Help!

[Hayleyb87]

I was prescribed zapain (30mg codeine and 500mg paracetamol) a while ago I take this daily due to the amount of pain I am in. It is no good and I think the effectiveness has worn off due to the length of time I have been on it. The doctors say they can’t prescribe me anything stronger as anything above zapain in strength is for cancer sufferers! Surely this can’t be the case, I can’t carry on in so much pain. As anyone on anything different/stronger that can advise me? 🙏🏽

[Fabbird]

Hi, how many times a day do you take that dose?

I use the same drugs, but have got my GP to give me the codeine in separate pills. This means I can start taking 1g of paracetamol, then add 30mg codeine as needed. I hold off as long as possible on the codeine and I think doing it this way means I take less than I did when I was prescribed the two together in the one tablet.

It’s true that if you take the codeine continuously it will stop working. It’s an opioid, so we build up tolerance to it. It’s dangerous to just keep taking more.

Most (maybe all?) painkillers cause problems if taken continuously. I think the usual advice is to alternate between different kinds. This stops tolerance building up and reduces side effects. Your GP should be able to advise, but I’m wondering if there’s something else you could take for a few weeks? My dad has a chronic pain condition and his excellent GP has him regularly rotating between different pain meds.

[Hayleyb87]

Thanks for the reply. I can’t really cope with the pain and working full time I can only manage it with taking painkillers as soon as I start to feel the pain. But if the doctors are correct and can’t prescribe me anything else I don’t know what else I could do to cope!

[Fabbird in reply to Hayleyb87]

If you’ve been taking the codeine daily for a while it’s probably not helping much. What pain relief you do get may primarily be from the paracetamol, which of course isn’t very strong.

If I were you, I’d simply ask your GP for a change of pain meds. You may well not need anything stronger. There are several options. The group of drugs called NSAIDS are often recommended: mefenamic acid is a common one. They work in a completely different way from opiates like codeine, so you will get the full effect. Just make sure you consider how to withdraw yourself from the codeine. Again, your GP should be able to advise, or there is stuff online about how to taper it off.

The problem with NSAIDS is that they can be hard on the stomach so after a couple of months, it can be wise to switch again. By this point codeine should work again, and so on.

Does that make sense? If you have pain every day switching every couple of months seems to be the recommended way to manage all the problems of tolerance and side effects. The idea is that you don’t build up tolerance and so don’t need get into high dose opiates with all the risks they bring.

[JadeH92]

Hi Hayley,

Ask your G.P to refer you to your local pain clinic at the hospital. Many G.Ps are reluctant when prescribing opiate based medication. However my G.P has prescribed me Tramadol, Oramorph and MST in the past for my endometriosis pain, so saying other medication is just for cancer patients is incorrect.

There are other none opiate based medication that I have also been on for my endometriosis pain such as low dose Amitriptyline (higher doses is used as an antidepressant) and also Pregabalin/Gabapenitin. I came off these as I am trying for a family and they are not advised during pregnancy. These medication would be better for work as opiates can make you very drowsy and I personally found these did not have as much of an effect.

Keep on at your doctor though because there is more they can do to help.. Don't let them fob you off.

Best of luck,

Holl xx