Alternative to tramadol

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New here, hope someone has some insight. Apologies for the long post, trying to anticipate questions.

 have had moderate-severe (it comes and goes) back and neck pain for years. I've never had any scans or x-rays as they say it's just strain/wear or something about my c3 vertebrae from being overweight, computer work, long outdoor shift work, etc. They've never really found a proper solution just stretches etc. and suggested losing weight, which I'm working on separately.

Medication I currently take daily:

For the pain; co-codamol 30/500 max dose, naproxen max dose

To counter the GI effects of the naproxen, omeprazole

Due to an anxiety disorder: fluoxetine 40mg and occasionally a few mg of diazepam when acute.

Due to a sleep disorder: occasionaly zopiclone

My info: I'm male, 24, very overweight, very tall.

My pain is getting worse to the point where I'm routinely tempted to take an extra tablet to ease it off, particularly at night. In the past when this has happened I have gone onto tramadol instead of the codeine, still with paracetamol, but that is not compatible with the fluoxetine it seems. I've tried amitriptyline but it interferes with my sleep even worse and doesn't seem to do anything for the pain.

My question is, what would be the next 'higher' painkiller than codeine, that isn't tramadol? I've heard about fentanyl, oxycodone, hydrocodone, and all sorts including morphine but I can't believe that my pain is so severe I would be needing morphine, if you know what I mean. Used to that being for hospitals etc.

Hope someone can share some experience


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4 Replies

  • Posted

    I have same pain for years, got diagnosed with degenerative disk disease, lortab and lyrica and zanaflex or soma work some..enough to make it but never really take the pain away.
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  • Posted

    Hi Ewan,

    "Next higher" pain reliever would be in this order:

    hydrocodone for mild to moderate pain, then oxycodone for moderate to severe pain.

    Common Tablet Strengths:

    hydrocodone/paracetamol = 5/325, 5/500, 10/325

    oxycodone/paracetamol = 5/325, 5/500

    Less paracetamol is better. With lower dosages, you can titrate up for your own personal pain relief without irritating your liver.

    Doctors usually begin with hydrocodone. One 5mg hydrocodone which is equal to 30mg, actually might work better than codeine or Tramodol, because of the chemical structure. Then try 7.5 mg hydrocodone. 

    Morphine is rarely prescribed for chronic pain relief. Fentanyl as well. There are long-acting forms of those, and oxycodone.

    Please look at The McKenzie Institute online and check out "Treat Your Own Neck" on YouTube. There are physical therapy offices that are certified with McKenzie Method all over the world. I happened to go to one without my knowledge prior to learning about Dr. Robin McKenzie. I went for my low back because my friend's neck pain with arm radiation healed quickly. I had tried so many other physical therapists and all the exercises and stretches with some relief, but I wanted to surpass the plateau I was stuck on. The McKenzie method is not about stretching the muscles, it is about spinal realignment. There are books as well. The one I bought was "Treat Your Own Back," yours would be "Treat Your Own Neck" and they are inexpensive paperbacks.

    Please see the chart below. it shows the equivalency of other pain relievers to 30 mg codeine.

    Good Luck!

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    • Posted

      I have some edits. Some paragraphs I wrote are incomplete. The following is the edit:

      "Less paracetamol is better. With lower dosages, you can titrate up the opiate for your own personal pain relief without the paracetamol irritating your liver.

      Doctors usually begin with hydrocodone. One 5mg hydrocodone tab, which is equal to 30mg codeine, actually might work better than codeine, because chemical structure is different. Remember: people react differently to different medications. If you have decided that 5 mg hydrocodone isn't enough, try 7.5 mg hydrocodone. They can be split."


      Names of Hydrocodone/Paracetemol are Lortab, Vicodin, Norco. There are other names I cannot recall. And for further information, Hydrocodone is an antitussive (cough supressant). 


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    • Posted

      Thanks very much for the well crafted response. I am at the doctor this week and will certainly be asking about some of the medicines you mention.
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