Chronic Pain

Introduction: medication for chronic pain and side effects

Chronic pain is difficult to treat and many of the people we talked to had tried a number of different medications before one, or more, was found that helped. Often people were taking a combination of different types of medication, commonly in combination with non-drug techniques (see also the 'Pain management approaches' section).

Regularly takes a combination of pain medication and antidepressant drugs and can vary other...

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Age at interview: 29

Sex: Female

Age at diagnosis: 23

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Yes, I have had to take medication, I was started on painkillers quite soon at the beginning, mainly just paracetamol or Ibuprofen at the beginning in quite large quantities, and then I was on anti-depressant medication actually for depression, what they actually do with fibromyalgia now is use a good painkiller is called tramadol, which works as a pain killer and also it works to increase levels of Serotonin, which dampens the pain down, messages from the brain to help, so it works on a sort of dual action sort of system.

And then they also use neurotransmitter drugs, like anti-depressants so you take tricyclic medication like amitriptyline, you take them in very, very low doses so they don't actually treat depression they just treat the pain and help you to sleep much more deeply.

Because people, as soon as you mention anti-depressants, people react, "I'm not depressed", you know "I don't need those, they need those", but they need to understand that at a low dose they work in a completely different way and also to increase levels of serotonin you can take drugs that stop it being reabsorbed as quickly by the nervous system called serotonin reuptake inhibitors.

So I take one of those in the morning to also act as a pain relief and also the serotonin can stimulate you and make you more awake, so that helps, I sort of take go to sleep pill in the evening, a wake me up pill in the morning and then I distribute my painkillers as I wish them during the day and that can completely vary on how you're feeling that day, depending on how you've slept or what you've done the day before and what you're planning to do that day.

So some days I'll take quite a lot, some days I might not take any, and in some ways that's good if you can control it yourself so, yes.

The type of pain can influence which medication is most suitable. People we talked to had used a range of different medicines including anti-inflammatory drugs, drugs that contain codeine and paracetamol, tramadol, muscle relaxants (benzodiazepines) and opioids.

Some people had also received drugs that are usually used for either epilepsy (anticonvulsants, antiepileptics) or depression (antidepressants). This is not because they have epilepsy or depression but because these drugs can also help certain types of pain.

Many of the people that we talked to had experienced side effects from these medicines. However, while lots of the drugs prescribed for pain relief can cause a wide range of possible side effects, this does not mean that everybody taking a particular drug will experience them.

Also, people often find it hard to know if a side effect such as heavy sweating or tiredness is due to the medication or some other cause, such as the menopause. One woman who suspected her heavy sweats might be menopausal realised they weren't when she met others (including men) who had the same side effects.

Side effects were often worse in the first month of taking a new medication, so perseverance might be rewarded. However, sometimes the side effects were worse than the pain. People stressed the importance of having a good relationship with their GP and working together to find the best pain relief with the least side effects.

Experiences mild side effects and advises people to persevere as side-effects are often worse in...

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Age at interview: 29

Sex: Female

Age at diagnosis: 23

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Did you experience any side effects from any of the medication that you take?

I think I'm quite lucky because I don't think I do, I mean obviously you get constipated quite often, from the amount of painkillers you're taking, a lot of people can get side effects from tramadol, which is the painkiller I take.

You can get dizziness and nauseous and slight tremors and things, but I get absolutely none whatsoever, and with the tricyclics you take in the evening you can get a dry mouth, which I do have but I don't particularly find that very bothersome, you can get weight gain, it can make you really, really sleepy, so you can feel quite fatigued through the day if you take too much.

So its important to mess around and get the right dose, in conjunction like with your GP. But a lot of the time when you start taking new medication you'll get side-effects for the first month or so anyway, while its beginning to work and then they'll actually fade away so it can be worth persisting with a specific type of drug before you think, 'Oh no I can't take this', because you might actually be throwing away an effective drug which might help you in the long term.

Advises people to tell their GP about side effects and emphasises that side effects can vary from...

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Age at interview: 50

Sex: Female

Age at diagnosis: 45

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So it was like a continuation of everything. So you've got to be very careful, you've got to know your doctor, you've got to be very frank with your doctor and say to him look this is what's happening with this tablet. They've heard it all before, they're not going to hear anything that's going to shock them, so it's a case of if you're honest with your doctor and say 'Look this is nae, this really this isn't working, is there anything else you can suggest'.

As long as you've got a good rapport with your doctor you can sit and talk about any tablet you're going to be put on, he will give you the most major side effects that goes with it, and you can discuss it with him, if its going to be beneficial to you and is there another tablet that doesn't give you so many side effects, if there is would it be because you're on some other tablet, would it be counteractive to that tablet.

So as I say a good relationship with your doctor you need to have, you need to discuss it with him or her, and say 'Look what is the best thing for me'. You've got to be willing to try different tablets. I mean even if the doctor says to you these tablets side effects are horrific, it might not be the side effects that you get, because every person is different.

So it means that you're not getting the same side effects as somebody else is getting on the same tablet, so as I say its your body, it's the chemicals or whatever the make up of your body, its how that deals with any foreign substances that you put in it. And you have to actually be aware and be able to turn round and say to the doctor ok I'll try it but if it doesn't work I'll come back.

Some found another similar drug or one with slightly different ingredients that gave them less troublesome side effects. A woman described how she had ended up taking the antidepressant drug imipramine for nerve pain because a similar drug, amitriptyline, had made her feel drunk. Others found that they had to try a different type of drug altogether. One man went back to taking tramadol because he could not tolerate the side effects of strong opioids.

She was originally prescribed one drug but couldn't tolerate the side effects so was given a...

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Age at interview: 38

Sex: Female

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The actual antidepressant I'm on is Imipramine. I did, they gave me amitriptyline initially and that was awful. I only took a very short term, I was due to take it for quite a while and then I was only on, I think it was on 25 or 30mg a day, I can't remember exactly.

I took the first dosage and the next morning I felt like I was drunk. It was the most horrendous feeling. I drove to work, but I really shouldn't have done because I really did fell very peculiar. I didn't feel I was, it was almost like having an out of body experience. That's the only way I can describe it, it was a horrible feeling.

And at work, all morning I was really struggling just to work and it wasn't till about half past eleven, twelve o'clock I was actually able to be awake. And I thought, 'Well I can't do that, obviously'. So I spoke to a friend of mine whose daughter's on it, unfortunately her daughter's got ME, and they're giving it her because she has a lot of joint pain and they've given it her for that, although they've since changed her medication.

So she said to me 'Don't take it just before you go to bed, take it about eight o'clock and the effects should have wore off by the time you go to work' and it did work, but I still didn't feel very well at all. I really... the doctor at the hospital did say that there are alternative drugs they can give, so I did actually stop it straight away because I just felt, and I was fine then, I had no problems.

So, when I went to the hospital for the injections into my facet joints, I explained what had happened, and she says 'fine, we can give you another one, that's not a problem' and that's when she prescribed imipramine, which I don't have any side effects, apart from the constipation.

He has very few side effects from tramadol but had a very bad reaction to strong opioid drugs.

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Age at interview: 63

Sex: Male

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Do you experience any side effects from the tramadol?

No, not a lot, no. Nothing compared with the rest, I mean they're, the other painkillers I was taking like Diconal, like the Oxynorm and the Oxycontin I was prescribed, I mean, they put you in a different world altogether, they just, you were thinking and trying to do things that you weren't capable of doing.

I mean, I found this happening, as I said, I shouldn't be feeling this way, this is not a way the medication is meant to work, its meant to be helping me stomach, its not meant to be affecting me in this other way, its meant to be sorting out the problem in the stomach, but its not, its affecting the rest of my body, its making me want to do things I don't want to do, like drive my car into a wall or something you know, along that kind of lines or I'll jump off a roof or something or, or go and swim 100 miles.

I mean, something that you wasn't able to do, and it makes you feel so stupid but only within myself because I didn't react outwardly to the effect the pills was having on me. I tried to keep it to within myself, I just tried to shut my eyes and forget about it when this kind of medication happens, and I'd just say, 'Well I'm sorry, I can't take these any more' and when that kind of thing starts happening, and my wife will tell you, I'd just go straight back to the doctor and give him the pills back, and I'd say, 'I don't want anymore, keep your pills, I don't want them' and then we've got to start from scratch again.

Many people commented that the medicine never completely relieved their pain but did reduce it to a level where they could cope. This was important for some people as they felt that they could get on with what they wanted to do. However, others worried that because their pain was dulled their activities might be causing further damage (see also 'Exercise and activity').

The combination of medicines she uses doesn't take the pain away but takes the edge off it.

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Age at interview: 32

Sex: Female

Age at diagnosis: 26

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But, the other thing that you also learn is that most medication is actually for acute pain, it's not for chronic pain. So that's why sometimes these drugs that they give you aren't always effective, which I didn't know at the beginning. Which is why I've ended up on a cocktail really.

But also, you learn that they don't tend to take the pain away. What they often do is take the edge off it and just get it to a level where you can carry on and do things without your back stopping, well, without my pain stopping me really, but my back. And, that for me has been really, really important, it is having that.

Because I remember when I was really bad and I just got to a point where I couldn't do very much and now I'm at a point where, in combination with the medication and my epidurals, I am almost living more than I was a couple of years ago. It's sort of been a question of balance really, balancing out my social life, my medication and my work and I have managed to get it all to balance and I mean the one thing you have to be aware of on long term medication, is side effects and I definitely know that I've got some of them.

I mean I can't take things like Voltarol or Brufen any more, because of my gut. I do when I'm desperate but I usually regret it for about a week afterwards.

Realises that medication is not always the best for her body, but using it allows her to get on...

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Age at interview: 24

Sex: Male

Age at diagnosis: 18

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I think I'm quite pragmatic about the type of medication that I take in that it does help me do what makes me happy. I try not to think about it too much because I know that it's probably better for my body not to take the strength of medication that I do have to but, at the end of the day, I would much rather be physically able to do a job and actually have a social life, than perhaps have a healthier stomach. It's a question of balance again.

People often talked about weighing up the pain relief against the side effects, seeking a balance of the problems and the benefits of taking medication. Although most people stressed that they do not like to take drugs, the short and long term side effects were usually thought worth bearing for the relief from pain.

However, sometimes side effects are so bad, or other techniques so effective, that people decide to stop taking any medication (see also 'Managing, taking and stopping medication').

Some pain medication can interact with alcohol. Whilst many said they avoided alcohol completely others drank in moderation. One woman said she would have a drink sometimes if her tablets weren't helping as much as usual, although she knew it was probably wrong. Several others, who were not using medication, said that a moderate amount of alcohol helped their pain although they knew that it would be wrong to drink excessively or become dependent on alcohol.

Occasionally has a drink of alcohol when her medication is not working as well as usual, even...

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Age at interview: 80

Sex: Female

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Now, I just suffered and took, now what did I take in the way of painkillers?

I think they were giving me Distalgesics already and at some point, about a year or so later, a GP said you know 'How many are you taking at a time' and advised me to take three, he said it's a matter of getting the dosage right. So pretty well, since then, I've been on an almost routine dose of eight a day, which is the maximum. I never, ever take more than that.

Occasionally, when it's been very bad, I will have a slug of scotch or brandy to potentiate it. Now I know this is evil, but it's better I think, by and large, rather than doubling up the dose yet again.

A few people discussed the use of cannabis for pain relief. All were aware that possession of cannabis is illegal and that you can be charged and prosecuted. Whilst some felt it helped them relax others tried it but said it did not help the pain and they found the side effects extremely unpleasant. A few people were aware that cannabinoids, derived from cannabis are being tested in the treatment of MS pain and nerve pain.

Last reviewed August 2018.

Last updated November 2010.