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Stages of pain meds

Hi All

Just wondered if anyone could tell me if there is a standard 'road' that GP's tend to follow when prescribing pain relief for RA? I read on here about people on morphine patches etc and just wondered what stage the disease has to be at for this kind of med to be prescribed?

GP prescribed dihydrocodeine a couple of weeks ago, but this doesn't seem to be helping.

Don't want to keep pestering her saying the pills aren't working

Any advice would be appreciated.

Thanks and keep smiling

Mandy :-)

8 Replies

I was wondering that too, when I read that about morphine patches. My rheumatologist prescribed naprosyn & max doses of paracetamol, and I have severe joint damage. Morphine seems extreme to say the least, but maybe the disease is completely uncontrollable.

I would e very interested in the why ? My more in law is on morphine patches at 84 for severe osteoporosis of the spine, collapsed discs. She is doubled over, god help her it's no life.

Maybe, there is some criteria for morphine where all other routes are exhausted, but given it's addictive nature, I'd like to know the criteria also?


I started on cocodamol and various other pills like that and then onto tramadol which is OK. When my pain is bad my rheumatologist tends to up my steroid dose. Morphine patches sound interesting. Xx


My GP told me that steroids are safer overall re side effects than the stronger NSAIDs and pain meds? TTx


As I understand it there is a definite "ladder" of pain relief, and you get prescribed the minimum the docs feel necessary to control pain. So there's the mild pain bunch of paracetomol type things, then mild to moderate codeine mixes and then the first rung of the moderate+ things that are opiate based like tramadol. And then a huge step to the more heavy duty opiate things which I think docs don't hand out lightly. And they'd need to be sure that you had tried the less strong things properly, ie not just taking them as & when but had tried to use them fairly intensively. There's some info re managing pain that I've found useful on following link...



My GP prescribes morphine patches when i'm having a severe flare i.e. unable to move.I normally have codeine and naproxen.He will only give me enough for a week and if i need more i have to see him again.I have to say i only have them when i'm in extreme pain,and i stay on them for a short a time as possible.I'm currently on the patches as i'm waiting to see rhuemy on Monday as an emergency,once i see him hopefully he can do something about the flare and the morphine can stop.

Mandy,i wouldn't worry about bothering your GP-if your painkillers are not working you need something that will and there are a lot of options

Julie x


Thanks for the feedback.

Think another visit to my GP may be required to help try and control this unbearable pain.

Will keep you posted on progress.

Mandy x


All GP's and hospital consultants have guidelines and pathway of care for different conditions, if you check the N.I.C.E website it has the pathways on there.

While pathways of care are in place doctors still have their own preference for medications. My own doctor will not prescribe patches until all other pain relief has been tried, they feel if you become to reliant on a particular pain med it makes their job more difficult during severe flare.

I've attached the link for NICE guidelines for treatment of RA patients.

Beth xx


Don't use GP use Rhemey


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