Whats stronger than tramadol?

I currently take tramadol andstrongco-codamol for my fibro pain as well as other fibro meds but lately they arent touching the facial pain or especially the pain in both knees.I have been sat crying with the pain. I have just made an appointment with my gp and i would like ideas of what to try next. Does anyone top up their pain relief with oramorph? Does it work? Many thanks xx

30 Replies

  • Hi Charlii

    My doctor has put me on Gabapentin and Ibrofen as well as tramadol, co-codamol and Paracetamol by the ends of the day I rattle a bit. the problem with these tablets is the side effects, I am lucky as I don't have many side effects or perhaps I do but as the pain is still bad I don't notice. also as I have a hiatus hernia I have to take tablets for that and with no thyroid I have to take some for that also. Side effects are not bad for me thankfully,I think just the dry mouth and the constipation.

    I do have access to oramorph and that is only a last minute drug to have as the body gets used to it and you need more and more to do the same job.

    All these are to help with the pain and it is bad with them and with a flare up nothing does work and all you can do is wait for it to go away and swear you will not overdo it again.

    Hope this is not to scary but I have had pain problems for over thirty years and so have worked up to this over the years.

    Kindest regards


  • Thank you for taking the time to reply Terry. I am on the max dose of gabapentin and like you i have a very dry mouth as a side effect. I can usually manage on my usual meds but im having a flare up at the moment and it was my birthday yesterday and i was in so much pain that i would have wept but the tears would hurt my face too much and i just need an extra pain relief in those circumstances x

  • Hello,

    I too like you both suffer terrible pain, dry mouth I can deal with, but not the continued pain.

    I take Zapain.

    Ask your GP they should be able to prescribe it for you, it's the only one that helps take the edge off the pain for me.

  • Charlii, it would be a good idea if you spoke to your GP about this as we really can't advise or condone "topping up" meds with Oromorph. These are very strong opioid medications and you need a medical professional to advise you about doses and what med is safe to take with another med etc. I am sure you can appreciate this.


    Please don't top up your meds up folks, certainly not with morphine. This isn't a good or safe idea, it is also potentially extremely dangerous and not advisable. The side effects from doing this can also be dangerous.

    (((hug))) xxx


  • (I forgot to mention that opioids are highly addictive too. Another reason to be extremely careful about these meds please.)

  • I take Pregabalin, co-codamol, tramadol and Diazepam at night and if needed during the day if I am having muscle spasms. If I am in a major flare or in a lot of pain I do take Oramorph. It does take the pain away and I sleepy but only like to take it on an emergency basis so I don't get too used to it, so its no longer effective.

  • I understand that Zapain is a trade name for for co-codamol which we most of us know by that name, so as Charlii is already taking that she could not take Zapain. Most medications have a trade and generic name

  • Quite right Ebony, Zapain is a brand name of Co-Codamol. Thank you for pointing this out.

    Info on Zapain below -


    As Ebony says, Charlii is taking this medication at the moment already.

    (((hug))) xxx


  • I'm taking tramadol (x2), paracetamol (x2) and ibuprofen (x4) together when I absolutely need a break (turns out that's quite a lot...) but it doesn't do much. I think it's only the ibuprofen that's actually doing anything and only at very high doses. Because of this I think it must be an inflammation problem (is fibro inflammatory (?) this week?). I've already tried pregabelin (Lyrica), duloxetine (Cymbalta) and a lidocaine infusion and they did nothing. Co-codamol doesn't do much either and makes me feel drugged. I'm thinking of asking my GP if I can try Low Dose Naltrexone or if she won't prescribe that maybe a patch... (I'm buying the ibuprofen myself - it's not prescribed as I didn't think I would get it long-term.)

  • Hi all

    I am sorry if I misled you all about the Oramorph but what I was trying to say was don't take any of the heavyweight drugs. Even those drugs that are not addictive will get you in the end because the body gets used to them and you need more to do the same until you reach the fatal dose which although it does stop the pain is not really a good outcome.

    As I said these tablets I take have been building up for a long time and if you were to be prescribed all these within a short time of being diagnosed then I think your doctor would be most unprofessional.

    Reading what slowmomax has written reminds me of what my wife's doctor told her when she was waiting for her hip - Take two paracetamol and two ibuprofen together but only at the last resort.

    Speak to your doctor or your pharmacists may be able to help and might give a suggestion as what to ask the doctor for.

    Strangely enough Charlii it was my birthday on Saturday (quick check of the calendar, yes thats right) so Happy Birthday to you Charily and I know you did not get your birthday wish because you are on here. It is a pain (no pun intended) having to put on a brave face even when you just want to scream 'go away'. personally i have whittled it down to people who know how I am, thankfully they do not have any expectations of me so I can mostly be me.

    Kindest regards


  • Hi Charlii,

    Are you on the max dose of tramadol? & have you tried the slow release tablets?

    C x

  • Hi everyone and thank you for replying. I am already on the max dose of tramadol and yes, i have tried the slow release ones butthey didnt work for me.

    Liberty,i read your post and felt myself prickle somewhat.....maybe i read it wrong but i felt like you were talking to me as though as i were a bit daft....,,.i am fully aware of the dangers of oramorph and similar drugs its just that i couldnt think of any others at that moment. I am not happy as it is taking all the meds i do now but if i can be a mum,wife and a friend by taking them then so be it.

    Terry,you seem to understand where i am coming from and you wasnt misleading about oramorph.....oh and happy birthday for saturday x

  • Lucy, what is zapain please?x

  • Strong opioids are not recommended for Fibro - they cannot work as effectively as "usual" in someone with Fibro, but we are prone to side effects, so the risk-benefit ratio is poor.

    Targeted treatments are a far better idea. If you have a lot of neuropathic type pain, then a drug used for neuropathic pain might be a good option to consider - these include Pregabalin and Gabapentin. If you have a lot of muscular tension, then a drug with a muscle relaxant effect, might be good. If your sleep quality is poor, this should be targeted....

  • happy birthday Charlii and Terry!



  • Use what ever works. I take a combination of codeine phosphate, ibuprofen, paracetamol, fluoxetine throughout day and night for pain, and clonazepam, zolpidem and / or temazepam for sleep. I'm very aware when I seem to need more of one med due to increased tolerance, in which case I use more of another type. I'm def not pain free and am considering other meds which work in different ways (eg neuropathic).

    i don't worry about becoming addicted as such because if one has pain, one needs pain relief. however, maintaining the lowest effective dose is important to me.

  • I take Zapain but I haven't found it to really control my pain. It's a paracetamol/ codeine mix, but with a higher codeine content than usual. The major drawback for me is the constipation!! I also have osteoarthritis, which of course affects my bones, which in turn is difficult to medicate. Along with all the other meds I take it's difficult for my GP, who is excellent by the way, to find something that doesn't contraindicate with my meds!! The vet may be better help d'ya think??? XX

  • Opioid medications can cause constipation Sue, that's a common side effect of taking this type of medication. xxx

  • Thanks friends, there are certainly a few drugs to try that i wasnt aware of.I wasnt simply thinking of going onto oramorph, i just didnt know the names of others i hadnt yet tried.I was warned before staarting the strong co-codamol that it causes constipation butthat hasnt happened to me...to be honest, being constipated wouldnt always be a bad thing for me sometimes! Thanks Lindesy,i have taken your advice...but do you know why they dont work as well on us fibromites please?im curious now lol!

    The reason i ask is when i go to see my gp next week, she will call my name over the tannoy and then walks along the long corridor to greet me and to help me walk to her room.She then gets us both settled and asks how i am....fatal! I sit there crying and moaning while she just sits and listens carefully. When im finished she will ask me what i would like to try next and if i dont know she will look at my recent meds andgo from there but if i say "well other sufferers use this and that" she will check which meds are compatible with my own or whichones i need to stop in order to be able to try new ones. Sheis so wonderful and i know how lucky i am to have her. She believes in fibro 100% and says that one day soon all the doubters will look like fools cos they will find medical evidence that cant be ignored and its about time some docs went back to med school!

    Sue, i think youre onto something with the vet idea lol but no liberty im not thinking of that horse stuff folks use before you think it! Whats it called again?......ketamine! But thanks again friends...youhavegivenmeideas....take care charlii x

  • Hello Charlii, the reason strong opioids are not recommended as treatment for Fibro is because with Fibro you have fewer available opioid receptors than normal. Opioids cannot work as effectively in someone with Fibro and having Fibro can make you more susceptible to side effects. So the risk-benefit ratio is poor for these drugs.

    Hope this answers your query. :) (((hug))) xxx


  • Thank goodness for that Charlii, regarding the vets! lol! ;) xxx

  • What Libs said. :)

    It may help to take in printed info from both the FibroAction and NHS websites. FibroAction have worked with NHS Choices (formerly the NHS Direct online service) since we started, and their information isn't bad. Many GPs are happier to work with NHS information rather than that of a charity, though this may change as we produce more information accredited under the Information Standard.

  • I have myofascial pain as well as fibro, which is why diazepam and the occasional dose of Oramorph work for me as myofascial is more inflammation of the muscle lining, etc. Oramorph only lasts for 4 months in the bottle, so I often have half a bottle left when I have to get a new one, hence occasional use. Am on Pregabalin for fibro. Also change every 6 to 8 weeks between co-codamol and tramadol, to try to prevent getting too used to each so they don't work as effectively. Pain clinic advised taking tramadol with paracetamol as they work well with each other. I am unable to use anti inflammatories due to family history of stomach issues.

    Bit of advice just in case you don't know but I used to work for gastro consultants and a lot of people came in with stomach bleeds. If taking them make sure it is with food or milk and if you are taking long term, see your gp and get stomach tablets such as Omeprazole. Sorry if you already know this

  • Thank you for explaining all this to us Jom, it seems you have a very controlled method of coping with your pain and this is supervised by the pain clinic.

    Thanks also for your very good advice about taking anti inflammatories and also using Omeprazole.

    Speaking personally my eldest son spent a spell in hospital recently with a stomach bleed, he had been taking ibuprofen for pain in his back at work without lining his stomach as he was always on the go and didn't eat or drink sufficiently. This affected his kidneys too. He can never take anti inflammatories again and has to take Omeprazole permanently. He's only in his 20's, it was a terrible worry at the time and could have been so much worse.

    Thanks again Jom! :) (((hug))) xxx


  • I would just like to endorse what Libby and Lindsey have said, and that is although this is a forum open to sufferes it is very dangerous to talk about various meds as it is down to the G.P. and or consultant to decide along with their patient what is a potentially suitable medication to try, We are all individuals and as such there are so many things going on with us that what suits one person will not suit another and then there are many interactions with a host of medications, so it really is a science. If you can foster a good relationship with your G.P. it will work in your favour. It may take a while to get your meds balanced but I would ask any one going through this to be patient.

    Gentle Hugs to all x x x x

  • Hi Jom

    Have you ever tried Clonazepam? Some of the top Fibro docs use it for their patients as it is often great for myofascial pain but also works to improve sleep quality in a way that is very important for Fibro (so many meds work to increase sleep quantity not quality). As I understand it from talking to these experts, it is preferable to diazepam for Fibro because of this, but has similar muscle relaxant effects. Many UK GPs are not comfortable prescribing any benzodiazepines, but if you're already on diazepam, it might be worth asking your GP about it.

    Best wishes (and thanks for posting that info on NSAIDS - very important and often isn't pointed out!).


  • Thank you, I will check this out on my next Pregabalin review just after Christmas with my GP.

  • I am taking Cymbalta 40mg, amitriptyline 25mg 2 naprosin i slow realise tramadol then 2 tramadol twice a day. Of late pain breaking through so take between 2.5 mil and 5mil of liquid oramorph. I am then pain free as long as i remember to pace.

  • I know this is mega old but thought I'd reply anyway, Ive been in chronic pain for 10 years so there's no chance whatsoever your Dr will prescribe what I'm on so I'll just give you names of what led to what if you know what I mean? First is was co-codamol 30/500 which were no good, then Tramadol that made me sick. After that dihydrocodeine 60mg 4x daily, they were really good so was on those for about 1 year. Then Oramorph 5ml 4x daily, then MST which is morphine modified release so I only needed to take 60mg twice daily and oxycodone 20mg whenever I needed it. Then it was OxyContin that is oxycodone modified release 40mg twice daily plus the oxycodone immediate release. Then Fentanyl patches 50mcg/hr plus immediate release oxycodone. Anyway know this is old so I hope you got sorted and this comment is for others who found this page who too had same question.

  • This is a very old thread but I thought I would mention that after a surgical procedure my partner was given nefopam 30mg.

    They currently take 75 mg amitriptyline, duloxitine and tramadol but have found that the addition of nefopam has made a huge difference in hip and back pain to the point of barely noticing the pain!!! This is massive for them as no pills have ever taken away pain to such a degree.

    Also we are hopeful as nefopam is a non opiod that this will be a better pain relieving option in the future.

    Here's hoping at a reduced dose the pain can be managed without the body getting used to it!

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