If you have been taking painkillers for a long-time please read below:
We are particularly talking about a type of painkiller called an opioid; like co-codamol, co-dydramol, codeine, dihydrocodeine, and tramadol.
Recent medical evidence questions the benefit of opioids (which are in the morphine family) for long-term pain. Strange as it might sound – we don’t think that they are very good at killing pain at all when taken for more than a few months.
There are risks too – they can:
- sometimes make pain worse
- cause side effects to the intestines and the stomach
- make the body feel dependent on them so if you miss a dose you feel jittery and anxious
- increase the risk of fall
- reduce sexual function in both men and women
- there’s even a risk of overdose and death, especially if taken with alcohol or with some other medicines such as benzodiazepines (like diazepam) or pregabalin
For these reasons we suggest you try a “drug holiday”. This means you gradually reduce and stop your painkillers over a month or so to see for sure whether they’re helping or not. It’s not unusual for pain to flare up a bit when doses are reduced and discontinued but that’s to be expected. Many people take these “withdrawal pains” as a sign that the opioids had been working and need to be continued (or even increased) but that is not the case and most people will start to feel better after a week or two. It can be tough getting through this time but it’s worth it.
Once you’re off the opioids for a month you’ll have a good idea as to whether they were making a positive difference to your life. If they were, feel free to gradually restart them – but try to find the lowest dose that works.
Modern management of chronic pain is geared away from drug therapy and more towards self-management where the patients take control of their lives and their pain with the use of physical therapies, emotional / mindfulness type practice plus pacing strategies.
The following links provide more information:
- Psychological support such as cognitive behavioural therapy: https://me.silvercloudhealth.com/signupor https://www.northessexiapt.nhs.uk/mid-essex
- Mid Essex Live Well Link Well: a free and confidential social prescribing service that provides practical or emotional support of a non-medical nature. Opportunities to take part in community events and groups that have been shown to improve quality of life for people with long-term pain as well as support with money worries or other social issues: https://midessexccg.nhs.uk/livewell/live-well-link-well
- This video “Brainman Stops His Opioids” (https://www.youtube.com/watch?v=MI1myFQPdCE) from Australia is an excellent short summary of the reasons we are suggesting that you may benefit from attempting to reduce or stop your opioids.
If you’ve got any questions about this, or if you are also taking other opioid type medicines along with the ones listed above; feel free to talk to your community pharmacist or to make an appointment with your practice pharmacist or a doctor of your choice to discuss.