Chronic pain, injections & coming off codeine


I've had problems with neck pain since I was a kid. I'm now 27 and still suffering on a daily basis. After MRIs / x-rays /EMG etc I was diagnosed with chronic neuropathic pain and put on pregabalin, duloxetine, amitryptiline and codeine. I see a physio to help with movement as I have very restricted ROM. I've been getting debilitating headaches more an d more recently for the last couple of years, which the docs have now decided are 'medication overuse headaches', and I'm currently withdrawing from codeine to see whether it helps, which I'm finding difficult! Pain clinic has suggested trying some injections for pain relief - I wondered whether anyone has experienced this too and has any advice?

21 Replies

  • Nope never had your condition - although I have "come off" codeine before. I need you to know that I am "back on it" for other body drama (surgery on broken arm and a plate put in) Look I can ONLY speak from my point of view, I am not a Doctor. First time around was evil - but I DID get off it. I reduced dosage down to nothing and then went "cold turkey". I was very ill and cried a lot but it WAS worth it. I took just a store bought pain killer during and after, but I was in a very different head space then - Nothing including the injury or codeine was going to tell me what to feel. loufoy good luck with your body detox - you can do it!!! Please get in the winner frame of mind first :)

  • I am somewhat confused about the difficulties in "getting off" codeine. I have had chronic pain since I was 30. Over the years the pain has come and gone, comeback and gone again etc.

    I have been on drugs far more powerful than codeine. For example I now take methadone (for nerve pain), oxycodone and hydromorphone (both for severe body pain. At various times I have come off all of my pain medications for one reason or another. Two of my specialists told me the same thing: you will not get addicted to pain medicine IF you use it only to relieve pain. Over the 25 years to date during which I have had to use pain medicine, I have never experienced one withdrawal symptom - indeed, I have stopped using pain meds on about a dozen occasions - each time I have simply stopped all at once (no tapering off) and have felt no withdrawal symptoms at all. It seems as those my doctors were correct in their advice that you won't be addicted if you use pain meds for pain. I don't know if I am unique in this regard or not.

    So the fact that some people are experiencing withdrawal symptoms from codeine (one of the least potent pain meds) suggests to me that the patient took more than the prescribed amount (meaning that the excess was not used for pain control) or stayed on the drug for too long (meaning that it was used in the absence of pain).

    So I can't really advise anyone who is experiencing pain med withdrawal symptoms. But as a preventative action, take only the amount prescribed and take it only if you have pain. By the way, I also noticed that my head never felt woozy or "high" - if it does, that would be a warning sign to stop taking the meds immediately (if you are able to do so safely).

    Another thing that I would note is that I never had to have my dosage of any pain med increased (because the original prescription just "didn't cut it anymore"). I suspect that the need to have pain med dosage increased is a sign of impending addiction. Again, take only the amount of pain meds that is prescribed to you, take them as and when prescribed, and take them only if you are experiencing severe pain. Do these things and you might find that addiction and withdrawal are things of the past.

    I have one caveat to the above, it does not apply if you have an addiction problem in general. In my case, I don't drink coffee, I drink minimal alcohol (a beer ever two or three years), etc. I do not have an addiction prone biology. If you are prone to addictive behaviour, you need to discuss that with the prescribing doctor BEFORE you start taking pain meds.

    I'd live to hear some comments - perhaps my experience is unique or perhaps it is common. You tell me!

  • I would think that you are the exception to the rule. I'm not a pharmacist but have some years of experience and research so here goes....I don't know any one who has taken an opiate based pain killer for chronic pain that hasn't become addicted. The idea that you won't get hooked if you 'genuinely' have pain is rather dated and i think they know better now. The human body is actually designed to be 'hooked' on to opiates becasue they mimic very closely the endorphins produced by the body. If you think of it in terms of a key in a lock, your bodies endorphins are the keys that came with the original lock and the opiates are all the keys you've had copied. Addiction to codeine is a major problem for people in pain who they are efficacious for...for instance, someone I know got very upset with me for returning a big bottle of them when I first got ill because they did nothing for my pain...for me they were not the right key and hence they didn't work. For the freind who was upset (because she wanted them!) they were the perfect key for opening the lock to - and mimicing the effect - her endorphins had on her brain which was to make her 'high'. So in some ways if they don't give you a certain amount of euphoria they won't have any relief on your pain. Most opiate based pain killers work by making you 'forget' and 'not notice' how much pain you are in. Different pain killers 'work' or are 'efficacious' in different ways. Paracetamol and Acteylsalycilic acid (aspirin) work in similar (but not the same) ways by interfering with and inhibiting the bodies inflamatory response to if you don't have an infalmation related pain they won't work. So if you have pain that is neuropathic in origin you have no choice but to use opiate based drugs (I include codeine in this but a chemist might not) when the pain is severe. The insrtructions we are all taught to follow at the pain clinic are to head the pain off with pain killers before it gets to the stage that it's unbearable. This involves taking your pain meds as you would any other medication for a chronic illness with breakfast, lunch and dinner every day, now I don't know about you but my pain levels vary somewhere between a 3 to 9 on a daily basis so I have to take the drugs every day and there lies the rub...I've been taking them now for well over 10 years. I take the same amount every day and they still work and fortunatley for me I haven't built up a tolerance. But people do build up tolerances to pain essence because of how they work and how we have to take them. Being addicted to pain killers because you've been in pain for years is not the same as being addicted to pain killers or other opiates for 'fun'. There are different types of addiciton too. There's the physical addiction and the psychological addiction, one of which is much easier to stop feeding than the other but I can't remember which one at the mo... in've been lucky. I'm not sure if the idea of an addictive personality type is considered true anymore. There are too many factors that need to be taken in to account for it to be that simplistic. Hope that helps...I need a rest now ;-) Ttfn Heather

  • Thanks for your reply to my question, Heather. I guess I am one of the lucky unlucky ones. Lucky because I tolerate most pain relievers with no problem. Unlucky because I have suffered severe pain for the last 15 years. It seems, from other subsequent replies, that there are others like me who just don't seem to suffer withdrawal.

    The only pain med problem I've had is with IV morphone. During my 8 week coma and for 8 weeks after it ended, I had been put on a pain pump that was injecting morphone into me every 6 minutes. I was having constant severe headaches. The day they took me off the IV morphone, the headaches started to subside; on that occasion only, I felt minor withdrawal from the morphone (and I suspect that was because I used much more morphine than necessary to relieve my pain).

  • Dear pinknosedcat, there is a whole group of drugs for neuropathic pain and they aren't opiates,they are anti-convulsants eg. gabapentin, oxcarbazepine, lyrica, topiramate and many others. These are not addictive in the true sense ie. patient behaves illegally to get supplies off script. However as with most meds the body can get used to them and they have to be tapered off while the body adjusts. This is not addiction, it is normal, and also happens with basic anti-depressants. Re. tolerance: I asked my consultant for a peer reviewed published paper proving the existence of opiate induced hyperalgesia (so-called tolerance so patient wants higher dose). He couldn't do it. My view of addiction (I am trained in psychodynamic therapy) is that traumatised people who are in a lot of emotional pain self medicate to take the pain away. It just happens that alcohol is widely used by most of society to medicate anxiety and opiates, cocaine etc by the minority who usually have the worst life histories, or just access.

  • Yes i knOw thanks, i didn't bother including them because they aren't strictly speaking pain killers, as you rightly say thay are neural suppresants...I think I've been on most of them over the years. Yes you are quite rught with everything you say...I just got tired writing and stopped where i did. But good idea for you to bring it up. :-)

  • I'm not a specialist, though I do have 25 years of experience taking prescribed pain meds

  • I am also on hydromorphone and fentanyl patches, just got over a real bad flare,was on morphine drip for five days, never had any feeling of symptoms of withdrawal, my consultant also said. I wouldn't get addicted if using right dose for the pain. I have been on them for over ten years, and no when I need more or less,

  • I think you re at least partially right. I am on multimeds including tramadol and codiene. I very in my requirements each day and never feel woozy. Also if I have a lazy day of not much pain I can go without or without some without ill effects. But I would recommend caffeine along with pain meds as it helps.

  • Hi I would assume it's very rare to completely stop pain meds and not have horrendous withdrawals so would not recommend it. You seem to be doing the right thing by cutting down although difficult. Is it helping the headaches? If there is no difference then it may not be the codeine. Regarding the injections, steroid injections can be very helpful with pain relief and could last a while then be repeated if helpful. It is definitely worth a try but it is not a nice procedure and I always have sedation when I have mine but mine are in the hips, pelvis and pubic bone and a spinal needle is needed in some parts and because I'm a wimp! Good luck

  • Hi Sharelle, lucky my Consultant runs a consult with me all the time I am on the table for the jabs (about an hour). That distracts me from the pain.

  • Anything with codeine in it gives me a headache within minutes - yet another analgesic I cannot tolerate!

  • I have had steroid injections in the joints in my back twice and it changed my life. The first time they hurt but not the second time. I had withdrawal symptoms after being on tramadol for only 2 weeks but it didn't last long. Good luck

  • Over the years my doctors have, on several occasions, prescribed Tramadol or Tramacet. Like lionking7130. I couldn't tolerate the stuff. Within two weeks I would have clattering teeth and involuntary nervous twitches. What experiences have others had with Tramacet or Tramadol?

  • Although I've been on plenty of long term prescrip pain meds, I've never had probs withdrawing, but I do have experience of injections. And chronic headches/migraine.

    I am 60 & globally hypermobile. An injury falling on my head at 7 left me with spondylosis, especially in my neck. By the time I was in my mid 20s neck & shoulder girdle pain had become chronic, despite lifestyle management etc. NSAIDs & prescription analgesics just made me feel like a zombie. The alexander technique's postural training at least made a career possible despite this nightmare of constant pain & spasms

    During this time I discovered that mefenamic acid 500mg (ponstan forte is the brand name)...and this Rx has helped me cope with headaches due to adjusting to other meds too.

    Finally in 1997, the NHS booked me in for a double cervical discectomy, which I avoided at the last moment by demanding to see the pain consultant. He used spinal facet joint injections as a diagnostic tool to determine whether full on cervical facet joint denervations could help me. The injections did numb my neck pain temporarily, so I went on to have a series of denervations. All that has helped me enormously, but I still have to watch my posture & be sensible

    2.5 years ago, drs discovered I have infant onset systemic lupus. Treatment began nd has almost totally stopped any residual spine & muscle pain that hadn't been sorted by the denervations. So, my feeling is that it is great your drs have taken your symptoms seriously enough now, before you're older, and are looking hard at your treatment plan.

    Wishing you the best of luck. Take care

  • I have come off codeine once and didn't have any side effects: I just reduced the dose slowly over about 8 weeks. I would try the injections since you have been offered them, they are not easy to get and personally I have had great results from them. Years later I had to take morphine and tramodol, which I am still on, and I never feel high or woozy. I agree with jwyllie below. There are plenty of non-opiate drugs you can try, on prescription, if you really need them, so don't be worried there are no pain killers for you. Headaches, I was recently under extreme stress for several months and developed migraines (no aura). All that worked, and worked well were self administered sumitriptan injections. So if you have migraine not headaches there is help. However if you have overused meds and that has given you headaches stick to your Doctors' advice. Good luck!

  • I've had migraines ever since I nearly died after being in a drug induced coma to help me fight off Acute Respiratory Distress Syndrome (ARDS) 13 years ago. I have been taking rizatriptan (10mg) tablets ever since (I take one tablet if I feel a migraine is coming on. That med has worked very well for me, although it does make me sleepy (which is okay for me because I usually sleep off migraines).

  • Hi, I don't really know much about your specific disorder but having read your post the thing that comes to mind for me is your liver function. Have you had a liver function test lately? Only, I know that those neouro-inhibitors are very hard on the liver and I think this can cause headaches. In which case it's nothing to do with the codeine. Might be worth looking in to before having to give up a med that works for you. It's a simple blood test. Hope you get it sorted soon. Ttfn Heather

  • I had neck pain which put my migraine out of control. My doctor detected Arthritic deterioration in #'s 2, 3, 4, 5 disks. He Cauterized the nerves on left side. He said nerve in #1 is too close to brain. It lasts for 8-10 months and has given me 90 % relief.

  • Hi there

    did you know that one of the side effects of pregabalin is bad headaches I take them for my longterm chronic back pain I began getting headaches when taking 600mg per day i dropped the dose to 400mg per day for two weeks and the headaches went iam back on 600mg now and so far no headcould you could try that.Good luck with the coedine withdrawl I went through that after being prescribed coedine for over 8 years not a nice experience coming off them but it doesn't take long for your body to learn to live without them.good luck

  • Thank you so much for all of your replies. It's nice to know others experience similar things. Am now down to 1-2 a day codeine from 6-8 a day 2 weeks ago. Side effects weren't too bad, but I am obviously noticing the pain more (they never took it away completely, but like others have said it makes you notice it less). I will definitely give the injections a go and see what the results are. The thought of spending the rest of my life in this level of constant pain is too much to bear!


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