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.