Pain Concern

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Taking two 30mg co-codamol pills permanently

I have chronic back pain, probably because of my long computer working hours. Long story short, I started to take co-codamol (30mg codeine + 500 mg paracetamol). I love it, not only does the pain disappear, but my miserable, painful, depressed, and tired day becomes the happiest day of my life, I feel the rush of warm blood circulating through my body, warming up my legs, my mind feels in heaven, I'm happy, and even work twice as well and fast as usual.

I don't feel side effects, well, the only side effect I experience is that I completely gave up on alcohol, I used to drink almost every day, now, for some reason, I completely lost appetite for alcohol, its "happiness" feeling is just nothing compared to opioids.

I keep my dose at 2 pills a day, when I wake up, now for approximately 3 months. This dose makes the difference between having a miserable day and a cheerful day.

Am I addicted? Is this dangerous? If I don't feel any side effects, does it mean I'm fine and it's safe? If I'm addicted and need my 2 pills daily (and I'll stay with this dose), is it bad? I'm also addicted to water and air right? Is addiction bad by definition? Should I stop with codamol and return to suffer just because "opioids are dangerous" by textbook definition?

Please let me know if you're experienced in this. Joel

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44 Replies

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Hi Joel.

Taking 5 at a time is dangerous. That amount of Paracetamol in Co-Codamol will cause more harm than the Codeine will.

If the taking 2 helps your pain then fine, but it sounds like you're taking them to feel better mentally?

In time that 2 won't do anything & you will start to take the 5 more often as your tolerance builds. This is when you will have to take them just to be able to function and feel "normal"

It's a very slippery slope to go down, so please think seriously before it gets out of control.

Thanks a lot, yes totally agree. Well, 2 pills a day are sufficient for the pain control, and I'm taking two for 3 months already, without having increased the dose. I don't think I'm taking them recreationally, as I already built a tolerance for this dose long time ago, mentally I don't feel anything at all when taking two pills, but they allow me to have a pain free day.

Good luck with the constipation A very bad side effect

Try to cut back a little

It’s a high dose... typically all strong pain medication has the same side effect

I’ve had it morphine for severe back pain

The main concern would be " tolerance" . Needing to take more to get the same level of relief.It's a very slippery slope.

I had to stop using codeine for that reason.

Your description of the ' rush' is an indication of addiction tendency.

Just be very careful.

Good luck.

Thanks a lot, very appreciated.

opioids can actually cause pain to get worse in the long term. The body thinks that it should be feeling pain, so it dials up the pain response to be higher, so that the pain breaks through the codeine. Opioids were never meant to be used for long term pain, it was meant to be used for acute pain like post surgery or a distinct injury, just to get over the worse of it before it heals, or for end of like care where you would only be taking it for a short time.

I think you need to think carefully about this and take professional advice to find something else that can deal with your back pain on the long term, such as exercise. Many people get that same rush from exercise as they do from opioids.

Actually, the whole "opioids don't work for long-term pain" thing is incorrect. There just isn't much evidence that they do. That's because very few randomised controlled trials go for longer than 6 weeks. Reason? Cost.

possible. That is why I'm taking them long term, because they work, and I haven't increased the dose, and my pain is pretty much gone.

Yup. On tramadol for many years. I become dependent sometimes, but never have any issues with addiction. My dose hasn't increased either.

You recommend "exercise" - well, that is something I can't do because I can hardly walk to the bathroom from my bedroom each morning! How can I exercise when that is exactly what causes my severe lower back pain, for which I am on dihydrocodeine/paracetamol tds? I'm awaiting medial nerve radiofrequency ablations for this (severe spinal stenosis/spondylolisthesis) and much as I would love to "exercise" the only time I am not in pain is when I am sitting down upright in a hard chair. I can't even walk from the car to the swimming pool. Are you a physiotherapist? (As I found "exercise" is all they can offer and it didn't work at all for me. I am very slim, 76 and was formerly a gymnast.)

I was not replying to you abellemed. What I said was not meant for you, I have no idea about your symptoms or what you are doing about them.

I thought you were offering general observations/advice, as is usual on these forums, as everyone else does. I only merely suggested that "exercise" as such is very difficult for some of us and felt it could help some people who read these threads on the forum who find themselves in the same situation as me.

It is also very difficult for me, but clearly the OP is more active than us.

OK, I appreciate what you say, perhaps I should have DM'd you instead but I was just, in all good faith, making a generalised point. For that omission I apologise.

I'm on the same tablets and have had them for years on an as and when I need them basis I'm not concerned at all about taking them and don't feel addicted as sometimes I don't need them and don't crave them or anything like that

2 a day seems very reasonable and if they help that's fantastic and much better than alcohol

I agree with the other person that 5 is too much though

Pain is so wearing I'm so sorry you are suffering

Take care of yourself

Thank you for sharing, glad to hear you're fine for several years. Well, you and I consider 2 pills reasonable, my GP yesterday just told me I should worry because that's the equivalent of 5 mg of morphine, but again... every time I call a GP I get different information.

Well I have osteoarthritis and been through 2 hip replacements the pain waiting for them was just excruciating and I'm now waiting for a knee replacement which at the moment is going to be a long time I had my second hip replacement in Sept 2019 and started walking again in January during the first lockdown I walked miles and didn't need any tablets at all until my knee gave out a few months ago I've seen loads of doctors and of course the surgeon and no one has ever been negative about the tablets

I've not heard that about the morphine equivalent I can't take morphine I was given patches when I was waiting for my first hip replacement and I was really poorly sick and dizzy but I don't have any side effects on the co codomol I have to have pain relief at the moment

What is the outlook with your pain are you having physio ?

I hope that you get well very soon

All the very very best

Thanks for sharing, and my respect for what you're going through, I can only imagine this. Yes, I tried everything, physio yes, from soft pilates to hardcore gym... sometimes it gets better, sometimes not. I also tried acupuncture, sometimes it helps... but not worth every week spending 60 quid for it.

I must say, in this year of trials, and improvements, by the way, the few things that absolutely work a lot are:

- taking warm bath, once or twice a day

- opioids

- sleeping more upright, like a hospital bed position, this removes a lot of pressure from my shoulder against the bed

Glad that you have found some things that help and I really wish you all the very very best Have you been to an osteopath ?

Just take good care of yourself and I hope you feel more comfortable very soon

If you are finding hot baths help here is something to try. Once Covid has calmed down and things get back to normal. It might be worth trying exercise in a swimming pool. I got some exercises to do in water from the internet and do those. Start of gentle and gradually increase time in water. Eventually I added some swimming into my sessions. Be warned initially it made my back very sore but overtime it did help. Because of my general health and then Covid I haven’t been able to go to the pool for a long time. But I hope to return in the summer but will start gradually again to build myself up.Hope this helps.

I’m sorry but from some of your descriptions “ my mind feels in heaven, happiest day” etc. It sounds to me that you are already getting far more than just a physical effect.I would be treating them with caution. Should not be taking these every day and I believe you need to speak to you doctor about this.

You run the risk of addiction (if not already) or needing more and more tablets. Eg already admit to taking up to 5 at once which is highly dangerous.

When I am REALLY bad with pain I take these but do everything to avoid. You seem to have quite a cavalier attitude to taking a highly addictive and strong drug.

Please consult your doctor.

Thank you, I am consulting doctors for a full year now, have spent thousands and tried everything, one doctor says this, the other that.

If you feel I have a "cavalier attitude" towards this, it's because I'm open and direct, yes I took 5 sometimes, not to brag, but simply because that's the fact. Yes, I describe the ecstatic effects, not to sound chivalrous, but exactly because this feeling is what makes opioids dangerous, and it belongs in the context of this conversation.

Taking 5 at once is not a good idea at all if you look at what the Paracetamol does to your organs on overdose! As for Codeine it is a misconception that is is not an opioid. It makes the opioid receptors react and give you the hit that opioids do. I will explain what I experienced. I have 3 compression fractures in my back and suffer multi conditions including Arthritis. I was taking the max amount of CO-Codamol a day until they did not seemed to do anything. I was then moved onto Tramadol which I also maxed per day. But was still getting some pain along with a muzzy head. I had been taking these for quite some years!

I received a letter from a study group because my GP had put my name forward to try a opioid reduction/deletion course. I took it up and I am now Opioid free and the strongest pain tablet I take is Paracetamol. Now I am not pain free but the pain is no worse and I manage it with a better posture and mindfulness with distraction techniques. It took a bit of time to wean myself off them but it has been the best thing i have ever done. I have a clear head and do not feel lethargic at all now.

Be Well

Thanks a lot for your honest reply. Your max dose of co-codamol I understand it to be the 8 pills a day (240mg of opioid), I haven't reached 8 yet but (just) 2, maybe the "5 tablets at once" I mentioned is not actually my standard usage, that was basically a "mistake" I did once or twice. May I just ask: how long did it take you to get off the medication without feeling withdrawal?

I did it in about 8 weeks but I also have a good tolerance to morphine which may of helped ?

Hi, taking painkillers to deal with your back pain is all very well as it allows you to work while not feeling the pain. Three months on this dose is not a long time and eventually you will want to up the dose to combat the pain. However the thing is you want to look at other ways to combat the pain as long term it may lead to worse scenarios. I have a sitting job too and it lead to back pain etc. In the end it lead to a lot more than just that and caused me to have 4 spinal ops. My son started with back pain too, a web developer so again a desk job, and we looked into things to improve his outlook. He had an MRI and it showed a very small protrusion. So he started physio but that alone was not enough so he looked into his work station etc and decided that an up down table was the answer. So now he can adjusts his workstation so he can sit a while than stand a while, goes for small walks in between and does his back strengthening exercises twice a day. I know not everyone can have an up down work station but if you can it’s well worth it. Apart from that though everyone can stand up regularly and have a 1 to 2 minute walk or longer if possible and everyone can do exercises twice a day. Believe me just taking tablets to mask the pain is not the long term solution but will help while it’s acute.

Thanks a lot Emma for your kind information. Yes in fact I have a standing desk for a half year now, my mid-back pain has disappeared as a result, so that's a miraculous discovery, however, the neck pain has not changed, as probably I haven't changed the way I lean forward with my head when working. My X-rays show I have a "military neck", straight, instead of bent backward.

Hi, Where to begin?. Apart from being addicted you risk both liver and kidney damage. For your own sake , get help pdq.

Giving up alcohol when you've been a regular drinker can cause feelings of low mood.... as can any addiction-

As for your back, ideally your employer should provide the type of chair/ workstation which is suitable and not cause back problems..in between time if your back problem is caused by your working position, buy yourself a wobble ( balance) cushion. This will ensure you sit upright and it eventually strengthens your back.

You may also find that if you are car driver, your driving seat may also be playing havoc with your back... a well known cause.

Likewise, your chairs & settee at home. If they encourage you to lay backwards rather than to sit upright with a lumber support, then they are the wrong design for you.

Have to say 5 tablets at once definitely a no no, you may overdose and that’s not what you or anyone else wants! Please stick to the dosage prescribed and as someone who’s been on these things for coming upto 4 years I know how dependent I have come on these and i’ve Had to weigh up the side affects which their are and the pain i’m Experiencing. Being honest about being Opioid dependent or addicted and what you’d feel like not taking them is something only you know, but remember although the up feeling is great and all their is always a down . Be careful and please if in doubt speak with your doctor if this medication isn’t working! You should only be taking a max of 8 in any 24hr period.

Hi User codeine, paracetamol can be very effective. In hospitals they now give paracetamol intravenously and has proven benefits. Take care and all the best.

There is a tremendous difference between addiction and dependency. Dependency means your body has become accustomed to that particular drug and so when you stop it cold turkey you may experience some withdrawal symptoms. Prednisone can cause this dependency but no one takes it to get high. On the other hand addiction is the mental side of it. People with substance use disorder have a strong desire to get high. And typically they will have one drug that they favor drug. For a lot of people it has been opiates for other it's methamphetamine. But I think you get the point. There's just one thing I want to say about your codeine, it is an opiate. It is a very weak opiate but it is an opiate. Therefore there is the slight possibility that if you were to take it long term and stop cold turkey your body might react. But it should not be very miserable and it should not be very long unless of course you miss the high. Although most people in pain do not get a high from opiates. The relief from pain is just too wonderful.

Nice reply, in fact, it sparks lots of thoughts. I realized in fact that one day waking up, I decided to skip my 2 pills, and shortly after my day started to become painful, so I took the pills, and problem solved. That sparked the big question: is this addiction or something else, what you call "dependency". My logic is simply that my back hurts, and I crave for my dose simply to get rid of that constant pain, not because "I'm sweating and shaking as you'd see it in movies". Although I don't get high from the 2 pills, I feel like my body has getting used to accepting that 30mg of opioid as "additional help", almost like someone has an iron deficiency and needs iron supplements not to feel fatigue.

I'm aware codamol is an opioid, I hear both versions, some say it's weak, some say it's strong. My GB for example was worried a few days ago when I called, warning that my 30mg co-codamol pills are "very strong, the strongest one", but then again, how much is formality and "from the textbook" information that GB simply have to tell their patients, and what actually is realistic in the context of a person suffering.

Codeine is the weakest opiate.

No, I don’t believe you’re addicted. These two pills are providing the pain relief you require. Question is..... what’s causing the pain?

Hello, actually nobody knows the cause. Both MRI and Xrays are fine.

Have you been assessed by an Osteopath? What about a functional doctor?

yes I've tried everything, including physio, acupuncture, massage, gym, chiro,... the list goes on

Everyone is different what ever you find helps then do it 👍🏻

Hi there. Many years ago I was put on kapake, which if I remember correctly was the preferred pain killer at the time before co-cadomol - I may be wrong there but this is not the point. I was taking them every 6 hours due to neck and thoracic pain and was on them for 4 years, until I developed duodenum and stomach ulcers ( the camera down the throat is fun). I soon realised that the pain from ulcers was worse than the neck pain, and I was told to stop taking them and avoid lots of nice food, which I liked! Coming off them was not nice and I had to do that gradually but rapidly. MRI of my neck showed that I had bulging discs but no action was taken.

I developed coping mechanism - heat pack, cold packs, gentle stretching exercise to keep the muscles supple, swimming and a very good sports physio/chiropractor who helped me. 25 years later, I still have bad neck and shoulder pain when I work behind a laptop, but I have sought advice from occupational health and adjusted the way that I sit and take regular breaks (every 10mns) when I feel the burning coming on. If it becomes too much , my body is telling me to stop - I stop and do something else like reading reports, etc.. I also have Dragon software installed to help. I now take 2 paracetamol and 2 codeine every night, but I have far bigger problems with my spine and I am on a lot more meds for various things like spinal stenosis, Cauda equina syndrome, adhesive arachnoiditis. The paracetamol and codeine help me sleep at night because of the pain. So my advice, do not take them if you do not have to, and only do if you really need them. Listen to your body, gentle stretching is better than pumping iron in the gym and keep an eye on your spine - you only have one and even if the doctors tell you everything is fine, get a second opinion - it does not hurt nor cost anything, but it will give you reassurance. I wished I had!!

Hello, yes, sounds very similar, maybe I'm your version 25 years ago, when I even approach my comuter, my neck, shoulder and T1 area starts to hurt, almost like an automatic car alarm that goes off at the slightest touch. In fact, I didn't sit at the computer for a year now, only standing. It feels like the problem is the posture, the rounding up of the shoulders forward and the constant keeping up my head to watch forward at the monitor.

What gave you the stomach ulcers? The codeine or paracetamol?

Hi there. Not sure probably a combination of both. They give omeprazol now to line the stomach so that it does happen so easily

Hi codeine user,If you are just taking 2 a day when you could take 8 I would say your doing great. I don't think it's the codeine that's making you happy but the fact you are pain free and can work and do things you wouldn't be able to do if you're in pain. Give yourself a pat on the back and keep smiling. Happy New Year.

I wish I only took 2 a day most days I’m on 4-6 on really bad days it’s 8 in total although I would take more if I could I don’t want to up my dosage as I feel that will make my ibs worse I think just taking 2 a day is good if you need them take them I’m in constant pain I’m active but I just get so tired and ache all over so the pills although don’t take away the pain completely they do help me get about on a daily basis I’ve never had any problems just stopping co-codamol so I’m not worried about getting addicted just wish the docs would find out what is wrong before pushing the pills on me but I couldn’t manage to do normal things if I didn’t catch 22 gets you every time

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