Drugs. How do they work?

Dianne, your post reminded me of a mother's quote that I recently read on a CaringBridge Site:

"Dr. ____ (at big name clinic) has his opinions of "B's" head pain. She has gottten so many various opinions which frustrates her a great deal. He admitted how difficult headaches are to diagnose and trerat and also said a roomful of neurologists would never come to the same conclusion on her head pain. They would all have their own thoughts and opinions."

Cheryl

Dianne, you are right of course about the fact that doctors can disagree on many issues connected with migraine and headpain etc.
This discussion has been going in different direction, so I should have made it more clear that I was only refering to Pen's question:
But if no one can say what the difference between addiction and MOH is, then one has to assume it is the same thing
This was the subject that I was refering to since people have often strong feelings when the word addiction is mentioned.That's all. Sorry about misunderstanding.

Another thought occured to me is that if doctors have different opinions, how can anyone on this forum come with the right answers, since we definitely know much less in terms of brain chemistry and brain functioning.
We know one thing for sure: that each of us finds our own ways of dealing with migraine, but our way is unlikely to work for another person. The treatment that works for us might stop working, new things are tried. But no medicine works in exactly the same way for everybody.

This is why sometimes someone from outside "the pain" can have a better perspecitve and experience of seeing and talking to thousands of patients,so I suppose when they talk about MOH it is because they see it in their patients.
One day we will get alll the answers to how medicine works, and why they don't work for evryone.

But if no one can say what the difference between addiction and MOH is, then one has to assume it is the same thing

Really? even if it - addiction- doesn't cause headaches ???

If smoking cigarettes is addiction, does that mean it is also MOH??
since addiction and MOH is, as you've said THE SAME thing.. and smoking is addiction, like it or not...

Risa

Exactly my point Risa. How can they be the same thing?
And if, as it seems only some people succumb to addiction....even cigarettes...I was never addicted.
Then maybe there is a clue to why/how only some people seem to get MOH. And others never do.

Still be interested in the how and why of the drugs.

My neighbour's sister takes the drugs every day, and she started to take them for headaches.
Now she still has the headaches, and takes more of the drugs.
So decided she must be addicted to the codeine and that it is not helping the headaches.
She had never heard of MOH. Wont go to the dr about it because of fear she is labelled an addict...

So the other option is she is addicted to the codeine, but also has MOH.
Or she has daily headache and the codeine isnt working.
or......

I dont know, but whatever is happening, the codeine is not fixing the problem....

Pen

Is MOH like addiction?

Pen, I suppose, after a certain time these two partially "layer" on each other.
here's the best example because it's visual:


So, the addiction and MOH albeit two different things will have commonalities.

But the addiction is one thing, MOH another.

MOH is simply a headache caused by the use of the same medication whereas an addiction is an uncontrollable habit.

MOH I guess can led to addiction, while addiction not necessarily to headaches.


Now, whether or not your friend is addicted to the pills she is taking- who knows.

The only way to find out is if she took at least two weeks- or better yet - two months break from her meds to be able to say.
If after two months her headaches would improve, this would mean she does have MOH.
If she turned out to be unable to stop taking the medication not because of the head pain
but because she is craving the drug, it would be obvious she became addicted to them.
If she stopped but during and after two months of stopping her head was no better, then it would be pretty obvious she is neither addicted nor it is MOH.

However,
this is so hard to just not take anything just to find out if what we have is MOH, or not.
Very, very hard... She would need a lot of support, and ongoing care from her family at least.


Risa

As a derivative of morhpine codeine is a highly addictive substance.
So, it follows that taking it on frequent basis means that you are likely to become addicted quite quickly (that overlap from above drawing).

If it is taken for headache what happens is that taking codeine might also lead to MOH process, which means worse, more frequent headaches if you do not take it, since you body is use to having it.
However you can only tell for sure just as the previous poster said, by completely stopping the suspected medication for a considerable time as the stuff stays in the system for quite a long time.

Of course when you stop taking it for few weeks, you will most likely suffer much worse h/aches, simply as a result of withdrawal. This is why so few people try this, or do not stay off the mediciene long enough in order to find out for sure.
You need to clean it out of your system completely, and this takes time.

You might ask those questions:
Is your headache worse since you started to take codeine, Syndol (or some other drug) on a regular basis. Do you always wake up with a headache. Is your h/a more frequent since you started taking it.
If the answer to those question is yes, you are likely to be suffering from MOH which means your headaches were caused by the medicine you took to get rid of it, in the first place.

After you have stopped to take it for few weeks and now experince less frequent headaches, specially if you find a suitable perventative as well, it was definitely MOH. Migraine will not go away completely since at the moment it is not curable (with few exceptions) but you will have much longer painless periods, in between.

You cano ask to be admitted to a hospital if you wish to go through that withdrawal stage under supervision to get help with initial withdrawal pain.

Syndol is very likely to be the cause MOH, specially if you headaches were not as frequent in the past, andt got worse after the start of taking them, on a regular basis.

This is the theory - but you need to go through the experince of "doing it", to know for certain. No other way to know.

NOt all frequent headaches are caused by MOH, there are other causes.

However such prolonged treatment is the only way, to make absolutely sure that you headaches were not caused by MOH. Otherwise you will NOT know.

Total agreement with the above two posts.

I'm one of the vocal ones about it not always being MOH or rebound. However, I am only speaking for myself. I went off ALL meds for four months. No preventative, no OTC. It wasn't shear will power, I had had a horrible experience with multiple meds and was frankly scared to death to take anything.

But, even after four months I was still getting daily migraines. So, the Dr and I were able to rule out MOH exclusively in my case.

But, the only way to find out is to buckle down and walk the walk. It's not pleasant, but it's the only definitive way to determine it.

Hope he doesnt mind me cutting and pasting, but part of this is pertinent to this thread also.
Thanks.

Re: a huge vent after seeing a new neurologist.
lrobb98 Today at 4:57 am

Some(many) doctors do not listen....what we as patients need is someone to listen and piece everything together.....The problem with chronic migraine is that medication overuse is almost part of the syndrome, because9of course) people try to take whatever, in order to get thru the day. Triptans can cause rebound or withdrawal headaches, but not as much as certain short-acting opioids, caffeine meds(Excedrin) and butalbital. I have never been big on diagnosing rebound, except in obvious cases, I thought the pendulum had swung much too far toward that diagnosis, and now it is swinging back; well done studies indicate that going on preventives, or Botox, even without withdrawing the daily analgesics, is still helpful and worthwhile. The problem is that we do not have good enough preventives(they only help, long-term, in about 50% of people). Larry Robbins,M.D. http://www.headachedrugs.com

As a derivative of morhpine codeine is a highly addictive substance.

Yes and no.
It is derivative of morphine, yes, but just because it is doesn't always mean automatically it is "highly addictive" in every case.

Codeine is many times weaker than morphine, to begin with, and it would depend how much and in what form you take the codeine to develop an addiction.

In most M medication we take, starting with T1 where there is 8 mg codeine content to usually most prescribed
T3 with 30mg of codeine in it, the risk of addiction is quite low, unless one abuses it.

A physical dependency, though, it's a whole a different pair of shoes,
where our bodies get used to the drug and go thru a withdrawal once the drug is stopped but that has nothing to do with addiction.
It's the same process as stopping, say, Neurontin where you simply can not just stop but slowly titrate down if you need to stop taking it as your body may go into shock from sudden withdrawal otherwise.
Same with sudden withdrawal from prolonged use of any painkillers.

Now, if you were using, say, a codeine tablets without any other additives like caffeine or acetaminophen, then the risk of addiction increases. A lot.

But we here are talking about using M medications.

Comparably, stronger narcotic pain relievers such as Percocet or Vicoden or similar offer way higher risk of addiction than codeine medication than we take.


Now, about Syndol - I don't know if there are different kinds of Syndol in UK like we have T1, T2, T3 in USA and Canada with different codeine content in each
but I see online that Syndol has only 10mg of codeine.
This much highly addictive? That's would be a laugh.
In Canada T1 with 8mg of codeine is sold without prescription over the counter, in Australia -Panadiene Extra has even 15 mg and also is available without Rx.

http://www.superliving.co.uk/pharmacy/your-health/pain/tension-headaches/syndol-30-tablets-p-17.html

Syndol Tablets contain the active ingredients:

* Paracetamol BP 450mg
* Codeine Phosphate BP 10mg
* Doxylamine Succinate NF 5mg
* Caffeine BP 30mg

http://en.wikipedia.org/wiki/Codeine#Australia


Risa

I can see that you obviously have interest in the subject. It is always helpful to know as much as possible about our medicines, we all must do that. However, it is always best to look at the wider picture.

In countries where it is possible to buy any potentially addicitve products such as codeine, it is easy to slip into dependency without even realising it, then this might lead to addiction, of which we are not aware at the time.Then you might suspect something is wrong, but it is difficult to realise that it is our favourite medicine that is causing it, so then comes denial etc, etc.. And it follows that there is always lot of emotional issues around the whole subject of dependency, and addiction.

So, lets just look at some of the facts calmly by looking at the information which is provided for the patients here in UK, included by the pharmaceutical industry who are producing OTC medicines containing codeine on sale in this country.
Surely they are the people who must know their product, and so they must have a good reason to warn us about it, even though they are trying to sell it to us.

They include a following list in their leaflets, warning patients who are buying medicines including codeine, that there is a depenedency/addiction problem, if it is taken for more then 3 days.
Surely they would not do that, if 10mg or so, of codeine was as harmless, or as "laughable" as you say.

Obviously it is not a laughing matter to them. IT must be very serious if they do that. They must know, there is a serious possiblity of dependancy, or addiction. So, they ask you to check if youru are taking their medicinet properly, which means for not more then 3 days! 3 days only, after that you are on your own, they did warn you.

Their check list is simple.
Read it, and you will know if you have a problem with codeine dependency/addiction, or not.
All you need iss to answer their list of questions which follow below.
How many "yes" did you answer?

Do you take pain killers for more than 3 days?
Do you watch the clock till its time to take your next dose?
Do you take more than 8 a day?
Do you use two or more pharmacies for your purchases?
Do you need them to help keep you calm?
Do you mix the types of painkillers you take?
Do you suffer from aches and pains, shivers and flu-like symptoms if you don’t take any?
Do you feel like you are the only person with this problem?

Finally, perhaps you also want to read th e following article.
It makes things even more clear, that is if you still have any doubts.
Manufacturers state plainly enough that even after 3 days, codeine becomes addictive, even in such small quantities:
http://www.dailymail.co.uk/health/article-1211028/Addiction-warning-codeine-tough-new-controls-counter-sales.html

BTW one of my doctors is constatly trying to prescribe for me co-codamol (with codeine) for a painful joint, and tells me to take it all the time, but I dread taking it for more then one day, for fear of possible MOH - I just do not want to risk it ,after what I read about MOH.

All nice and dandy but we are talking about codeine addiction and Syndol, sweetheart, and if I am not mistaken in UK Syndol is by Rx only.

So, if the person in question was to get Syndol she would need to see her dr first, and unless she is getting this thru multiple pharmacies it's unlikely she is taking it in excessive doses.


To me, knowing what M pain is and how UK doctors treat M pain it looks like she her pain is simply
grossly under-treated, hence the increased usage.

She is simply desperate for relief. And from my own experience I know that also when a medication is ineffective it can actually INCREASE a headache right after you've taken a pill, which in turn make you take more of the same medication - and which it cause a downright spiral.
And the only way to stop this is to find a RIGHT medication to treat the pain.
Which means either a right triptan or stringer painkiller, or both beside a right preventative.

I was given Mersyndol 25 years ago (it's the same as Syndol) and it was like popping Tic Tacs. Zero relief.


Risa

Manufacturers state plainly enough that even after 3 days, codeine becomes addictive, even in such small quantities:
http://www.dailymail.co.uk/health/article-1211028/Addiction-warning-codeine-tough-new-controls-counter-sales.html

pffftt, according to UK MHRA, Mail and Natural News only so far


and that's because:

Some people were taking up to 70 pills a day, putting themselves at risk of serious complications such as bleeding stomach, liver problems, gallstones and depression.

Read more: http://www.dailymail.co.uk/health/article-1211028/Addiction-warning-codeine-tough-new-controls-counter-sales.html#ixzz15rkuE9CC


No wonder they had to put out such a warning - they HAD TO do something to prevent possible litigations.
I would do that too, if I didn't want to be sued for millions and millions of pounds/euros.

Perhaps for 1 out of 10000000 people it IS true.

But I know I can sleep peacefully when I am taking T3 and Percocet for three days by row. Like a baby.
Now, if I was to take it for three MONTHS everyday - I'd get concerned, then.

I am not saying 'be careless' - I am saying being extreme in any direction is not healthy.

A little common sense in everything is always the golden rule. If for someone preventives and trigger avoidance does not work - then I am sorry, triptans and painkillers is what's LEFT.

Just use with caution, don't get stiff with fear just because it spells n-a-r-c-o-t-i-c and M-O-H.
And live your life as best as you can.

Risa

I just forward the information which is available,and what people do with it is up to each person - you are free to agree or disagree, there is no obligation.
Yes, common sense is very important, agrred, but common sense often means different thing to different people. But, in meantime I believe that knowing the facts is the best starting point, if we try to use the common sense.

Just to comment on what you say CKitten pffftt, according to UK MHRA that as far as you see it it was "only" recomendation by MHRA.
Perhaps you are not familiar with what MHRA means; MHRA is the same type of agency like an american Federal Drugs Agency since they approve all medicines for patient's use in UK just like the other agency does in US. You can look it up:
http://www.mhra.gov.uk/index.htm

They are the people who decide, what is safe and what is not and the are not happy about codeine use in OTC medicines, hence the demand for restrictions .

BTW, narcotic is not my won definition, it is an official scientific description for codeine, therefore codeine is a narcotic no matter what the dose is. It is not an opinion - it is a scientific definition.

I like to know about medicines OTC of even iff they are prescripbed by a docotr since medicines can do a lot of harm if we do not know how they work. I want to know what is potential dmage and s/e they cause.
Here we often share suchs information here with others - this is what I am trying to do.

No, C Kitten, you don't need Rx to get Syndol in UK - it is available OTC, and you can buy it at any chemist, it is also quiet cheap to buy.
Maybe this is why this woman in might have a problem but we don't know what is happening with her, since all we know here isl someone's hearsay.

The common sense tells me that best advice anyone can give her (if they insist on giving advice) is to go and see her own dr and to be referred to neurologist to try to find out, and sort out her problem.

i think youll find clueless that it was the article about the us drs that were in cohoots with drug companies which is why they can dish out criminal amounts of drugs and go off living the life of riley while the pts they prescibed to go on living in daily pain. if you compare the migraine diary of the under prescribed drug pt and the over prescribed pt you will find one has daily head pain and the other doesnt i think that talks for itself.

Dawn,

I'm not sure I follow you. Some doctors here do have an uncomfortable relationship with drug companies but not all. I think you'll find that there are a lot of under-treated patients in the States rather than over-treated.

Also, perhaps I'm being dense, but which patient would be pain-free? I didn't follow that bit.

No, C Kitten, you don't need Rx to get Syndol in UK - it is available OTC, and you can buy it at any chemist, it is also quiet cheap to buy.

Really? I wouldn't know that, but I believe you,
because I don't live in UK and only checked one internet source, here:

Syndol is a prescription medication commonly used in the United Kingdom for the relief of pain and the reduction of fevers.

Read more: About Syndol Tablets Side Effects | eHow.com http://www.ehow.com/facts_5503255_syndol-tablets-side-effects.html#ixzz163FABfjl

Perhaps you are not familiar with what MHRA means; MHRA is the same type of agency like an american Federal Drugs Agency since they approve all medicines for patient's use in UK just like the other agency does in US. You can look it up:

Oh, no, I know very well what MHRA is, I just am not impressed with UK doctors at all.

As I explained a few times before I participate on Polish M forum as well, and we have many Polish immigrants living in UK exactly just like you Nika, who are living there for 20, 30 years.
They know the language well and their environment so this is not the case of being "fresh off the boat".

Also, I do my own research online and I can compare what US research says as opposed to UK.
Besides, why look far when I see right here what do you say, what Dawn.Binks say and I see a huge gap between our opinions on various treatments and medications regarding M.

So, what are UK (and Polish) M patients offered for this severe, agonizing pain?
SOLPADEINE, NUROFEN, SYNDOL and the likes which is all weak OTC which is a laugh.
The meds like triptans are restricted to no more to three a week.
Once again, not everybody is a lucky star for whom preventatives are working.
In fact I dare say those are in minority.

Now, knowing how M pain - such a serious, serious pain- is being treated in UK,
reading such a warning issued by - who else in the world but only MRHA - doesn't exactly inspire my confidence
in anything else they write.

So, once again - you can get addicted to 8 mg codeine after just three days, eh?
Maybe, maybe 1 in 10000000 person indeed can, just as 1 in 1000000 can get addicted to alcohol
just from drinking alcohol for the first time in his life from a few beers daily for three days by row.

Things are not black and white - there is so not being said in between.

Again, I am not saying jump thoughtlessly onto narcotic boat,
just don't go to the other extreme and don't demonize them either
for they
DO CAN BE your ally in combating severe pain.


Risa

And how are YOU Dawn? how is YOUR head pain???

Risa

Its true Risa> Syndol is OTC with 10mg of Codeine. £2.50 for 20.

Syndol Caplets contain:

Paracetamol BP 450.0mg, Codeine Phosphate BP 10.0mg, Doxylamine Succinate NF 5.0mg, Caffeine BP 30.0mg.

No good for me though, I just cant cope with Codeine any more.

Maybe just as well though...



Oh Mini, I hope that's not my hearsay you mentioned. Because it isn't anything of the kind.
I know Kate and her sister. I posted fact, not supposition. I would not do that.
The problem is just trying to determine MOH from addiction, and I have found this whole discussion very interesting.
Even if we have no conclusion (which was probably always going to be the case.)

Doxylamine Succinate also can be addictive, and because it cause drowsiness it is used as a sleeping aid -
some may know it as Unisom.

Certainly Syndol combined with Doxylamine is way more addictive than the same amount of codeine alone.

Risa

Yes I can imagine Risa. It is that which knocks me out in Syndol.
I cant take anti histamine at all....

I wonder if Kate's sister could have a problem with the codeine, or....
The anti histamine....

Hmm, good point Risa,

Thanks.

P

I think it can be everything together - codeine, antihistamine and caffeine, too as it is also addictive.


Risa

Pen, about hearsay - I meant ANY hearsay.
Unless the person tells their own story we can never get a full picture, if it invoves someone else. Even if they are trying to be as truthful, they might overlook some things, or extent of the problem.

It is only the person with the problem who knows how they feel, or why, and unless they are willing to do something about it and decide when it is the right time to seek help of a professional, a doctor, anything else is unlikely to work.

Dawn, I totally agree with everything you say - you are absolutely correct.
Let's see - hardly a week goes by that we don'tt hear in the newspapers of another famous person's death in US, due to overprescribed drugs (often painkillers), courtesy of their doctor.

Our docotrs here might not be perfect, true, but they are careful about prescribing things which might be a short term solution, but could lead to long term dependency/addiction and they do not get any finacial rewards when they do.

In fact it is not easy, to get any heavy duty narcotics for anything here. Certainly not for migraine. I know that nothing so powerful was ever offered to me for my migraine - even when my migraines were really bad and I am very gald, since I might have been tempted to take it, and perhaps end up with a serious dependency, and all additional problems it brings.

As it is, I have a good management program which works for me and like you said Dawn, I also have many painfree days. Pen lso reports here, that she has many painfree times.

I would be interested to know, if anyone from UK was ever offered things like Vicodin etc for migraine? And if so, for how long a period?

Some of our doctors are great, most are average, some are really useless, but at least they are independent from pharm companies, and they have no finacial interest whatsover to prescribe heavy duty drugs, or take advantage of their patients by pumping them with drugs to get finacial gain.

However, there are now some dramatic changes coming our way in UK, and things are beginning to look quite gloomy in NHS: too much power if being given to doctors by this new governement, and I am sure that these changes will affect our doctor/ patient relationship in a negative way, since they will make ALL our treatment decisions from now on, so much freedom of choice will be taken away from us. Some say this will be a kind of privatisation of NHS, by the back door, since dotors might gain financially, by not offering us treatemnts. We shall see. We dread it. But this is another story.

Hi Mini,

Interesting post. .....Thanks for clarifying the hearsay. To answer you question, I am in England and have never been offered anything stronger than an NSAID.
One night when I had dreadful migraine and after pain from a wisdom tooth extraction the dr sent some form of morphine.
I didnt take it. I just dont want those drugs. I am not sure why. I dont seem to get rebound and I sure dont seem prone to addiction, after 20 years of dihydrocodeine, but I do seem to get every side effect I can... So no, never been offered Vicodin. Didnt know it existed until I joined this forum.

Now pain free days. No I dont get them, ever. I am in pain all the time. BUT I also have Fibro and this has given me myofascial pain.
So there are days when that is "all" I have. Thankfully, that was "all" I had on Saturday and I made the party.

Migraines are every 3/8 days. Usually about 5/6 these days. I take Triptans, to Hell with the consequences. (My neuro doesn't believe there are any for me) I may live a slightly shorter life, who knows, but I will have had some quality. Without them...none. At 60, this is my thinking now......They are not going to come up with a cure in time for me I think....
So Migard it is, and I treat it with respect. As long as it continues to work (and it always works, but the efficacy varies), I dont want anything else. BUT I would like something to work on the myofascial and the neck pain.....

As for the NHS and government changes. As a totally non political person I am not aware of the things you and Dawn outline.
I asked my husband who is into politics (probably the reason I am not ) He hasn't perceived the same as the two of you.
I have asked him to take more notice of this in future. I cant read much any more. My concentration is bad from the fibro, but after 40 years, I trust him to do this.... I do hope your worst fears do not come to fruition....

Pen

Mini wrote:
Let's see - hardly a week goes by that we don'tt hear in the newspapers of another famous person's death in US, due to overprescribed drugs (often painkillers), courtesy of their doctor.

What on earth are you talking about? The last person of any note that died was Michael Jackson and that was over a year ago!

It is quite apparent you do not like those of us in the States (and our health system) but if you are going to cast this negativity at least have your facts correct!

I don't know what will happen with the NHS but I think a shake up is desperately needed. Privatization in certain areas doesn’t have to be a bad thing. It will help to introduce an element of healthy competition and result in better service for patients.

The NHS is okay for day to day problems, prescriptions etc. but for any serious problem I am off to native Austria, where a doctor's practice actually looks like one and the hospitals and clinics are spotless and gleaming. No superbugs and no postcode lottery and nobody dying while waiting endlessly for surgery.


P.