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Treating pain in COPD…

Posted Nov 05 2010 5:15am

When I wrote this post , about pain in COPD, for some reason I just skimmed the surface of analgesia. This is intended to remedy that.

The intercostal pain I wrote about at that time has worsened considerably, and kicks in often within minutes of going to bed (changing position brings only brief respite). I do have a solution for that , DHC in the evening, but it’s just not feasible on a regular basis (see below). There’s also a permanent low-grade ache throughout the day, now, interspersed with mercifully brief jolts of severe pain.

As I’ve mentioned before, in addition to the pain from COPD, there is also that from wide-spread osteo arthritis (affecting my hips and knees and, increasingly, my hands); and from the long-term effects of being struck by lightning back in 1983, which I’ve covered elsewhere in detail

The main plank of my analgesia is Dihydrocodeine Continus (the sustained-release variant of DHC). The prescribed dose is 120mg twice a day, However, as a number of my meds already cause constipation, if I’d like my bowels to continue working I’m limited to just once a day, which I take at 06.00 along with my COPD meds, a couple of hours before I get up.

At 10.00 or so, my daily headache has arrived, so I take 2 Paracetamol (during the day I take Paracetamol Plus (with caffeine, which has no analgesic properties but staves off any drowsiness). As well as treating the headache, it reinforces the DHC.

I also have Co-codamol (aka Solpadol, 500mg Paracetamol plus 30mg codeine), of which I normally take 2 at bedtime. However, on bad days I’ll take these instead of Paracetamol in the mornings, plus a dose at 17.00, again with my COPD meds.

That’s a lot of opioids and Paracetamol to keep track of, complicated by the fact that I have codeine linctus as an antitussive. However, with the DHC and codeine in my system already, the need for that is minimal. Just as well, really, as my doctor appears to believe that coughing til I puke or pass out is preferable to adequate medication – 300ml of the stuff a month, were it not for the other opioids, would be useless.

There is, by the way, a TV programme called Mike and Molly (or possibly vice-versa), about two very fat people and their embryonic relationship (from the same stable as Two and a Half Men, it’s best avoided by PC freaks!). Anyway, in one episode Molly has the sniffles just before a date, so her mother gives her some cough medicine (why?). Molly swigs this from the bottle (hey, me too!**), and her mother panics, yelling “Whoa, that’s got codeine in it!”. 10 minutes later, Molly is stoned out of her mind (the writers seem fond of the codeine gets you stoned shtick – in TahM the local pharmacist is always flying on the stuff).

**I can take 10ml straight from the bottle with considerable accuracy – I’ve measured it – but this isn’t something I’d recommend. The official dose is 5ml – utterly useless!

The thing is, though, it’s all bullshit – you do NOT get high on codeine. Or, at least, I don’t – bummer! ;-)

Now we come to the contentious part – self-medication. The usual caveat applies – unless you have the necessary knowledge to do it safely, don’t do it at all.

I used to get the NSAID, Naproxen, on prescription. Then I had a gastric bleed and my GP cut off my supply. The bleed was nothing to do with Naproxen, but was caused by 12 hours of vomiting because my bowels had simply stopped working .

Without Naproxen I seize up completely, and the night-time intercostal pain is much worse, so I was left with no alternative but to source my own . These are Naproxen Sodium (the prescription drug was plain vanilla Naproxen), weaker but more effective than the prescription drug – 1 200mg tab is at least as effective as 2 225mg tabs of the latter.

The downside is that they’re not enteric-coated. However, one GP has told me that this makes not a bit of difference – the presence of the drug in your system is enough to cause a bleed. No idea if that’s true or not. Anyway, I take it only when I must, and with about half a pint of milk (I don’t eat during the day in a so far futile attempt to lose weight).

If, however, I were to take it in the evening, after my daily meal, it would dramatically improve my nocturnal pain – I just have to decide when I want the maximum pain relief – a choice I wouldn’t have to make were my GP not a cretin.

So, to sum up:-

120mg DHC Continus at 06.00 daily

1 200mg Naproxen sodium, mid morning, as needed

2 Paracetamol mid morning, daily (or 30/500 Co-codamol if necessary)

2 30/500 Co-codamol at 17.00 if needed

2 30/500 Co-codamol at 23.00 daily

On seriously bad says I’ll also take another dose of DHC Continus at 17.00.

Life would be a lot better were I able to do so every day, but unless I can find a solution to the severe constipation problem, the risks are just too great. Beer works but, of course, that’s not an everyday solution, as it takes a gallon. Which causes its own problems, not to mention the cost. It’s worth pointing out that the crisis referred to above was provoked by not drinking for almost 2 weeks.

There’s some information about the risks of analgesia in COPD here .

Be aware that what I’m talking about here is a reduction in pain. Eliminating pain entirely is an unrealistic expectation.

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