Pain control using codine & paracetamol

[Adelee1961]

Happy new year to everyone.

I’m looking for some advice please.

I was diagnosed in September 2019 like most I started at 15mg of prednisone .. that went to 20 mg quite quickly to get control of the inflammation. On my journey I fortunately have had only one big relapse. Presently I’m close to 2 mg. At this point every reduction seems to bring a wave of mild stiffness and exhaustion (no pain) that seems to settle down after a while until the next reduction. I’m presuming this is my adrenal glands catching up. Tapering at around 10% per month all being well it will not be long before I’m free of pmr. My question is at this point I’ve found one dose of Paracetamol and Codine taken first thing in the morning really gets things settled down by which time as the relief offered wears off I’m generally moving around and all is well. I’ve done this for the last seven days before getting out of bed. I’m aware of the additive nature of codine but taking it in such a small dose each day is really working well I’ve found.

I haven’t spoken to my doctor yet.

Has anyone else used a mix of codine and paracetamol as I’m currently doing and I’m hoping will be endorsed.

[Constance13]

Hmmm! I've been on Cocodamol (on prescription) for 10 years and I'm not dead yet!👵🏻

[Adelee1961 in reply to Constance13]

Appreciated.. Nice to hear

[PMRpro Ambassador]

Very few people find ordinary painkillers do anything for PMR pain at all and if you are getting relief with it it suggests whatever it is, it isn't due to PMR. Painkillers do seem to help with steroid withdrawal pain though.

However - never forget you aren't reducing relentlessly to zero, you are looking for the lowest effective dose for the disease activty at the time. I think you are maybe correct that this is adrenal territory - but maybe also skating on thin ice in terms of PMR. The lower you get, the slower you need to go to ensure your adrenal function has the best possible chance to recover at the same rate at which you are tapering.

I'd be more concerned about the constipating effect of codeine - do be aware of that and prevent rather than need to cure it! I can't take codeine - makes me feel horrible!!!

[Adelee1961 in reply to PMRpro]

Thanks PMRpro. As I said I’m not really in pain.. I really think it’s the codine effect that’s really helping me ease into the day.

Yes the only downside is a little constipation.

[SheffieldJane]

I think that if this little regime is working for you then it is relatively harmless. GPs don’t seem to have the memo about painkillers not working for PMR pain and happily prescribe strong painkillers. Tramadol in my case, which doesn’t cause constipation and takes the edge off my arthritic pain. Paracetamol has started hurting my gut.

[DorsetLady PMRGCAuk volunteer]

Some I would say could be steroid withdrawal (stiffness) as well as adrenals (exhaustion) . Maybe have a look at following links -

healthunlocked.com/pmrgcauk...

healthunlocked.com/pmrgcauk...

Personally, as you are less than 2 & half years into PMR, I would be thinking about easing up on tapering (even increasing by maybe a mg or 2) rather than adding in other painkillers which can cause other issues.

[Adelee1961 in reply to DorsetLady]

Thankyou Dorset Lady for your advice. .. something else to consider.. I will also talk to my doctor this week.

[Hidden]

I use this mix for RA and it works well but does cause constipation which I try to counteract with seeds, fruit, prunes and extra water. If you can do yoga or similar it seems to stimulate the digestive system and helped my constipation when I was still able to do yoga.

[Constance13 in reply to Hidden]

My recipe too! But as porridge, with prunes, muesli, dates and sunflower seeds. Starts me off on the day.

[Hidden in reply to Constance13]

Porridge helps reduce cholesterol apparently, I have it daily for breakfast followed by 4 fried eggs 🤣😂🤣😂

[Theziggy in reply to Hidden]

I'm so jealous, I just can't abide the taste and texture of porridge - it's like wallpaper paste to me!

[Lovebikes in reply to Theziggy]

I used to be the same until I discovered... a small serving of porridge, push in a few pieces of broken up 85% chocolate, some berries (frozen at this time of year), a sprinkling of seeds and nuts and a few dollops of natural yoghurt. Love it!!

[Sweetpeasoprano in reply to Theziggy]

Try jumbo oats. They take longer to cook, but don’t have the consistency of wallpaper paste! I’m an All Bran girl myself, served with a bit of granola (home made) and low fat Greek yoghurt.

[Constance13 in reply to Hidden]

4 fried eggs?? I can't ever remember eating even 2 eggs at a sitting except in an omelette!

[Hidden in reply to Constance13]

I jest of course 🤣

[Constance13 in reply to Hidden]

😂 I fell for it!

[DorsetLady PMRGCAuk volunteer in reply to Hidden]

Good . Eggs wouldn’t help with the constipation 🤣😂

[Looby60]

Hi there . If finding constipation a problem I can highly recommend. Cosmocol. My Dr prescribes it but you can get it over the counter it’s gentle on the stomach .

[Viv54]

I have used this for years, never had a problem , i take them when i need,and stop when i dont, never had a problem with addiction.

[Exflex]

Constipation is a side effect already mentioned by PMRPro.

The packaging recommends not using for longer that 3 days, I can see why, then again addiction is another issue I suppose!

[Odosmum]

I suspect that if you are taking paracetamol and codeine without the doctor's knowledge, you are buying them over the counter. If that is the case, the pills contain 500mg of paracetamol and 8 mg of codeine. Quite a low dose, even if you take two pills per dose.

The preparation prescribed by the doctor is usually 500mg paracetamol and 30mg codeine. A much higher dose. I have been taking them for about 20 years and am fairly certain that I am not addicted to them. I usually take 1 dose per day (2 pills) at bedtime. That enables all my muscles to relax when I sleep and help me be more mobile when I awake. I have inflammatory arthritis as well as PMR, and so morning pain and stiffness can be a big issue for me. If I am in particularly bad pain, I take more doses but no more than 4 per day and I try to space them every 6 hours.

Yes, constipation can be a major problem and I have tried to ensure that it doesn't get a hold. Yes, the usual foods are useful, and I particularly endorse prunes and oranges, and take large quantities of liquids - this is really important. It is useful to keep a pack of fybogel around and just take one dose at night if you need more help. I wouldn't wait more than two days before trying something more - codeine caused constipation seems to take hold and once established becomes quite difficult to sort out. Maximum doses of fybogel and lots of water do eventually work, but the results are not pleasant. Better try to sort things out much earlier, if you can.

Hope you find this helpful.