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Chronic Pain

Medication: other analgesics and muscle relaxants for chronic pain

In the early stages of their pain people were sometimes prescribed paracetamol. They thought that paracetamol by itself wasn't effective for chronic pain, but several commented that it helps when combined with other types of medication.

Many people we talked to were taking a combination of codeine and paracetamol. Codeine is a mild opioid with an analgesic effect. Many got good pain relief from these medicines although often they had tried different preparations to find the most effective.

Most people found that they could take a stable dose although a few told us that they had sometimes increased their dose because they had become more active. One woman who had just started work had changed to a different codeine medication and was concerned that she might be becoming tolerant. Some didn't get enough pain relief from codeine medicine and were prescribed stronger opioids (see also 'Medication' strong opioids').

People taking drugs containing codeine described problems with constipation, nausea and sweating. Such drugs (drugs with the prefix 'co') often also contain paracetamol. Often people worried about the effects that the paracetamol might have on their liver and kidneys. There is no evidence that, at moderate dosages, paracetamol damages previously healthy liver or kidneys when used for long periods.

It is important to talk to the GP about medication regularly, to ensure that paracetamol intake is safe. Some recent research* into the long-term use of paracetamol has shown that high doses can have potential effects upon the cardiovascular system, kidney and gastrointestinal system, but it is agreed that further research is needed and individuals should consult their doctor if concerned.

A few people were using anti-inflammatory drugs (NSAIDS - Nonsteroidal anti-inflammatory drugs such as asprin, ibuprofen, diclofenac and naproxen) and a couple had been prescribed a new type of anti-inflammatory drug, a Cox-2 inhibitor (celecoxib), which produces less side effects in the stomach and gut (see also 'Introduction: medication and side effects').

People taking anti-inflammatory drugs often experienced mild stomach or gut problems and said it was important to take their tablets with food. Sometimes people had to take additional medicine together with it to protect the gut lining. However some people found that they could not take or had to change their medication.

One man had a history of ulcers and could not take anti-inflammatory drugs. A woman who had developed irritable bowel syndrome changed to a cox-2 inhibitor, which does not affect the gut lining.

 

Changed to a different anti-inflammatory drug which doesn't attack the stomach or gut because she...

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Age at interview: 41
Sex: Female
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I've changed, yeah. Medication, painkillers I have changed several times. I've forgotten exactly what the difference is, I know that there are two types of painkillers and what I am now on and have been on for many years are anti-inflammatories. 

And the last lot that I was on, that I had to come off because they gave me IBS were you took one in the morning and one at night and they were sustained release. And within 10 minutes you knew you'd, you knew you'd taken one and this carried on lasting and sadly, I must have been on those for six or seven years and eventually they made me so ill that I had to come off them.   

And I'm now on something called celecoxib or Celebrex, which makes it sound like a breakfast cereal. And it's an anti-arthritis drug. It's for people with rheumatoid arthritis and I take half the maximum dose of that. Again one in the morning and one at night. Unlike the previous ones though, the benefit is you don't have to have them after eating because they don't attack your stomach lining. So I can have those whenever I need them. And if I am going through the acute phase I will sometimes up the dose to three. I don't think I've ever had four in a day. 

The first painkillers that I was ever on, and I can't remember what they were, but they were the ones that, that just sort of play with your head so I think that you're less aware of how awful the pain is. And they are, I would not want to be on something like that on a long term basis because they impede your ability to concentrate, whereas the one's that I'm on now don't.

A few people had bought creams or ointments containing an anti-inflammatory. Some people with arthritis found these helpful - a woman got relief from massaging an anti-inflammatory cream into her hip and knees. Others felt they were ineffective and not worth the money.

One woman with work-related bilateral wrist pain had tried capsaicin cream (contains extract of chilli) and menthol cream. She had some relief from the cooling effect of the menthol cream while also taking an antidepressant for pain.

 

Tried capsaicin cream and menthol cream for bilateral wrist pain and got some relief from menthol...

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Age at interview: 32
Sex: Female
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Can you tell me what happened when you went to the Pain Management Clinic?

When I first went I went with a complete open mind, because I know there's no cure. I might get better one day, but it could be a long, long process. So, I went with the open mind to think 'Well, if she's, if there's anything there that can help, if they have anything that can alleviate or just help me through the day, that would be great'.  

So I went in thinking 'Okay we'll see, we'll try, I'll just try anything'. We tried different topical medicines, capsaicin cream for osteoarthritis, thinking maybe there was nerve pain connected there. We tried them. The heat within that cream caused the pain to be much more intense.  

So we realised then that cold and ice is the only thing that will stop it. So they've tried amitriptyline to try and block the nerve pain and that's actually helped me get a sleep at night now. I wasn't sleeping for a good few years, my sleep pattern was terrible. So the amitriptyline has helped on that side.  

Then I'm using menthol 2% cream and that freezes from the inside out, very, very cold sensation and that seems to alleviate to a point where I can carry on and do, not more things during the day, but just carry on that little bit longer without sitting back and having to resort to the ice packs and stuff. 

Qutenza patches are now available through the NHS. They contain a high dose of capsaicin which over stimulates the pain receptors in the skin and desensitises them. The patch needs to be applied in the outpatients’ department of a hospital as specialist training is required. The patch is applied to the painful area and left for 30 to 60 minutes and removed. It can take 1-14 days for the full pain relief to take effect. It can provide relief for some people, for up to three months. Some may not get any benefit from the treatment. The treatment can be repeated every 90 days. No one we interviewed had tried this treatment. 

Occasionally, people had been prescribed a benzodiazepine, prescribed mainly as a muscle relaxant, but these drugs also have a sedative effect. People who take a benzodiazepine for a long time can become dependent on them and need to be weaned off them.

One woman said she used to reserve this type of medication for severe muscle spasm as her doctor had warned not to use it regularly. Another woman who had moved GP practices had mistakenly taken a benzodiazepine for a long period and had to be weaned off it very gradually.

 
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Was prescribed ibuprofen and co-proxamol, and diazepam which she reserved for severe muscle spasms.

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Age at interview: 42
Sex: Female
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My doctor had initially prescribed ibuprofen for me and I sort of took that for quite some considerable time. I couldn't actually tell you how long, but it must have been for months at a time. I also was prescribed diazepam, which I kind of kept for emergencies, when I had sort of severe spasms, I would take a diazepam just to try and relax the muscles. 

But, again, my doctor had warned me that it wasn't something that I would particularly want to take on a regular basis. And, the only other thing that I really used was co-proxamol. And using those three things, I was generally able to control my pain.



* Roberts E, Nunes VD, Buckner S, et al. Paracetamol: not as safe as we thought? A systematic literature review of observational studies. Annals of the Rheumatic Diseases. Published online March 2 2015.
For an overview of the research see NHS Choices - Is long-term paracetamol use not as safe as we thought? 

Last reviewed August 2018.
Last updated May 2015.

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