doc then told SWIM that he would decide if a stronger medication would be needed after the four weeks.

Great... another moronic doctor that can not listen to a patient's needs.

[AddyCrazy]

SWIM would tell the doctor that taking NSAIDs every day is not good for ones health in the long run and an opiate would be much safer even combined with an NSAID because it'll reduce the amount needed. SWIM supposes at this point the only option would be to wait it out until the doctor realizes SWIYou needs stronger meds. He must look at it from their standpoint they can't just go handing out opiates to everyone who complains about pain they want to make sure the person is serious about it. Also might want to ask his doctor for liver tests if he is going to be on a NSAID daily. What NSAID and what dose at a time and combined daily?

[dark12]

It is meloxicam. It's taken once a day. I am not sure on strength. I never even picked up my prescription because after returning home I did a little research and saw the list of side effects; ironically back pain is one of them.

SWIM thinks he is just going to stop going to this doctor and go to the next one down the list within the next week or so. SWIM is just hoping that he won't start building too much of a tolerance to codeine until then. SWIM still hasn't heard from his doc about the x-ray results so we'll see. It is likely that this ends up just being a temporary muscle spasm and only require a couple weeks of therapy or whatever. SWIM is hoping this is the case, especially when he sees what he has in his corner in terms of pain relief.

Oh well. SWIM has an appointment with the dentist soon to finish a root canal. Thankfully, SWIM is quite certain that he will get something for it because of the intensive process. The best part is he won't have to convince his dentist that it hurts. :/

[AddyCrazy]

SWIM doesn't condone tricking dentists or doctors but one could definitely get a couple codeine, hydrocodone and oxycodone because when SWIM got his teeth pulled he was prescribed T3's but it didn't help so he got 5/500 hydrocodone/APAP and it still killed so the doc gave him 5/325 oxycodone/APAP. And yes the side effects of that NSAID look not too promising apparently gastrointestinal problems such as bleeding or severe pain are a common side effects, more so the pain, from what someone read on a few medical sites. Good luck with the doctors sometimes they just can't empathize with their patients so they don't start out with a good treatment. SWIM's doctor believed he had mild depression and mild anxiety but after going to a specialist and doing 2 days of testing it turns out he had moderate depression and very severe anxiety so much for doctors.

[Spare Chaynge]

4 weeks. If swiys pain is serious he can wait the 4 weeks. Until then why doesn't swim get a third opinion and drop the first 2 drs medication so he can reach a conclusion of what dr he wants to choose. Swim would not recommend filling or continuing to take scripts until swiy has made his choice this would be considered dr shopping.
The thing about drs is they are hesitant to start anybody on an addictive drug. Because once you start taking opiates for pain its almost a never ending cycle eventually leading to higher and higher dosages. Which leads to addiction and negative consequences.

Once your in the ball game they seem to not care.

[dark12]

Very interesting.
SWIM feels hesitant to go to another doc because in the past 2 days he has had 2 scripts called in and he doesn't want it to look like hes doc shopping. I guess SWIM could just call the pharmacy and cancel this NSAID bs.
bleh... :/


EDIT: Wow. Seems I skipped part of your post. Well, either way, my thoughts exactly. I am definitely holding on to my T3 script while I play doctor musical chairs, but no more new scripts.

[AddyCrazy]

SWIYou could try poppy tea in the mean time or kratom even these will definitely boost painkilling effects of NSAIDs.

[dark12]

SWIM has been down both those roads and doesn't think they are worth the time or effort at this point. Thanks for the suggestion though.

[AddyCrazy]

SWIM doesn't know if its SWIYous thing, SWIMs assuming not or else he'd be doing it but marijuana is a very good painkiller and some studies show on some people it is more powerful than morphine when given in concentrated forms and especially when consumed orally. Just another suggestion to ease SWIYous agony while one sorts it all out. Also DXM has been linked to having good pain killing properties via the NMDA receptors.

[dark12]

More good suggestions!
Unfortunately, SWIM signed a release at his new job saying he will allow random drug tests. Because of pot's ridiculous fat soluble properties, SWIM decided to quit smoking.
Drug tests are an invasion of privacy. That is for another thread though, since I could bitch about that for hours. :/

[TheNewLeft]

explain to your doctor that your sister's experience with heroin has made you very sensitive to issues of drug-addiction and has endowed you with a certain degree of caution regarding painkillers....all of which i imagine is true.

then explain you are not a drug addict but a human being in a considerable amount of pain who finds this entire conversation demeaning and insulting....and request something stronger.

there is no good reason for a person to be taking ANY dosage of codeine over 60mg for actual analgesic purposes....which is the entire reason narcotics like oxycodone and hydrocodone were created.

i imagine 10mg of oxycodone would provide superior pain relief to almost any reasonable amount of codeine.

Reputation Comments on this post:

Straightforward and sensible advice.

[dark12]

Thanks for the advice.
SWIM will give this a shot when he sees his doc next. He is completely booked until Saturday so hopefully he can manage his pain till then.

[TheNewLeft]

i happen to have a very trusting and understanding doctor who is very loose with his prescription pad...but i realize most people do not.

every doctor walks a fine line between enabling drug addicts and giving patients the benefit of the doubt...i for one sympathize with that predicament. but the doctors who are so cautious as to allow people to suffer for their own piece of mind....that's something that bothers me a great deal.

[RoboCodeine7610]

It is meloxicam. It's taken once a day. I am not sure on strength. I never even picked up my prescription because after returning home I did a little research and saw the list of side effects; ironically back pain is one of them.

Well I don't know about that side effect but meloxicam is a very effective NSAID since it has a higher affinity to the COX-2 receprtors therefore it is more selective.

[3xtr4]

SWIM would really give the NSAID that the doc prescribed you a go - after all he did give SWIY them for a reason. In the case of back pain like SWIY has, opiates will create an endless cycle of: relief > tolerance > increase dosage.

Reputation Comments on this post:

very true, good point

[drguildo]

Originally Posted by 3xtr4

SWIM would really give the NSAID that the doc prescribed you a go - after all he did give SWIY them for a reason.

Exactly. SWIdark12 chastises the doctors for apparently treating him like a drug abuser (although so far that seems to be nothing but SWIdark12's perception) while at the same time posting on a forum primarily for recreational drug users about how he is going to keep refusing help and switching doctors until he gets the drugs he wants. Gee, I wonder what they could be?

Also, just because something is listed as a potential side-effect, doesn't mean the drug actually causes it. I've been told that while drugs companies are conducting trials they get the people using the drug to list any problems they might have experienced while taking the drug. The drug company is then obligated to list those "side-effects" in the drug documentation. So for example Jim signs up for an anti-depressant trial, only he is one of maybe a small number of people for whom it isn't effective and so reports back that while taking it he felt depressed. It goes in the list of side-effects and all of a sudden you have an anti-depressant that causes depression.

Medicine has a pretty poor history as a science and only recently seems to have got it's head around the difference between correlation and causality.

Reputation Comments on this post:

rude inductive logic that is flawed

[AddyCrazy]

Not to nit-pick or discredit anything SWIY said but the anti-depressant thing is a very bad example because its actually very common and happened to SWIM that people become more depressed usually before they starting getting better and if one isn't on the best anti-depressant for ones body chemistry it often times makes the depression worse as SWIM experienced multiple times just saying side effects are not just random things that happened to the people during trials that have no correlation at all.

Reputation Comments on this post:

please read the posts you comment on more carefully