Firstly, I understand no one can give medical advice. But any help in the right direction would be gratefully received.
I have a knee replacement followed by a manipulation last week. I didn't get to speak to the surgeon afterward but my discharge notes said I needed adequate pain relief. I am struggling with the pain and trying to bend it.
I called my GP and what I got was a lecture on opioid addiction. To cut a long story short she was as helpful as a chocolate teapot. She has prescribed me gabapentin. Looking this up on Google this is for nerve pain. I am not sure if this is the correct prescription. Has anyone been prescribed gabapentin? Does anyone have any insight if this drug is the right one? The GP filled me with zero confidence and I don't know if I should be going back to them for a second opinion?
Thanks in advance. 😊
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Angjoplin
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I would not take Gabapentin lightly as you say it is for nerve pain ,I am on Pregablin which is a similar drug but I have RA and fibromyalgia and it really helps . When I had a double knee replacement Paracetamol was my go to drug but then I was prescribed dihydacodiene and though it’s good for pain it’s very addictive and it needs to be increased to get the relief you need ,I have slowly over time reduced them to just 2 at night and hope to reduce further and only use in a flare up . Paracetamol is very under rated but taken as instructed it is very effective and is widely used in hospitals.It’s early days for your knee op and given time and physio it will improve, just make sure you keep it moving,best advice ever given to me , good luck .
Thank you for your reply. I need to get back to work, hence the need to push things along. I have been having co-codamol but I miss doses because it makes me feel very sick. I will give paracetamol on its own a try. I thought gabapentin might be the wrong medication. She just wanted me off the phone....
I asked the gp to read the discharge notes when I made the appointment. I even attached a picture of said notes to the online thing to request an appointment. The gp didn't read them. So, I read it out to her. 😕
Thanks. I can't tolerate tramadol it gives me heart palpitations. She did say tramadol and seemed miffed when I said I couldn't take it. Maybe I upset her plan.
Tramadol like most opioids only works for a time. I took it for a few yrs ,but it was the addictive process that kept me hooked, and the pain came back!
Just a thought how about calling the hospital speaking to your consultants secretary and saying no medication advice was given what is the best way forward and maybe ask for them to put a note on your file/email your GP with their recommendation? Explain pain and what you can and cant have and go from there.
I tried but unfortunately the secretary is on annual leave. If I don't get anywhere I will try again next week. Last time I spoke to someone filling in for her they gave me the wrong information.
I am not advising you but passing on what I have been told about paracetamol. It must be taken correctly to work properly. It is no good taking it when you are in a lot of pain then not taking it for a day or two. Paracetamol needs to be taken on a regular basis to build up the pain relief. I was told to take it every four hours until not needed anymore so it keeps the pain at bay. On saying that, you must not take any other medicine that contains paracetamol as it is very easy to overdose on it and can be very dangerous. If taken accurately it is a very good pain relief without other side effects. Perhaps you could speak to your Pharmacist for confirmation. Good luck.
I would like to second that. I was told by a podiatric surgeon that they used to tell people to start the paracetamol the day before the surgery but then they stopped doing that and he found his patients struggled to keep the pain under control so he now went back to telling patients this even though it wasn't 'official'. So my last surgery I did that and other than two naproxen tablets I didn't take anything else.
You summed it up well this is exactly what the A&E consultant said yesterday every four hours and it builds up, seems to work for me so far and I can't risk a pain killer that does more damage to my kidneys.
Speak to you pharmacist…failing that call your surgeon’s secretary to get his advice….messing about with painkiller’s can cause long term tummy upsets.
PS: try to to speak to a physio about exercises to bend your knee….you can do more harm than good by forcing movement.
I am under the physio at the hospital. They can't advise on pain relief though. I know messing about with pain relief isn't wise. I'm surprised the gp was so bad about it. Didn't seem to take it seriously at all.
I honestly think a lot of GPs are acting disgracefully these days…..I class them with people who are whingeing to work at home for no other reason than they “quite like it”…no annoying patients to talk to….just make unsuitable suggestions over the phone!
To be honest I rather got the impression she would have had exactly the same attitude face to face. Location doesn't make you good or bad at your job, your attitude does.
Did you see this in the news yesterday? I presume it was GP’s in England.I have no objection at all to GPs being well paid….but only if they actually do the job they are getting paid for.
“GPs saw their earnings rise to £142,000 during the pandemic in a Covid pay boom, new data show.
The official NHS figures reveal that as surgeries closed their doors to patients, routinely restricting face-to-face appointments, doctors’ incomes rose to unprecedented heights.
GP partners – who make up the majority of family doctors – saw average incomes rise by £20,000 to £142,000 in the 12 months after the first lockdown.
The 17 per cent rise, the largest on record, came as the NHS moved to a system of “total triage”, with patients refused GP appointments in person unless they had a telephone consultation first.”
I read it too. Even accounting for media hyperbole, GPs salaries are way too high for their education level, hours worked and care provided. This recent, largely unseen hike is amoral.
Are GPs busy...yes I'm sure they are, at least they used to be when I was married to one...but so are many other workers paid around 30% of a GPs salary with the similar education levels.
A medical degree does not give some mystical insight into the human body, unattainable to most people.
It is a highly competitive degree to gain entry too, not at least driven by the high salary on completion, prestige and status the degree provides.
But, fundamentally it is a 5 year knowledge based degree which requires no meaningful personal research, followed by a practical based year in hospital, (where they are very much put upon and work very long hours for a similar salary to other workers). Then a 3 year GP training programme, again receiving a reasonable salary.
Working for average salaries for 4 years, then bingo over £100k per year on completion, no climbing the greasy pole required, is not quite the same as working for an average salary for ever.
Many GPs I know could not begin to assimilate the requirements of philosophical logic, aerospace engineering, astrophysics , computer science, physics.....and many more challenging disciplines.
Many years ago my husband and GP friend were undertaking a CPD programme into coronary heart disease, the friend failed as he could formulate his thoughts into a readable essay. He was permitted to pass on oral questioning. As a lecturer myself I found this alarming that he could not organise thoughts and put them down on paper... a basic requirement of diagnosis?
My husband told me essay or extended writing was not a requirement throughout his medical degree, it was multiple choice questions, short answer questions, oral questioning and the likes... all with their strengths of testing knowledge...(but do not require the depth of knowledge or organisation of thoughts that an essay does).
The BMA is one of the most powerful trade unions in the UK, hence the big salaries.
Absolutely shocking headlines. Thankfully it's not true. This is where the Telegraph, driven by their own agenda, have taken one figure from a data set and spun it to suit that. GPs have seen a roughly 5% increase in pay, but lost more than 600 in number while providing more appointments. Given the increased workload and CPI, I don't think a modest increase is unreasonable. It takes 11 years to qualify as a GP so the idea that they do not have an exceptionally high level of education is frankly laughable. If being a GP is so easy and well paid, why are so many leaving?
I stand by what I've said, and did acknowledge the most probable hyperbole of the media, but GPs are overpaid for the work they do. Medicine has moved on, it is highly technical and more specialised than a generation ago. There is little public wish (perhaps outside London) for a basic trained Dr sitting on the end of a phone, or by telemedicine 'diagnosing' complex issues.
The misdiagnoses rate, even with F2F appointments, acknowledged by the BMA, runs between 20 - 40 % depending on which research you read. But there is no debate, misdiagnosis rates are very high in the medical profession.
9 years to train is not unusual in today's world, and they are earning a reasonable salary for 4 of those years. In Scotland were I'm from there are no university fees to pay. Training for all Drs at all levels is paid from the public purse.
I have 10 years tertiary education, earning for 5 of those, studying whilst working like GP trainees, but I paid university fees for 4 years. My two daughters studied 9 years with no salary, whilst paying university fees, my son 5 years , no salary with 1 year of fee paying
My partner studied for 6 years with no salary, but no fees.
Many GPs work part time 3/4 x 10 hr days per week and have no on call, at all, yet earn eye watering salaries. In my own job I worked 5 x 8 hr days and around 5 - 20 hrs over and above per week, at home in the evening / weekend, depending on the time of year, after the children had gone to bed. I earned considerably less than half of my GP husband, yet had more tertiary education.
My daughter has a Phd, is a lecturer in a high ranking university and earns mid £40k, she has publication requirements each year to maintain her employment. She sits on the ethical committee, makes decisions, represents the university at conferences...no 3/4 day employment choices with more than double the salary.
My SIL is a biomedical scientist, did the same 3 year entry degree as the medical students...they finalised their education in medicine, him in biomedical science. He manages a virology lab, covid and all that, and is paid less than half his GP friend, and does not have the flexibility of hours and works on a rota to cover weekends, no extra payment, but time off in lieu.
When I was married to my husband we did 120 hrs per month on call, as his wife I was not paid for answering the telephones...weekends or overnight....we worked every 6 full weekend 48 hrs straight, and then went to work on the following week Monday to Friday as usual, having worked a full week before the on call, so 14 days straight work and 4 overnights (we covered a night per week too). One patient call per hour on average, GP did house calls then , so he was in and out the house like a spinning top all weekend. The children were wakened by the phone constantly ringing overnight, I got little sleep taking the calls (pre mobile phone days).
I do not wish anyone to have to work like that. I'm glad it has changed.
Today's GPs do not work as there predecessors did.
I suspect many GPs are giving up GP ing for similar reasons to the rest of the workforce...people do not wish to work the way they have in the past, unrestrained Capitalism is biting hard. Hospitality, nurses, carers, school teachers....and many more are also very overworked and short of staff. GPs are no different to other workers, many feel overloaded with work in today's modern world.
Of course GPs should have a reasonable salary after their long training, but the way a lot of them have been behaving throughout the pandemic is disgraceful.
They had no more right to shut themselves behind closed doors than did the cashier at Tesco’s …who stayed at her post throughout the whole pandemic.
Arrangements could’ve been made to ensure that they could carry on with their job far more than they did ….they just ran scared….& are still not willing to make an effort ….shown by the fact the majority of them are apparently only working a three day week.
Many senior doctors in all fields of medicine are leaving the NHS because of the archaic rules on their pension fund limitations.
But as everybody with half a brain knows ….unless the NHS is taken out of the hands of politicians it’s going to continue exactly as it has for years…. Throwing lots of money to the same inept people - to make the same mistakes - year after year with the majority of them knowing nothing about medicine and nothing about running a business which is what the NHS is these days.
I was given a limited supply of cocodamol after my knee replacement by the hospital. I didn’t need them all. Did you see a physio at the hospital for exercises? Both my knees were NHS Scotland
I used to be on cocodamol. You have to take it after food otherwise it really upsets your stomach. Even so I wasn’t keen. It is a mixture of codine and paracetamol. So now I take paracetamol for my RA and only add in codine when I need it. Which works better for me. Codine has to be prescribed though as you can’t buy it over the counter. Note that codine can give you constipation so you will also need something like Fbryogel (a drink) to move things along if you are taking codine regularly.
I have a regular prescription for cocodamol. But as you say it makes me terribly sick, and dizzy too into the bargain. Doesn't matter what I eat with it. I only take it under extreme pain if I really have too.
I was prescribed Gabapentin for arthritic pain,but gave me brain fog, so only took it at night. Then a consultant in old folk(!) told me it lowers blood pressure.As I have postural hypotension, I've just stopped it. Hope to now find a substitute that's not opioid.
Thank you for the info. I specifically told the GP I didn't want something that would make me foggy. I asked about the side effects of gabapentin and she told me to read the leaflet. When you took it at night did you still feel foggy the next day? Did the pain relief last till the next day?
You are correct that gabapentin is for use with nerve type pains, and is very good for that. So patients with fibromyalgia find it helpful. It is imperative to get your pain under control, to get the knee moving, otherwise you risk needing another manipulation under anaesthetic. Are you applying ice to your knee?, it is very effective, should only be used for 10 mins at a time, but can reduce swelling, making it easier to get the knee moving, and is a good painkiller in itself. Also when resting keep it elevated, otherwise the swelling will worsen and pain will increase. Hope you are able to get another GP to review, but do stress the need for pain to be managed in order to avoid another MUA. Good luck
Thank you. I don't use ice as much as I should tbh with myself. I spend too long sat at my desk working. You are exactly right, I want to get the pain under control so I can get the knee moving. I absolutely don't want another MUA and I need to get back into the office. I've tried getting through to rheumatology but the lines are closed. I really just want to bang my head against the wall. I will make more efforts to ice.
I'm afraid I think that borders on the negligence! It is a highly inappropriate medication for the pain you are having.
I would talk perhaps to the pharmacist, if you have an accessible one.
You might find that soluble solpadeine (contains the same dose of codeine and paracetamol as co-codamol) is easier on your stomach as it's effervescent but it seems in short supply right now. Or try taking the co-codamol in fizzy water?
You have already been given good advice about taking paracetamol on a regular basis before you need it but keeping a close eye on total dosage in 24 hours. I presume that you can't take non-steroidal anti-inflammatory drugs?
Yes. I thought her whole attitude bordered on negligence. Thank you for the tip on solpadine. I will look that up. I think I am going to set up an alarm on my phone for paracetamol and give that a try.
Sorry to read about your less than helpful Gp conversation. Re the cocodamol just wanted to pass on my experience with using it for pain relief - I find I can’t tolerate the standard dosage either without feeling sick/dizzy. So my Gp gives me smaller dose codeine tablets which I can take alongside paracetamol when I have bad pain with a flare, and that seems to work better for me in terms of side effects whilst still taking the edge off the pain. Good luck with your hospital appointments xx
My GP gave me 15mg tablets, after I struggled with the 30mg ones. She recommended starting with 1 x 15mg tablet and then if pain still bad to half another tablet and take that as well. To be honest I haven’t yet tried the 22.5mg dosage so don’t know what the sickness/dizziness would be like at that level, but I seem ok at 15mg. Xx
I was given Oramorph after my hip replacement. It was amazing for the pain and a good sleep. I weaned off it after leaving hospital and physio rehab. I now take Gabapentin for nerve pain, 2 X 100 mg per day.
I was given Gaba when I had very bad sciatica together with morphine. Now I take Gaba as pain control for cancer side treatment effects. It works very well, takes a couple of weeks to become fully effective and you can't come off it suddenly. You have to stop by gradually reducing the dose. Best of luck. I hope you find a painkiller that works for you. Luckily I only needed cocodamol after my knee replacement.
Hi there, I’m so sorry you are going through this. I have chronic pain and use gabapentin every night before bed. It is helpful for sleeping and my body adjusted to it and I feel fine when I wake up during the night. It is quite a safe drug from what I’ve been told by various doctors. That being said, it’s important not to stop taking it suddenly. You need to gradually taper off of it. Sometimes if my pain is really bad I will take during the day. I also use a TENS unit (Amazon) and that can help. Reveri has a good hypnosis app for pain. Surprisingly, it’s quite helpful. I also find that heat and cold help. Wishing you the best.
I don't know about Gabapentin but you have my sympathy as I broke my fibula on Saturday in 2 places and it hurts ! I have a boot and crutches which I find hard to use but just wanted to say that the Amazon loo seat raiser and shower seat have been great. I had a shower this morning and feel so much better. I am not allowed Ibruphrofen or Codiene due to kidney disease but paracetamol is working although has to be taken regularly. I'm not sure why but may be low clearance rates and I'd not risk any of my remaining kidney function. I also have found frozen peas good and so best wishes for a speedy recovery.
Many GPs have a blanket objection to opioids - mostly because of negative connotations. Doctors should have a more nuanced and informed view because they fill a very useful place in pain relief. They are safe and effective if used properly. However, that means the doctor has to be on the ball and proactive, which is too much effort for some. As others have remarked, paracetamol can be surprisingly effective in taking the edge off some kinds of pain (especially when doubled-up with ibuprofen in my experience, although if you might want to consider omeprazole alongside to protect your stomach). I hope you find relief.
Have no experience of Gabapentin but do have experience of Etoricoxib which has been very effective for me. I was first prescribed it for the extreme pain in my shoulder but it did nothing. Nearly 2 years on my rheumatologist knows why: shoulder was not RD related but a separate issue adhesive capsulitis known for being difficult to get under control in terms of pain. I have however reached for etoricoxib since for flare ups to avoid prednisolone and have been surprised by how effective it is even after one tablet.
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Anyone on gabapentin for RA
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Please Advise...RA 
