Opiate Drug Interaction

Treatment and medication
1

Hi, 

I've seen that there are a lot of posts about opiates so I'm, sorry to start a new one, I'm just at a bit of a loss. I want to start by saying that my post will be entirely honest, I'm desperate for some sound advice so pulling the wool over anyone's eyes isn't going to do me any favours. 

I have had a repeat prescription for cocodamol (30/500) and codeine (30mg) for about three years - I'm 31. I suffer really badly with terrible back pain that radiates up my back, into my neck and then causes really bad headaches. I am aware of 100 things that contribute to all of this, I have terrible posture which won't help, I seem to sleep like I'm crazed and for over a decade I was morbidly obese which can't have helped my skeleton so to speak. I underwent gastric bypass surgery 5 years ago which as a complete success but a year later I was diagnosed as a myoclonic juvenile epileptic and am prescribed Keppra every day to control seizures. Over the years my pain has moved through my body and a huge percentage of me can hurt for the majority of my day - awake and asleep. I haven't been diagnosed with any condition, much like everyone else has said pushing the pain killers in your direction seemed the knee jerk reaction. I'm at a stale mate now however. The combination of the cocodamol and supplementary codeine aren't 'working', at the very best I can reduce my 10 out of 10 pain down to about a 3 or 4, the pain never completely goes (and I honestly have a good threshold to pain). I take the cocodamols in sets of three with one or two codeine just to have some level of pain relief, my tolerance to them is now sky high, I can take these sets every couple of hours so I'm ramping through a month prescription in just over a week - even if I am trying to be well behaved. I then spend the rest of the month taking ridiculous amounts of over the counter cocodamol because I don't have any prescription ones left. 

Last year, I explained this to my GP (I didn't go into exact figures but I did say I was taking far too many). He suggested tramadol and I had been prescribed this before following a surgery, I didn't think it was a great alternative and he said that from a GP perspective he was at the "ceiling" of what he has the authority to prescribe. As I am an epileptic he wanted to write to my neurologist and ask if there were any alternative meds that they could suggest because he wanted to avoid interaction. I am convinced that there was some sort of misinterpretation because the response came back and suggested  amitriptyline and so he prescribed me that and told me that this will a). help the cocodamol last longer in my body and b). make me feel the effect of it more, thus negating the need to take my doses too close together. 

The amitriptyline made no difference whatsoever and over a month later I asked him to remove it from my prescription. He then said that at this point, he would need to refer me to the pain clinic because only they can prescribe drugs above and beyond what I have already had. The pain clinic called me to book me in the other day and they advised that all the beginnings of this referral are group therapies which teach you mind skills to help you manage your pain?? So now I don't know if I'm going the wrong way? 

To add to everything, in April of this year I went into A&E with a perforated ulcer and had to have open surgery. I was prescribed both instant and slow release oxycodone which I now hear is incredibly addictive and very hard to come off of. I had no problems with this prescription ending and at the same time, cold turkey kicked a 15 year 20 a day smoking habit, I also wans’t taking anything other than the oxycodone, all other pain relief had been replaced with this. I know people really want to believe "everyone" who has problems like this are "addicted" to opiates, but I honestly don't feel that's the case. I feel that I am drug dependent - severely, but I don't feel like I have an addiction problem with these. 

I want to rediscuss all of this with both my GP and my neurologist maybe by way of an open letter to both of them, I want to know if there are any other pain relief medications that people are aware of that are effective but don't interact with Keppra? I work in an industry high stress environment and going off sick or absent isn't an option, I don't want to not be at work, but just for a little bit of the day I would really like not to hurt like this. I would really like just to be ok every once in a while. 

I've tried to play every game, I've gone to every chiropractor, sports therapist, physiotherapist etc. I have the special wedge pillows for support when I sleep, I've completely bought into pilates, and so on - all of these things suggested by my GP. 

I also know that excess pain relief in itself can also cause pain which is another reason I'm trying to find another solution, the vicious cycle of this is really disconcerting. 

I'm sorry this is so long, any help anyone had - I would be so grateful to hear it. 

Thank you

2

I would like to address you in a private email rather than on this thread because I'm going to make some suggestions of sites you can go to for support and I know those will be monitored out so please watch for an email from me.

3

Thank you very much - that's incredibly kind of you. 

4

Dear SSW, After reading your letter, I found that I had tears running down my cheeks, I felt so sad at what you, as a young person, are going through.As a very old lady who has been through much in life, I have a

few suggestions.

1. I guess you have had full blood tests? Are your vitamins and mineral levels where they should be? If not, perhaps see a Naturopath .Eat only raw or healthy foods, cut out sugar(use dextrose instead.It is sugar with the fattening fructose cut out.)Take probiotics for stomach and bowels.

2.Any chance of curing seizures to get you off Keppra?

3.I am glad you are off tramal.I went cold turkey on tramal after it started causing problems following surgery. I am coming down off Targin (oxycodone) after more surgery and hope to be totally off it in a month's time.

4.Go to the pain clinic. I did, 7 years ago, and it helped me to cope.

5.Have you tried Chinese therapy? If you try it, make sure the practitioner

is a good one. Talk to your neurologist about it. I hear they work wonders

How you keep on working I do not know...you are incredible and I hope you find some relief..

5

Betty I admire you. I have weaned off of opiates on one occasion. It isn't the end of the world but it is hard. But to go cold turkey, yikes! Unfortunately for me my pain came back so I had to start the opiates again.

Like you, it always breaks my heart to see a young person suffering from chronic pain. I feel like they have so much more life left to live and to have to live that life with pain,.. well it's just sad. I was in my early 40s when I injured my back. I am 55 and now have PMR and osterarthritis in addition to my back. It kind of sucks to grow old when your body doesn't cooperate.

Best of luck to you.

6

Hi Both, 

Goodness me - thank you both ever so much. I genuinely didn't expect these repsonses, I'm incredibly touched. Amkoffee, I received your message and I will reply to that separately  

I think the most defeating thing for me is I whole heartedly 'don't know what to do'. I know only too well that this can't continue like this, but the pot of remaining options seems to be so little. I sit sometimes and I honestly don't understand where this world came from - all through my adolescent years and my twenties I was tortured by my size, I hated the life I had and the person that I was so when the gastric bypass was a success it was as if someone had handed me my freedom. Suddenly the life I waited so long for was coming - I visually transformed, found a new sense of confidence and met my boyfriend (my first ever relationship). I could hope for things, I could dream of all the things I wanted my life and my world to consist of and then everyhting started to go a little wrong! The epilepsy diagnosis was the beginning but it has just been one thing after another. I take, in retrospect, an incredibly low dose of my keppra and I do this for a really significant reason (in my mind). Keppra is only about 15 years old so the research data available for it is limited, it is the "safest" medication to prescribe to a woman but it will be a very long time before it can be confirmed that there are no long lasting effects from taking it. As an epileptic, you a). almost never switch drug - they just don't risk it, and b). you never really come down in dosage, you only ever go up. My lifelong dream, above and beyond absolutley everything else it to be someone's mummy, to bring a little person into the world, to be the person who makes my boyfriend a father - it's huge to me. When I was told I would need to be medicated for my epilepsy, I fought my neurologist tooth and nail to keep the dose as low as possible - the idea of putting one pill after another in my mouth with a baby in my tummy kills me. I've broken bones, suffered concussion, torn ligaments - even split my scalp open having fits, but I wont up the dose - if I can't come back down, it's not going up until it has to. That;s why I feel so desperate with the pain meds - in my view opiates are not a feasible long term solution for all the reasons we know, the tolerance and dependance of them grows until they become less and less effective. I'm not a believer (and it isn't a possibility at the moment) but if I found out tomorrow that I was pregnant - this, like you Betty, would end immediately. There isn't a chance on God's green earth I would take these meds within a pregnancy - hence also why I cold turkey stopped smoking. But will all of that said, how would I do that, how would I manage?

I feel like I'm losing such a great deal of the "quality of life". My partner has woken me up before now, in the very early hours of the morning to tell me I'm lying beside. him, sleeping it seems, with tears running down my face, I'm so sore it happens before I even register. Where do you go from there? I can't look at his face sometimes, we couldn't be more different in this respect - he's never even had an antibiotic let alone antything else! I hate what he must see when he looks at all of this in front of him and looks at his life ahead? This shouldn't be a reality for him.

To answer some of the questions you posed Betty:

I have to have regular blood tests after my bypass - I suffer with anaemia and have received ferratin infusions in the past, it's very much a fight to keep on top of this here, it's almost as if the NHS would like you to crash out before they intervene so I have to hit ridiculously low levels before any action is approved. I take a prescription multivitamin (Forceval) every day and after my ulcer I take omeprazole and thiamine and most likely will for the rest of my life. I carefully monitor my results especially for the copper, selenium, potassium and magnesium levels because of the knock on these can have I take a branched chain amino acid supplement which is supposed to help your muscles. I can't eat a great deal of high at or high sugar foods anyway as it seriosuly disagrees with my gastric bypass!

I was only given tramadol very very briefly and as I said - it was odd but I just didn't recognise any benefit to it. None of the pain diminished etc. People tell me it makes them incredibly woozy, sleepy, even incoherent but maybe there was something wrong with my ones because there was nothing! 

I'm a stockbroker by trade so very busy, very high stress, very demanding. Not working isn't an option realistically or even morally (for want of a better word), I'm a grafter by nature, I've had a job since I was thirteen! I have rent to pay, I need to be at work - and the funny thing for me is I'm the same kind of sore all the time, it doesn't matter where I am so work is almost a distraction of sorts. It's just also the place where I look at everyone else and realise how set back I am. I watch people skip around the office, bendind up and down, kneeling - anything really, and I realise that's what I would like to be able to be doing. 

I desperately want to have faith that somewhere, somehow - something will change and this will all be a period of time that eventually comes to an end. For now, until then, I just want to be able to sleep through a night, I just want to manage. 

My quest for non interacting pain relief will continue, I can't believe it would be this way but I almost feel like I have to take the suggestions to their door (!) which is madness, but I can't have their fear of interaction (if indeed they are concerned about that) to keep me in this position. If there is another possibility, they need to be presented with it and fight me back to this point because I can't stay here willingly anymore. 

I can't thank you both enough, I am so so grateful. I'm sorry forums like this even exist, that anyone lives a life of pain and discomfort, I would change this for everyone if I could. There isn't anyone I wouldn't 'make better' if I was able to. We are made of stern stuff to be able to do this