Information leaflets

Information leaflets

These leaflets are used by Central Surgery. The first is about opiates such as high dose codeine (30mg), tramadol, morphine, oxycodone and fentanyl. The second is about ‘nerve-pain’ modifiers such as amitriptyline, gabapentin, pregabalin, fluoxetine and carbamazepine.

Opiate medication information leaflet

PATIENT INFORMATION: OPIATE MEDICATION

What is an opiate?

An opiate is a medicine related to morphine. These include weaker opiates such as codeine 15mg and stronger opiates such as Codeine 30mg, Tramadol, Morphine sulphate (Zomorph), Oxycodone (Oxynorm) and Fentanyl. This leaflet is about ‘stronger’ opiates.

What’s the problem with opiates?

They only work in about 20 % of people with non-cancer pain – 80% of people do not benefit.

Your GP will only prescribe an opiate  as a trial of 2 weeks.  If not working it will stop.

You might also want to look at other ‘non-drug treatments. For example, you might want to join one of the GP Practice run pain management or reduction groups – ask the receptionist about these.

What are the side effects?

Side effects are common.

Common:Dry mouth (50% of people), constipation (20-40%), sweating (35%), confusion or sleepiness (14-29%), weight gain (29%), sleep problems (26%), reduced sex drive (25%) and memory loss (24%).

Less common:Risk of falls and fracture, mood changes, emotional ‘flatness,’ increased pain and immune and heart and lung systems affected. The death rate for people on high dose opiates (over 120mg of morphine or 60mg of oxycodone) is 5 x that of someone not on an opiate.

Other consequences: Tolerance – your body gets used to it so it loses its effect. Dependence – withdrawal symptoms when doses missed (shaking, sweats, tummy pains). Drug seeking behaviour – overusing and asking for more. Ask your GP for help if you feel you are dependant and want to reduce your opiates.

What conditions areapproved for having a trial of an opiate?

  • Cancer or palliative (end of life) pain
  • Pre or post operative surgery pain – limited to 2-8 weeks’ maximum
  • Severe back or joint pain – short term but for no more than 1-4 wks. Repeat long term prescribing is unlikely to be continued. 

What conditions are NOT approved for having a trial of an opiate?

  • Fibromyalgia
  • Simple back or other muscle, joint or bone pain
  • Sciatica – there are approved other better medicines
  • Neurological pain – ‘nerve’ pain
  • Pain of unknown origin

Assessment for a trial of an opiate will cover;

  • Your risks of being dependant
  • Potentials side effects and interactions with other medications
  • Agree when you return to review it’s impact
  • They will agree a stop date if not working
  • You will sign a contract which talks about length of prescription, review and stopping
  • They will continue as part of plan that includes what else you can do to reduce your pain.

What else can I do to reduce my pain and increase my mobility

  • VIDEO AND LINKS: on our website PAINNET.ORG
  • LEAFLETS and a lot lot more on this brilliant site http://my.livewellwithpain.co.
  • ESCAPE-PAIN: A programme for people who it’s knee and hip pain (Over 55). More details 0191 4566903.
  • BLISSABILITY: A programme (any age) that helps people with chronic illness and pain. Ring: 0191 4271666
  • LIFECYCLE – Talking therapy: helps with anxiety, stress, depression and coping with pain. Tel: 0191 2832937
  • PHYSIOTHERAPY: Can be helpful in managing musculoskeletal pain and pain management. Tel 0191 6531072
  • PAIN GROUP: If you would like to attend one of our pain groups talk to a receptionist

Rules about regular opiate prescriptions

  • Do not ask for a repeat of your opiate medication unless that has been agreed as part of your management plan
  • Opiate prescriptions – there are controlled drugs and only issue in monthly amounts
  • The maximum about of morphine that we now prescribe (total daily dose) is 120mg, for oxycodone it is 60mg.

Written by Central Surgery’s ‘Pain Team:’ Dr Gallagher, Dr Tose and Mr. Urwin (pharmacist)    10.12.18

‘Nerve-pain’ modifier patient information leaflet

PATIENT INFORMATION: ‘NERVE PAIN’- MODIFIERS’

What is a ‘nerve pain’-modifier?

A ‘nerve pain’-modifieris a medicine that can help ‘nerve pain.’ This includes amitriptyline, gabapentin, pregabalin, duloxetine and carbamazepine.

What’s the problem with these medicines?

They only work in about 20-30 % of people – 70-80% of people do not benefit.

Your GP will only prescribe as a trial of up to 4 weeks.  If it is not working it will stop.

You might also want to look at other ‘non-drug treatments. For example, you might want to join one of the GP Practice run pain management or reduction groups – ask the receptionist about these.

What are the side effects?

Side effects are common.

Amitriptyline:Nausea or vomiting, Drowsiness or tiredness, Nightmares, Excessive sweating, Weakness, Headaches, Dry mouth, Constipation. More details – https://www.drugs.com/sfx/amitriptyline-side-effects.html

Gabapentin and Pregabalin:Common:headaches, feeling sleepy, tired or dizzy, diarrhoea, mood changes, feeling sick, swollen hands, arms, legs and feet, blurred vision, for men, difficulties with getting an erection, weight gain, memory problems More details – https://www.drugs.com/sfx/pregabalin-side-effects.html

Rare but serious: thoughts of harming or killing yourself – a small number of people taking pregabalin have had suicidal thoughts that can happen after only a week of treatment, difficulties breathing, severe dizziness or you pass out, hallucinations (seeing or hearing things that aren’t real) problems going to the toilet, including blood in your pee, needing to pee more often, constipation.

Duloxetine: Common: Nausea, Dry mouth, Sleepiness, Fatigue, Constipation, Loss of appetite, Sweating.

Rare but serious: thoughts of harming or killing yourself – a small number of people taking pregabalin have had suicidal thoughts that can happen after only a week of treatment, aggression, irritability, panic attacks, turning ‘yellow’ (jaundice), lip swelling, rashes, dependence – we are not sure how this happens but a withdrawal symptoms can happen (sweats, irritability, tummy pains)

What conditions areapproved for having a trial of ‘nerve-pain’ modifer?

  • Diabetes – all meds except carbamazepine
  • Sciatica – there is debate about using gabapentin here
  • Neurological nerve pain e.g. MS
  • Shingles pain – amitriptyline first
  • Trigeminal neuralgia – the best choice is carbamazepine which is rarely used 

What conditions MAY NOT benefit from having a trial of a ‘nerve pain’-modifier?

  • Fibromyalgia – only 10% of people get a reduction in pain with gabapentin and pregabalin – amitriptyline can help sleep
  • Simple back or other muscle, joint or bone pain
  • Pain of unknown origin

Assessment for a trial of an opiate will cover;

  • Your risks of being dependant
  • Potentials side effects and interactions with other medications – some of these medicines have lots of interactions especially duloxetine
  • Agree when you return to review it’s impact
  • They will agree a stop date if not working
  • They may continue as part of plan that includes what else you can do to reduce your pain.

What else can I do to reduce my pain and increase my mobility

  • VIDEO AND LINKS: on our website PAINNET.ORG
  • LEAFLETS and a lot lot more on this brilliant site http://my.livewellwithpain.co.
  • ESCAPE-PAIN: A programme for people who it’s knee and hip pain (Over 55). More details 0191 4566903.
  • BLISSABILITY: A programme (any age) that helps people with chronic illness and pain. Ring: 0191 4271666
  • LIFECYCLE – Talking therapy: helps with anxiety, stress, depression and coping with pain. Tel: 0191 2832937
  • PHYSIOTHERAPY: Can be helpful in managing musculoskeletal pain and pain management. Tel 0191 6531072
  • PAIN GROUP: If you would like to attend one of our pain groups talk to a receptionist

Rules about regular prescriptions

  • Do not ask for a repeat of nerve-pain medication unless that has been agreed as part of your management plan
  • Gabapentin and Pregabalin: from 1stApril 2019 these are controlled drugs and only issued in monthly amounts
  • Gabapentin and Pregabalin: If you are on this long-term you will need a yearly review. Often at this stage the dose can be reduced.

Written by Central Surgery’s ‘Pain Team:’ Dr Gallagher, Dr Tose and Mr. Urwin (pharmacist)    10.12.18

 

 

 

Self help resources for patients

Self help resources for patients

One of the best sources of help for patients and professionals is at ‘Live well with Pain.

The website and resources were developed in North Tyneside and my patients have found these to be extremely helpful in thinking about what ‘Persistent Pain’ is and how we can ‘dial down’ the impact it is having on our lives.

I would suggest that you explore the site and some of the links on it. You might want to print out something that applies to you that you can discuss with your GP.

One of the problems is that some GPs are not good about talking about persistent pain, but we are working with them to try and improve their knowledge and skills.

 

Dr Morris Gallagher

PS: Look at the short video on pain on the front page of this blog for a quick summary of the latest thinking – and action – that can help you live better with persistent pain. 

WELCOME

WELCOME

This is a trial site. It is intended for people living and working in South Tyneside, but is is publicly viewable.

The purpose of the site is to equip people with resources to help manage persistent pain. In the future it may host a forum for people with pain.

If you are interested in contributing to this site email me .

Dr Morris Gallagher

Central Surgery, Sough Shields

Services in South Tyneside

INTRODUCTION

The truth is that pain-killers are often not the solution to persistent pain. They may help a the beginning of a pain episode but they are best tailed off after three months and replaced with better things to re-programme the brain to manage the pain.

This is a list of services that may help you. What they have in common is that they help you to ‘re-programme’ your life and pain with exercise, diet, and mental skills. This has been shown to reduce pain and improve your life.

CHRONIC PERSISTENT PAIN RESOURCES IN SOUTH TYNESIDE

1. ESCAPE PAIN

OUR ADVICE: This is a brilliant service for people with chronic knee and hip pain, but you need to be over 55 years old. This is popular with our patients who tell us that after the programme they have reduced pain and stronger knees. 

Th website says that “Escape-Pain is a group based, NICE-approved rehabilitation programme for the management of osteoarthritis of the hip and/or knee.  Classes are run by Age Concern Tyneside South (ACTS) for six weeks with sessions on Mondays and Thursdays.  To be eligible you must:

  • do less than 30 minutes physical activity per week
  • be aged 55 years or older
  • have experienced chronic joint pain for at least 3 months
  • need a supervised exercise programme
  • be independently mobile and able to carry out regular exercise
  • Available to attend classes for 6 weeks

For more information please contact Age Concern Tyneside South on 0191 4566903.”

OUR ADVICE: ‘Pain-killers’ don’t work very well in ‘arthritis’ of the knee or hip and this is an excellent alternative. It does not matter if your pain is ‘mild’ or severe or are preparing for surgery this programme will help you.  

2. BLISSABILITY 

OUR ADVICE: This agency offers lots of help and advice. One of their programmes promotes ‘self care’ where you can look at ways of ‘re-programming’ your life with exercise, diet, and mental skills which improve your ability to deal with your pain. 

Summary

They provide a 6 week (2 hours per workshop) free course on “health and wellbeing in mind and body.”

The course looks at understanding what health is and what it is not. It looks at the body and mental and social wellbeing and how we can look after ourselves. Here is an extract from their website about this course;

  • “Behaviour change: Discover how we can try to change unhealthy behaviours and how the best motivator for change is ourself.
  • Self Esteem, & confidence: Learn how negative feelings can affect our behaviour which can affect our self-esteem and beliefs.
  • Stress: Find out what stress can do to our bodies and how we can chill out.
  • Nutrition: Investigate healthy eating, the eat well plate and food groups; salt, sugar and fat content and food packaging.
  • Exercise: Looks at what is exercise and how even a little is good for us; knowing where to go when things go wrong and social prescribing.”

How do I contact them?

You can refer yourself by ringing 0191 427 1666. This is the weblink.

OUR ADVICE: this is really helpful for patients with persistent pain where ‘medical treatment’ have not made much difference to their pain. It is a great way to look at other options to ‘reprogram’ the brain and reduce pain. some patients also like the shared experience of working with people who are ‘in the same boat’ 

3. South Tyneside Lifecycle Primary Care Mental Health Service – (formerly South Tyneside Talking Therapies)

OUR ADVICE: if stress, trauma, anxiety, low self esteem or depression are issues that you are dealing with then tackling them may improve your ability to deal with your pain

Also known as: South Tyneside Lifecycle Primary Care Mental Health Service or South Tyneside Talking Therapies.

They “offer a confidential service to individuals, families and groups depending on which method is most effective. We aim to help people through difficult times in their lives. We initially offer an assessment appointment to help you to decide, with the support of one of our experienced therapists, which therapy would be the most helpful to you.”

This is their list of things that they can help with

  • “Anxiety
  • Depression
  • Trauma
  • Stress
  • Bereavement
  • Low Self Esteem
  • and other emotional issues”

The types of therapy that they describe include:

  • “Cognitive Behaviour Therapy (CBT)
  • Cognitive Analytical Therapy (CAT)
  • Eye Movement Desensitisation and Reprocessing (EMDR)
  • Interpersonal Therapy (IPT)
  • Mindfulness
  • Primary Care Mental Health – workers who offer integrative brief therapy
  • Short Courses and Supported Self Help (4-6 weeks) that help people understand common mental health difficulties they might be experiencing and what they can do about them.”

Where is the service provided from?

This exciting six-day service will offer extended late evening appointments Monday – Thursday and Saturday opening. The main base will remain at Cleadon Park Primary Care Centre with appointments offered to clients at Flagg Court Primary Care Centre, Monkton Hall as well as other venues across the borough.

How do I contact them?

You can self refer on 0191 404 1322, This is the weblink.

OUR ADVICE: assessment is normally within a few weeks but the wait for treatment can be several months. in the meantime here is a link to some resources that may help you.