Pain Relief generally

[Polar Bear]

I take tramadol as part of my treatment for WED, taken in 3 doses:
50mg at 1pm
100mg at 6pm
50mg at 10pm
This is in addition to requip.

At present my back is giving me a bit of bother. Partly following a fall a month ago and which is now ok, and more recently because I've had such a cough and head cold (4 weeks) that I believe my back is sore from coughing.
However my back is always a wee bit of a problem and Fibro likely has a part to play also.

Here is my question.....
Tramadol is a part of daily WED medication and this does not do anything to relieve back ache, or indeed my general overall body aches and pains which would be a part of my fibromyalgia.

However if I take an over the counter pain relief such as paracaetamol 500 plus 8 mg codeine (combined pill of which I take x2), it helps within a half hour. It is the codeine that helps because paracaetamol on its own doesn't help.

So - 16mg codeine helps general body pain where 50 or even 100 of tramadol does not. Yet they are both opiates albeit tram is a synthetic.

At one time I had some codeine for my WED but Doc seems happier that I take tram for my WED rather than codeine because codeine is the more addictive.

I might ask for some codeine for my fibro, but then (if I was given it) I'd be taking 2 opiates, tho the codeine less often and only as needed.

This is my question - Can someone tell me in a very simple fashion why this should be.
I know that it it probably to do with receptors etc. but I know of people who take tramadol on its own for back ache with great success. With me it seems to be limited in what it is useful for.

And could 16mg codeine be as strong as tramadol. I would not have thought so.

Also regarding pain relief in general, others find that with certain medication it knocks them off their feet with its strength. This never happens to me. Indeed once I was given a pre op medication and the nurse couldn't understand that I was sitting up reading and conversing. poor girl nearly had a fit when she discovered I was out of bed and in the bathroom.

I have known friends to be reeling from a tramadol.
My d-in-law is a prescribing senior nurse and says she hopes I never need pain relief following major surgery.

I'd be interested in any comments.

[Chipmunk]

If I'm understanding you correctly, you are asking why the drug might affect you differently?

Drugs need to be metabolized by enzymes, which our bodies produce in varying quantities. So for example, say a drug needs Enzyme A to be metabolized. If you are deficient in Enzyme A then you will not process it quickly and could have mild effects for an extended amount of time. If you have plenty of Enzyme A, then a smaller dose will hit you harder OR you could need more because it is washed out of your system sooner.

In addition, many drugs use the same enzyme pathways, so if you are taking certain drugs together, your body can only process so much at a time.

There are known genetic links to the different drug metabolisms. One day we will be able to get our genome sequenced and from that, determine if we will be a fast or slow metabolizer of a given drug but until then just take notes on your experiences.

[Polar Bear]

In addition, many drugs use the same enzyme pathways, so if you are taking certain drugs together, your body can only process so much at a time

Thanks Chipmunk
I hope I word this properly.....

So - there can be a situation where no matter how much of a particular drug you take, or a combination of similar drugs, the body will only be able to reap pain relief benefit from the level that the body is able to process.

Also, if Drug A needs a different enzyme than Drug B needs, this could explain why Drug A may work better or not than Drug B in any particular person.

[Neco]

You need to be aware also, that Tramadol is not a true opiate in medical terms. It does act on some of the same receptors, but it does not come from a traditional opiate source if I recall correctly.


Also different medications may just affect you differently as well. Hydrocodone and Methadone don't really do anything to touch severe dental pain for me.. However Codeine works without fail, every - single - time. Even when I have Methadone in my system.

Of course my Doctor likes to claim otherwise, but its not my fault she's ignorant and won't prescribe the stuff when I have severe pain So I usually just don't tell her if I receive it from a Dentist.

But that's a bit off topic now...

[Chipmunk]

In addition, many drugs use the same enzyme pathways, so if you are taking certain drugs together, your body can only process so much at a time

Thanks Chipmunk
I hope I word this properly.....

So - there can be a situation where no matter how much of a particular drug you take, or a combination of similar drugs, the body will only be able to reap pain relief benefit from the level that the body is able to process.

Also, if Drug A needs a different enzyme than Drug B needs, this could explain why Drug A may work better or not than Drug B in any particular person.

Yes, exactly! There are certain meds that have zero effect on me, and others that knock my socks off.

Wellbutrin is one that I have to take a lower dose because at the normal dose it builds up in my system and causes numbness and tingling in my arms and hands. As long as I take a lower amount I'm fine indefinitely. I must not make enough of whatever that enzyme is that Wellbutrin needs.

Codeine is another one that I don't metabolize normally, along with some other opiates. I'm also low on the enzyme for lactose and the one that digests cooked apples, on the subject of things you really weren't wondering about...

[Polar Bear]

Thanks Zach and Tracy for your info.

[Rubyslipper]

Polar Bear--my doctor won't prescribe anything for my fibro pain except Tramadol which does NOTHING to help. I can take Excedrin Back & Body and get better relief. So what gives?

Chipmunk--another doctor has taken me off Wellbutrin because I get these weird tingles at different times in different parts of my body. I have never heard of anyone else having problems like this so maybe he knows what he is talking about! So what do I take instead?

I love life but sometimes it is almost too much! LOL

[Polar Bear]

Ruby,
for my fibro the doc prescribes me Amitriptyline 20mg as a sleeping aid and it does help. When I research it shows me that this is a commonly prescribed medication for fibro. However I have not noticed that it helps with my body aches when I have a 'fibro' day.

Also although I take tramadol for my WED which it helps, it does not help the fibro pain. I buy an over the counter med of paracaetamol/codeine called Syndol and this helps.