Analgesics
He began taking regular analgesia in 2001. In addition to paracetamol,
he was prescribed numerous analgesics over the subsequent few years
including celecoxib, codeine, co-dydramol, nefopam and meptazinol all of
which were ineffective, and diclofenac, which caused gastrointestinal
upset. Gabapentin and tramadol initially provided limited relief, but he
gradually increased his use of these medications to high doses over a
few months and their effectiveness waned.
In 2005, he was referred to an NHS 6-week pain management program, he
was cautioned against further dose increases of all analgesics and
advised to reduce his opiates. This intervention helped him realised
that opiates had largely been unhelpful for him and had caused
significant side effects. He concluded that there would be no complete
resolution of his pain with medication alone and he adopted a routine of
daily exercise including swimming and treadmill walking, weekly massages
and regular Reiki. To avoid further adverse effects from his medications
he stopped tramadol and gabapentin abruptly without medical advice and
he experienced significant unpleasant withdrawal effects.
He currently uses tramadol 50mg QDS, paracetamol QDS, amitriptyline 25mg
nocte, and topical Diclofenac. He has been stable on the same doses of
these medications for many years. He does not identify as being
dependent on any of his analgesics although he recognises that he has
developed some tolerance to tramadol and this is his primary motivation
for avoiding further dose increases.