HI, I've done a lot of research but can find no definitive answer to long term use of Cafergot (ergotamine) and Tramadol in "small" doses.

 I know it's suggested that both are not for long term use and Tramadol can become addictive, but since using for constant back pain (nerve damage) and headaches (possibly linked) life is much happier. Been taking for a year or so, and am not needing to increase the doseage as the body gets used to it.

 I’m only taking half a tablet (25mg tramadol 50 mg Cafergot) prob 5 or 6 days a week,sometimes together, sometimes alternated, when necessary.

Mid 70s very fit, gym 5 days a week, minimal aclohol and no other health issues whatsoever, but need to know if anyone else has been using any of these for a long time? And any issues that may have developed. I've tried all the usual pain killers etc but none really work. Any info/advice much appreciate thanks.

 

First of all, ergotamine has no effect whatsoever on back pain, it is not a pain killer as such. Its utility is only for throbbing (vascular) headaches i.e. migraine.

 

Are you actually having severe throbbing  headaches 5-6 times a week? If so, you need a preventive treatment and should see a specialist in migraines.  There are medications suitable for long term use that can prevent, or at least decrease, these headaches. Also, botox injections work well for some people (repeated about every 3 months). Botox is especially helpful for people with 15 or more headaches a month. Such treatments should make it possible to greatly reduce the ergotamine usage to an occasional level.

 

Note that Cefergot also contains caffeine, also an issue if taking regularly.

 

The back pain is a different matter. Ideally, the cause should be addressed. Prior nerve damage will not cause pain now (though it could cause functional limitations -- but sounds not so for you if you can regularly work out), but current compression of nerves will cause pain (as I know all too well first hand myself! This  can often be effectively treated with newer, minimally invasive surgical techniques. Have you seen a good spine specialist? (There are only a handful in Thailand, all in Bangkok).

 

Long-term tramadol use is definitely unadvisable. Addiction aside,  it is highly likely to cause GI problems (chronic constipation, IBS-like symptoms), and can also cause liver and kidney damage, cardiovascular problems, and weakened immune function. Nobody can tell you exactly how many doses/how often will have this effect but 5-6 times a week  is pushing it IMO. If you can get it down to say not more than 3 doses a week and never 2 days consecutively, you'd be safer.

 

 

Nerve damage would be cabapentin, no?

42 minutes ago, Sheryl said:

First of all, ergotamine has no effect whatsoever on back pain, it is not a pain killer as such. Its utility is only for throbbing (vascular) headaches i.e. migraine.

 

Are you actually having severe throbbing  headaches 5-6 times a week? If so, you need a preventive treatment and should see a specialist in migraines.  There are medications suitable for long term use that can prevent, or at least decrease, these headaches. Also, botox injections work well for some people (repeated about every 3 months). Botox is especially helpful for people with 15 or more headaches a month. Such treatments should make it possible to greatly reduce the ergotamine usage to an occasional level.

 

Note that Cefergot also contains caffeine, also an issue if taking regularly.

 

The back pain is a different matter. Ideally, the cause should be addressed. Prior nerve damage will not cause pain now (though it could cause functional limitations -- but sounds not so for you if you can regularly work out), but current compression of nerves will cause pain (as I know all too well first hand myself! This  can often be effectively treated with newer, minimally invasive surgical techniques. Have you seen a good spine specialist? (There are only a handful in Thailand, all in Bangkok).

 

Long-term tramadol use is definitely unadvisable. Addiction aside,  it is highly likely to cause GI problems (chronic constipation, IBS-like symptoms), and can also cause liver and kidney damage, cardiovascular problems, and weakened immune function. Nobody can tell you exactly how many doses/how often will have this effect but 5-6 times a week  is pushing it IMO. If you can get it down to say not more than 3 doses a week and never 2 days consecutively, you'd be safer.

 

 

Thank you, no the egotamine is only for the head pain and for some reason it seems to work even in a very small dose, not throbbing heads but seems to clear them, may be related to the back issues which are caused by bad walking gait due to neck nerve damage years ago, nothing I can do about it, hence the gym to build spine muscle support. Yep if I can cut them down to fewer times a week would be a sensible solution, think I've tried most other remidies! diet acupuncture physio etc, had enough! Maybe someone will suggest a similar pain killer with less side effects, thanks..

18 minutes ago, bubblegum said:

Nerve damage would be cabapentin, no?

Thanks will have a look..

Just now, Pappap said:

Thanks will have a look..

Is that Gabapentin?

2 minutes ago, Pappap said:

Is that Gabapentin?

Blimey seems worse than I'm using! 🙂 worth a look though ta..don't think so though..

25mg Tramadol is such a low dose that you should be able to leave it away completely or use other forms of pain management (Paracetamol, physical therapy,  acupuncture)

7 hours ago, Pappap said:

Is that Gabapentin?

Yes sorry

12 hours ago, Pappap said:

Thank you, no the egotamine is only for the head pain and for some reason it seems to work even in a very small dose, not throbbing heads but seems to clear them, may be related to the back issues which are caused by bad walking gait due to neck nerve damage years ago, nothing I can do about it, hence the gym to build spine muscle support. Yep if I can cut them down to fewer times a week would be a sensible solution, think I've tried most other remidies! diet acupuncture physio etc, had enough! Maybe someone will suggest a similar pain killer with less side effects, thanks..

I still think you should see a headache specialist and consider botox or preventive med. Where in Thailand are you? why would you prefer to kerp taking these meds ehen the headaches csn be prevented or reduced in frequency?

 

as to other treatments for the back pain it depends on cause. If due to inflammation, NSAIDs will do more than tramadol.  Be sure to take with food and lowest dose needed as heavy usage can be rough on the kidneys. A single dose a few times a week shoulx be fine if you have no kidney or stomach problems. 

 

If the pain is due to muscle spasm then heating pad, massage, maybe accupuncture (in addition to PT) are helpful.

 

If the pain is voming ftom a doecific nerve, nerve blick migjf help.

 

You should see a pain specialist. Again, where in Thailand are you? 

 

 

 

 

 

 

3 hours ago, Sheryl said:

I still think you should see a headache specialist and consider botox or preventive med. Where in Thailand are you? why would you prefer to kerp taking these meds ehen the headaches csn be prevented or reduced in frequency?

 

as to other treatments for the back pain it depends on cause. If due to inflammation, NSAIDs will do more than tramadol.  Be sure to take with food and lowest dose needed as heavy usage can be rough on the kidneys. A single dose a few times a week shoulx be fine if you have no kidney or stomach problems. 

 

If the pain is due to muscle spasm then heating pad, massage, maybe accupuncture (in addition to PT) are helpful.

 

If the pain is voming ftom a doecific nerve, nerve blick migjf help.

 

You should see a pain specialist. Again, where in Thailand are you? 

 

 

 

 

 

 

Thank you, am in Krabi but am happy to travel up to Bangkok which may be the sensible answer. As mentioned the back pain is caused by incorrect walking posture for many years, weak muscles due to severed nerves in the neck, actually started the Tramadol/Ergot route after taking way to many NSAIDS over the years, stomache started complaining!!!... I'll go with your first suggestion and decrease the regularity, using various Physio/Acu and gentler painkillers, when it flares up. Was hoping that longterm small dosage of Tramadol may be ok but seems not to be the case as you kindly pointed out. Will ease up for a month or two and reasses after that. Once again thank you for your time, and a pain/nerve specialist in Bangkok would be much appreciated.

14 hours ago, Lorry said:

25mg Tramadol is such a low dose that you should be able to leave it away completely or use other forms of pain management (Paracetamol, physical therapy,  acupuncture)

yes my thoughts as well but for some strange reason non of the over the counter pain killers even touch it, and have done the physio acu etc, acu did start to ease the heads so will prob go back to that, thanks..

59 minutes ago, Pappap said:

Thank you, am in Krabi but am happy to travel up to Bangkok which may be the sensible answer. As mentioned the back pain is caused by incorrect walking posture for many years, weak muscles due to severed nerves in the neck, actually started the Tramadol/Ergot route after taking way to many NSAIDS over the years, stomache started complaining!!!... I'll go with your first suggestion and decrease the regularity, using various Physio/Acu and gentler painkillers, when it flares up. Was hoping that longterm small dosage of Tramadol may be ok but seems not to be the case as you kindly pointed out. Will ease up for a month or two and reasses after that. Once again thank you for your time, and a pain/nerve specialist in Bangkok would be much appreciated.

One of these doctors (do nto be put off by fact they are on the cancer service, they handle any type of pain)

 

https://www.bangkokhospital.com/en/doctor/asst-prof-dr-pornpan-chalermkitpanit

 

https://www.bangkokhospital.com/en/doctor/dr-laksamee-chanvej

 

https://www.bangkokhospital.com/en/doctor/dr-pramote-euasobhon

 

They work with other specialties like neuro etc.

 

If they cannot address headache prevention, suggest you also see

 

https://www.bangkokinternationalhospital.com/doctors/dr-chakorn-chansakul

 

and ask specifically if you are a candidate for Botox or triptans

 

Re NSAIDs, concurrnet use of PPI likeo meprazole can help prevent stomach issues and you might alternate between the tramadol and an NSAId i.e. each just 2-3 times a week

2 minutes ago, Sheryl said:

One of these doctors (do nto be put off by fact they are on the cancer service, they handle any type of pain)

 

https://www.bangkokhospital.com/en/doctor/asst-prof-dr-pornpan-chalermkitpanit

 

https://www.bangkokhospital.com/en/doctor/dr-laksamee-chanvej

 

https://www.bangkokhospital.com/en/doctor/dr-pramote-euasobhon

 

They work with other specialties like neuro etc.

 

If they cannot address headache prevention, suggest you also see

 

https://www.bangkokinternationalhospital.com/doctors/dr-chakorn-chansakul

 

and ask specifically if you are a candidate for Botox or triptans

 

Re NSAIDs, concurrnet use of PPI likeo meprazole can help prevent stomach issues and you might alternate between the tramadol and an NSAId i.e. each just 2-3 times a week

Thank you ever so much, this is so much appreciated. 🙏😊