In so much pain. Need advice on what to do. Watch

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snowdrop965479
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#21
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#21
If it's REALLY bad go to A+E, this is what the doctor told my sister when she was complaining about her gallstones. Hope you feel better soon!
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Scoobster
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#22
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(Original post by Carpediemxx)
It just doesn't produce good analgesia in a good number of people. It is probably the worst codiene based pain killer
Codeine itself is terrible too, somewhere between 20 to 40 % of humans cannot even metabolise it producing no pain relief
It constipates like a ***** too

I like tramadol due to its serotonergic mechanism
Critics of it say it makes people go loopy, but i haven't experience that much with my patients and it works very well.
Without getting too technical, it's fair to say that:
Codeine is mainly metabolised into Morphine by CYP2D6.
Tramadol is mainly metabolised into Desmethyltramadol by CYP2D6.

So if a person has low CYP2D6 activity, this will nullify the analgesic effects of both Codeine and Tramadol, rendering both quite ineffective.

To say that up to 40% of people cannot metabolise Codeine is grossly inaccurate. Research shows that the figure is closer to:
6-10% of Caucasians
2-5% of Africans
1% of Asians

Though as you say, Tramadol does have the advantage of it's Serotonergic effects.
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Carpediemxx
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(Original post by Scoobster)
Without getting too technical, it's fair to say that:
Codeine is mainly metabolised into Morphine by CYP2D6.
Tramadol is mainly metabolised into Desmethyltramadol by CYP2D6.

So if a person has low CYP2D6 activity, this will nullify the analgesic effects of both Codeine and Tramadol, rendering both quite ineffective.

To say that up to 40% of people cannot metabolise Codeine is grossly inaccurate. Research shows that the figure is closer to:
6-10% of Caucasians
2-5% of Africans
1% of Asians

Though as you say, Tramadol does have the advantage of it's Serotonergic effects.
Nah that is incorrect, tramadol has a very complicated multi mechanism of action and is well know to not have the same problem as codeinewith people not metabolising it. its not even fully understood how it works
Also those figures aren't accurate these days either, I probably did over estimate Lol but its Cos I've found in my day to day practice that codeine is significantly Worse than tramadol
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Carpediemxx
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(Original post by Dumachi)
DHC is stronger than Codeine. Both are weak though and Tramadol is unique and very effective for some people.
Dihydrocodeine Is rubbish, we don't prescribe it much at all these days
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Dumachi
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(Original post by Carpediemxx)
Dihydrocodeine Is rubbish, we don't prescribe it much at all these days
Not according to personal experiences and this: http://en.wikipedia.org/wiki/Equiana...-centric_chart
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Carpediemxx
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(Original post by Dumachi)
Not according to personal experiences and this: http://en.wikipedia.org/wiki/Equiana...-centric_chart
Obviously there is anecdotal Evidence and if it worked for you then that's great
Just I have never seen it prescribed in hospital for anything and is well known for being poor

Edit: your chart tells you why, only 20% Bio availability
Also check the bnf
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hey, I was admitted to hospital. I've had morphine and tramadol, both of which haven't worked! but I guess I'm in the best place...
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furryface12
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#28
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(Original post by Anonymous)
hey, I was admitted to hospital. I've had morphine and tramadol, both of which haven't worked! but I guess I'm in the best place...
Hope you're ok! At least you're in the best place as you say, if anyone can do anything about it they can and at least they're taking you seriously. Get well soon


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Dumachi
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(Original post by Anonymous)
hey, I was admitted to hospital. I've had morphine and tramadol, both of which haven't worked! but I guess I'm in the best place...
Ask for higher dose of morphine.
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Dumachi
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(Original post by Carpediemxx)
Obviously there is anecdotal Evidence and if it worked for you then that's great
Just I have never seen it prescribed in hospital for anything and is well known for being poor

Edit: your chart tells you why, only 20% Bio availability
Also check the bnf
Bio availability is not a indicator of strength by itself. u-Opioid receptor affinity is just as important and its metabolites strength.
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Scoobster
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#31
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(Original post by Anonymous)
hey, I was admitted to hospital. I've had morphine and tramadol, both of which haven't worked! but I guess I'm in the best place...
Well as you say, you're in the best place. Was your morphine administered orally or intravenously? That'll have quite an impact on how much it helps.

(Original post by Dumachi)
Bio availability is not a indicator of strength by itself. u-Opioid receptor affinity is just as important and its metabolites strength.
Totally agree with this.
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MasterJack
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#32
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Disclaimer:
TSR forums cannot be held responsible for medically unsound advice. For medical issues, please refer to your doctor.
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Kindred
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#33
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(Original post by Anonymous)
hey, I was admitted to hospital. I've had morphine and tramadol, both of which haven't worked! but I guess I'm in the best place...
You are deffinately in the right place. It may take a while for it all to kick in, but just make sure you let the nurses know if you are still in pain or anything else is wrong. Good luck getting everything dealt with soon. You will be fine. You are in the best place you can be and they will take care of you.
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Jennie1987
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#34
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Gallstones can cause infection or get worse so I know you've been diagnosed but if you're in that much pain you could go to an out of hours or A&E again. The worst they can do is send you home again, but at least you would feel like you were doing something? Ive had gallstones for a while and I can completely empathise with you - it is one of the worst pains and likened to childbirth.

Edited: seen your update, hope it all works out!
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CookieButter
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#35
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(Original post by Anonymous)
Hi. I have been in agony pain since last Thursday. During this time I've been to A&E twice, had various blood tests and yesterday I had a scan which confirmed I have gallstones. I was told that my GP will be in touch next week to discuss.

I am in absolute agony though and don't know what to do. I cannot put up with this pain for much longer but know that if I go to A&E I will be treat as a non emergency and as if I am wasting their time. I have paracetamol and iboprufen every 4 hours which is not easing the pain. I have done some research and the waiting list for gallbladder surgery at my local hospital is 88 days. I simply cannot go on this long as it's affecting my life. I can't do anything and I can't sleep.

Please, I appreciate any advice on what to do. Thanks.
aaah, good old fashioned conservative style waiting times. This is generally what happens to this country when the conservatives stay in power for too long. People, especially those not wealthy enough to travel abroad for treatment start suffering.

I remember in the 90s breaking bones a few times. My average wait was 10 hours in A&E...Ten, freaking, hours just to have an arm looked at, x-rayed and plastered as a child. Health services were in disarray and if you didn't live in an extremely wealthy neighbourhood you were going to suffer. It seems like things are going down that road again now. Of course then labour came into power and there was a literal revolution in the NHS. Waiting times went down to mins.

Its unacceptable for you to be in so much pain and wait so long. I suggest you give your GP a call and arrange an emergency appointment on the same day. He can prescribe you with stronger pain relief or help prioritise your case. You shouldn't freaking have to wait a 100 days to get treatment for such a PAINFUL problem. Thats just crazy.
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Helenia
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#36
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This thread is 3 years old. I suspect the problem may have resolved.
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Etomidate
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#37
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(Original post by Helenia)
This thread is 3 years old. I suspect the problem may have resolved.
and OP is still waiting to be unloaded off a trolley.

hehehueueheheuh
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