Alternative to morphine?
Discussion
Mrs D's dad broke his hip a week ago and is in hospital having had an operation to fix it.
It turns out he's got a healthy fear of opiates. He's not a recovering addict, but in his younger days he saw people ruin their lives with opiates and I genuinely think he'd rather be in pain than take morphine.
Today, a nurse mentioned that he is indeed on morphine; he has now hit the roof and is refusing to have it (and is subsequently in a lot of pain).
Are any PH medics able to say if there any non-opiate pain relief that might be considered suitable in these situations, and does a patient have the right to request an alternative?
Due to Covid we cannot visit the hospital, so I've suggested Mrs D phone the ward to see if the doctor on-shift can discuss any options but it would be useful to know if it's a complete non-starter.
It might seem odd to many people, I realise. Thousands of people take morphine everyday etc. However I have some sympathy that he doesn't want to risk an addictive substance.
It turns out he's got a healthy fear of opiates. He's not a recovering addict, but in his younger days he saw people ruin their lives with opiates and I genuinely think he'd rather be in pain than take morphine.
Today, a nurse mentioned that he is indeed on morphine; he has now hit the roof and is refusing to have it (and is subsequently in a lot of pain).
Are any PH medics able to say if there any non-opiate pain relief that might be considered suitable in these situations, and does a patient have the right to request an alternative?
Due to Covid we cannot visit the hospital, so I've suggested Mrs D phone the ward to see if the doctor on-shift can discuss any options but it would be useful to know if it's a complete non-starter.
It might seem odd to many people, I realise. Thousands of people take morphine everyday etc. However I have some sympathy that he doesn't want to risk an addictive substance.
Back in 1999 I was prescribed Pethidine tablets for my Kidney Stones, and during out-patient visits for Lithotripsy (Zapping the stones) I got the same drug by injection.. I had never used illegal drugs recreationally (Not even rolled a spliff!), but the Pethidine tablets and more immediately the injection made me understand why people do drugs... Instantly hooked on them I felt so relaxed with a warm and calming feeling that nothing mattered. When I moved house and my new GP wouldn't prescribe them any more and gave me Co-codamol 30mg/500mg tablets instead. Chasing the same feeling, but was nothing like the same.. I got worried about the Paracetamol levels I was taking, so-much-so, my doctor just prescribed codeine until I went free of opiates all together in 2015.
So I wasn't looking for drugs - they found me and whilst others have suffered so much more and lost more, it was so easy finding something I wasn't even looking for...!
So I'd be cautious of opiates, or at least get them properly managed and reviewed regularly...
So I wasn't looking for drugs - they found me and whilst others have suffered so much more and lost more, it was so easy finding something I wasn't even looking for...!
So I'd be cautious of opiates, or at least get them properly managed and reviewed regularly...
rjfp1962 said:
GP wouldn't prescribe them any more and gave me Co-codamol 30mg/500mg tablets instead. Chasing the same feeling, but was nothing like the same..
I have a lot of sympathy with that - I was prescribed co-codamol for a slipped disc and on the third day realised I was clock-watching until I could take my next tablet. To quote Superhans "it was really more-ish". Fortunately that was early enough to cut myself off but I understood why people trying heroine often got hooked on the first dose.
Glad to hear you've managed to overcome it; can't have been easy after a long time taking codeine.
Hospital pharmacist here - with experience (amongst others) in both orthopaedics and acute pain team.
First up, yes, a patient absolutely has the right to request an alternative to opiates, and more than paracetamol is definitely required.
He will be bloody sore after a hip replacement....... the surgery is about as nimble and delicate as butchery combined with metal and woodworking classes for teenagers.
I would suggest he asks for a review either with the surgical team looking after him or the acute pain team
I suspect something such as gabapentin or pregabalin would be the first option. They would be titrated up over a few days to achieve decent pain control.
Non steroidal anti inflammatories (ibuprofen or diclofenac) can be useful short term (assuming no kidney or stomach problems), but are not very favoured as they can slow the rate of bone healing.
There are other non opiate options, but these tend to be more useful with nerve pain than post op pain.
I would also stress to him that the pain meds are only temporary - just to take the edge off things whilst he mobilises with the physio team. He shouldn't be a martyr, if he's in pain, he should definitely take what is offered as being mobile will speed up the recovery and reduce the risk of other complications.
Happy to chat via pm or phone if you need further advice/input.
First up, yes, a patient absolutely has the right to request an alternative to opiates, and more than paracetamol is definitely required.
He will be bloody sore after a hip replacement....... the surgery is about as nimble and delicate as butchery combined with metal and woodworking classes for teenagers.
I would suggest he asks for a review either with the surgical team looking after him or the acute pain team
I suspect something such as gabapentin or pregabalin would be the first option. They would be titrated up over a few days to achieve decent pain control.
Non steroidal anti inflammatories (ibuprofen or diclofenac) can be useful short term (assuming no kidney or stomach problems), but are not very favoured as they can slow the rate of bone healing.
There are other non opiate options, but these tend to be more useful with nerve pain than post op pain.
I would also stress to him that the pain meds are only temporary - just to take the edge off things whilst he mobilises with the physio team. He shouldn't be a martyr, if he's in pain, he should definitely take what is offered as being mobile will speed up the recovery and reduce the risk of other complications.
Happy to chat via pm or phone if you need further advice/input.
Edited by McVities on Monday 19th July 23:01
PeedeeTon said:
Tramadol might be an option, not an opiate but a step up from paracetamol.
It's a synthetic opioid and I'd avoid it like the plague. Nasty nasty stuff (having spent significant periods of my life on the max dose of the stuff)I always found the withdrawal from morphine/codeine much less unpleasant than stopping tramadol too.
PeedeeTon said:
Tramadol might be an option, not an opiate but a step up from paracetamol.
Tramadol is indeed an opiate, and not favoured in older patients due to a much higher rate of side effects than younger patients.Quite often these are psychological in nature as well as the usual opiate problems (respiratory depression and constipation).
Since I acquired a spinal injury two and half years ago I have a bit of understanding of opiates especially the ones they keep in the magic cupboard at the pharmacy. For the first six months I was on anti-inflammatories with various opiates.
While waiting for surgery the pain level went from bearable 6 to crippling 10.
I spent a good few months sitting most days high as a Virgin Galatic spaceship, it was absolutely horrible, wasn't allowed leave the house without assistance and driving was definitely off limits. I came to the conclusion they were doing me more harm than good and once addicted it would be very difficult to ween myself off so I chucked them.
So now I'm still waiting for surgery but being sent to pain management but the pain is nowhere near as bad as the effects of taking opiates. Another GP now agrees they weren't a great idea but my ex GP initially advised me to 'experiment with them' which my consultant told me would have put me in a coma or an early grave if I'd taken his advice literally.
I'm aware many people need opiates, a relative in their late 80's with bad arthritis takes MaxiTram and has done for years, they seem fine as they spend most of their time watching TV.
While waiting for surgery the pain level went from bearable 6 to crippling 10.
I spent a good few months sitting most days high as a Virgin Galatic spaceship, it was absolutely horrible, wasn't allowed leave the house without assistance and driving was definitely off limits. I came to the conclusion they were doing me more harm than good and once addicted it would be very difficult to ween myself off so I chucked them.
So now I'm still waiting for surgery but being sent to pain management but the pain is nowhere near as bad as the effects of taking opiates. Another GP now agrees they weren't a great idea but my ex GP initially advised me to 'experiment with them' which my consultant told me would have put me in a coma or an early grave if I'd taken his advice literally.
I'm aware many people need opiates, a relative in their late 80's with bad arthritis takes MaxiTram and has done for years, they seem fine as they spend most of their time watching TV.
IV paracetamol is what we give our neck of femur patients. They also have a buprenorphine patch sadly this is an opioid. I would strongly avoid ibuprofen if he is of any significant age, the issues it will cause are just not worth it.
Is there any reasoning that he would only require opioid for a few days? We would give oxynorm liquid for breakthrough pain but are under strict instructions to wean opioid medication as quickly as we can.
Is there any reasoning that he would only require opioid for a few days? We would give oxynorm liquid for breakthrough pain but are under strict instructions to wean opioid medication as quickly as we can.
McVities said:
Hospital pharmacist here - with experience (amongst others) in both orthopaedics and acute pain team.
Thanks for your post, that is incredibly useful. Mrs D is going to speak to the doc about these meds to see if his wishes can be accommodated within the other health issues that accompany advancing years (and with his other meds, of course).sutoka said:
Since I acquired a spinal injury two and half years ago I have a bit of understanding of opiates especially the ones they keep in the magic cupboard at the pharmacy. For the first six months I was on anti-inflammatories with various opiates.
While waiting for surgery the pain level went from bearable 6 to crippling 10.
I spent a good few months sitting most days high as a Virgin Galatic spaceship, it was absolutely horrible, wasn't allowed leave the house without assistance and driving was definitely off limits. I came to the conclusion they were doing me more harm than good and once addicted it would be very difficult to ween myself off so I chucked them.
So now I'm still waiting for surgery but being sent to pain management but the pain is nowhere near as bad as the effects of taking opiates. Another GP now agrees they weren't a great idea but my ex GP initially advised me to 'experiment with them' which my consultant told me would have put me in a coma or an early grave if I'd taken his advice literally.
I'm aware many people need opiates, a relative in their late 80's with bad arthritis takes MaxiTram and has done for years, they seem fine as they spend most of their time watching TV.
Everyone and every injury is different, but have you tried Naproxen? My GP described it as "ibuprofen's big brother" and put me on it whilst on the discectomy waiting list. It reduced the inflammation enough that I got mobile again, could stand for longer, which has in turn allowed me to manage my back better (I have sit/stand desks at work and home) and I asked to come off the waiting list, that was about 5-6 years ago now.While waiting for surgery the pain level went from bearable 6 to crippling 10.
I spent a good few months sitting most days high as a Virgin Galatic spaceship, it was absolutely horrible, wasn't allowed leave the house without assistance and driving was definitely off limits. I came to the conclusion they were doing me more harm than good and once addicted it would be very difficult to ween myself off so I chucked them.
So now I'm still waiting for surgery but being sent to pain management but the pain is nowhere near as bad as the effects of taking opiates. Another GP now agrees they weren't a great idea but my ex GP initially advised me to 'experiment with them' which my consultant told me would have put me in a coma or an early grave if I'd taken his advice literally.
I'm aware many people need opiates, a relative in their late 80's with bad arthritis takes MaxiTram and has done for years, they seem fine as they spend most of their time watching TV.
It's not advisable for long-term use but in my case it seemed to kick-start some degree of recovery.
donkmeister said:
rjfp1962 said:
GP wouldn't prescribe them any more and gave me Co-codamol 30mg/500mg tablets instead. Chasing the same feeling, but was nothing like the same..
I have a lot of sympathy with that - I was prescribed co-codamol for a slipped disc and on the third day realised I was clock-watching until I could take my next tablet. To quote Superhans "it was really more-ish". Fortunately that was early enough to cut myself off but I understood why people trying heroine often got hooked on the first dose.
Glad to hear you've managed to overcome it; can't have been easy after a long time taking codeine.
I was on the soluble ones - and took 8 a day for nearly a year, convinced i needed them as i was still in pain.
a forced spell away from home where i wasn't allowed to take tablets in early 1994 made me realise, i had become well and truly addicted. Thankfully the 3 months away helped clear the problem.
Now i see they have 'Do not take for more than 3 days' written all over the box!
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