I prescribe a dose of healthy scepticism

I have a few WIP blog posts but I digress briefly, to fulminate*.

On my sh!t list is the G.O.’s skin cancer G.P.

Late in July the G.O. brought to my notice a mark on his ankle that looked funny and wasn’t healing. We figured out he’d had it since early June. He also had a couple of, to use not-so-scientific terms, small skin thingies behind his knees, plus the usual surface skin cancers on his arms & hands courtesy of his occupation and heredity. Me being a modern woman, and the G.O. being a modern man, I left it to him to make a doctor’s appointment to fit in with his schedule.

In mid August, I called and made the latest-in-the-day after work doctor’s appointment I could for the G.O.  No problem. Off he went. The doctor zapped him well and truly ’til his arms & legs resembled leopard skin. Still good.

As the G.O., who is in his 50’s, and has operated heavy earthmoving equipment for more than two thirds of his life, rose from the chair to leave, the diligent doctor noticed his effort in doing so. After questioning the G.O. on the circumstances and history of this discomfort, the doctor provided him with a number of prescriptions for Durotram XR, explaining they were:

  • a natural drug which would assist to reduce the stiffness in his neck and back;
  • a non drowsy medication;
  • expensive but somewhat subsidised for eligible 55+ age group, and;
  • different strengths, and to start with 10 x 100mg, moving to 10 x 200 mg, then 10 x 300 mg, for which he’d provided prescriptions.

The G.O. dutifully brought home and handed the prescriptions to me, along with the doctor’s spiel, knowing I’d want to investigate. “Natural” resonated with the G.O. as I’d recently started him on a daily spoonful of liquid glucosamine + rosehip oil for the same reason, to which his body seemed to be responding. The G.O. dislikes taking tablets but was interested the pain relief the doctor had to offer, so I did my usual pharmaceutical due diligence. The highlights of which were:

  • Once-daily tramadol extended-release (Durotram XR) for pain
  • Tramadol extended-release is available as 100 mg, 200 mg or 300 mg tablets. Authorities for repeats or quantities greater than 10 tablets will only be granted for severe disabling pain that does not respond to non-opioid analgesics.
  • No published randomised trial of tramadol extended-release has studied efficacy or safety for more than 12 weeks.
  • Other analgesics should be considered before tramadol
  • Tramadol is a weak opioid that also inhibits the reuptake of noradrenaline and serotonin.
  • Tramadol extended-release is subsidised for short-term use
  • Tramadol extended-release is PBS subsidised for up to 10 days. Larger quantities of tramadol extended-release can only be prescribed for severely disabling pain that does not respond to non-opioid medications.
  • Adverse effects are common
  • The most common adverse events reported in trials of tramadol extended-release include dizziness/vertigo (10% to 26%), nausea (11% to 33%), constipation (10% to 34%) and drowsiness (7% to 30%).
  • In trials, up to 81% of people taking tramadol extended-release experienced an adverse event. A similar proportion of participants (79%) taking tramadol twice daily experienced an adverse event.
  • Between 8% and 21% of participants receiving tramadol extended-release discontinued treatment because of adverse events. Similar numbers of people taking tramadol once daily and tramadol twice daily discontinued because of adverse events.
  • Adverse events can appear within days of starting tramadol extended-release. 

In a nutshell, the G.P. prescribed the G.O. who works as heavy earthmoving machinery operator a “natural” opioid drug where dizziness/vertigo (10% to 26%) and drowsiness (7% to 30%) have been reported as side effects.

What a quack!

Source: http://www.nps.org.au/health_professionals/publications/nps_radar/2008/december_2008/tramadol_xr
and http://www.nps.org.au/health_professionals/publications/nps_radar/2008/december_2008/tramadol_xr?SQ_DESIGN_NAME=print_friendly

*What a great word!

24 thoughts on “I prescribe a dose of healthy scepticism

    1. We have a few other G.P. horror stories between us, and that’s why we take anything a doctor says with a handful of grains of salt, and never take anything prescribed unless I check it out first…


  1. I wouldn’t call a synthetic analgesic ‘natural’ and it was very naughty of the doctor to do so.

    I see in the extended use version that there is less risk of vertigo and nausea – although more risk of drowsiness….. (I think it was that way round).

    And did you read the withdrawals symptoms from this ‘natural’ opiate?

    I wonder why he prescribed that and not an NSAID? You’ve probably read about Pippa’s cox 2 inhibitors which he takes from time to time for arthritis in his front paw. Well, one of his front paws, he does have two. They seem to reduce the pain and he moves more easily so then we stop the dosage until the next flare up. Glucosamine seemed to work for a while, but we’ve stopped that now as the last lot were useless.

    So, what’s the plan now?


  2. I thought so too and the G.O. was quite clear on what the doctor said. Yes, less dizziness or vertigo but more drowsiness. And, yes I saw the withdrawal symptoms, which is why the ‘opiate’ origin rang alarm bells. No plan, the G.O. was coping without the input from the G.P. He didn’t go for that but for the skin cancers… unnecessary intervention. In the past we’ve had good results with glucosamine both for humans & canine family members. Time will tell how it works for the G.O.


    1. I agree, it’s not hard to find out about the side effects of drugs. I truly believe many GPs are too wrapped up in the pharmacology aspect of medicine, and it gets people in and out their door, plus it’s known they get rewards from the pharma companies. To be fair also I know a lot of people feel ripped off if they come away from a GP visit with out a script, but that’s not us, and the G.O. didn’t ask for it.


  3. Another problem I have with this is that the doctor prescribed medication for severe pain to an older man who had come in after a hard day at work and then spent some time being zapped for his skin cancers. I think most of us would have a bit of difficulty getting up out of the chair in such circumstances!

    I wonder if this GP would have prescribed these ‘non-drowsy’ meds if the G.O was driving his heavy machinery in the GP’s own backyard! Quack quack!


    1. Good point… I’m still, a week or so later, annoyed. The G.O didn’t realise he was being prescribed a painkiller – he thought it was a therapeutic drug. I felt so bad for him. He’s on the 2nd bottle of glucosamine (wouldn’t take it before in tab or powder)… Also as RoughSeas pointed out after she checked out the links, being an opiod, the withdrawals from the drug are significant 😦


      1. The G.O hadn’t even complained to the doc about the pain, so pushing such strong meds onto him is a little extreme too.
        Lucky for him that you are the suspicious sort and he didn’t just take it thinking he was doing the right thing. To me, if it needs a prescription to be supplied it is something to be suspicious of!


        1. Thank you. Sadly, I agree with your comments. We live in the middle of the city – you would think we had access to quality medical advice via any doctor but not so – we’ve had bad experiences with local GPs, and don’t go to the doc unless we have to, which is not clever on the face of it – medical issues should be checked out, but not such a simple proposition…


  4. As one who maintained a drug-induced sleep for a decade, I am ALL for natural remedies and holistic care. I worked diligently to wean myself off Trazadone, and was able to do it with the help of acupuncture, warm milk, strict bedtime habits, etc . . . unfortunately, in the wake of all “this” I resorted back to what worked and will now need to do the same once I am in a place to do so.

    Medication, while helpful for those undergoing certain pains, can in fact be very damaging to those with less concrete medical issues. The side-effects can cause the person to think they are not healing, but getting worse! And then the withdrawals . . . It’s such a slippery slope, making it incredibly difficult to know what to do in any given situation. You are wise to prescribe a healthy dose of skepticism. In every case possible, I always think it best to look to food and stress relieving activities.


    1. Thank Cara, for the wise comment, and coming from you it adds weight. I agree, appropriate medication properly prescribed can make the world of difference to health and life (with an understanding and eye towards support during withdrawal), and that’s what also annoys my about careless prescribing, it undermines what good can be done. Yep, sceptism, and due diligence – Google is my friend 🙂


    1. Thank you – my thoughts have bee with you also. I questioned him re pain levels etc. It’s an over-use injury but he manages it quite well. We have a year or so in our current work-life situation, and once that changes, the injury will then have time get as better as it can.


  5. Good grief. What a mess. The problem with taking something is that it seems to start throwing other stuff in the body off – and you end up with more problems.
    Glucosamine is a good place to start (works well with some people and not at all for other) I think high quality fish oil reduces inflammation (and it’s good for the hear, too)
    Here, pharm companies aren’t able to treat docs/ give as many perks as they used to – part of the problem is so many new drugs on the market – and so many are being prescribed off-label (encouraged by pharm co) – you really have to watch out for yourself and go armed with info talk with Doc.
    Hoping he feels better!


    1. Thank you. The G.O. is same same. He was fine-enough. Some of his joint stiffness is cold weather based also but his body is 57, and has had a tough life! I’ve suggested fish oil as it’s good for heart health also, but using remedies with him is challenging as he has fussy tastebuds (mental & physical) & doesn’t like taking tabs/stuff. ATM, the glucosamine & a good men’s multi-v is the hugest victory to-date! Not sure about he extent of changes to the G.P. pharm regs in Australia, in some cases there is a lot of prescribing going on and are definitely still beneficial relationships between them. Also heaps of pharm co. advertisng disguised to look like lifestyle advts…


      1. As my 100 yr old uncle would say – if you wake up and can get out of bed and walk around, it’s a great day!
        (If you do manage the fish oil, only get the coated kind – less burps! Salmon once a week is supposed to help – check WIKI entry for “What has omega 3 fatty acids” for other sources..
        Some foods are now being fortified with it.
        Fish oil seems to help arthritis compared to NSAIDs for pain.
        But I know what you mean about trying to get any cooperation…..


    1. Thank you. Summer is on its way, and will be kinder to our bodies 🙂 Yes, one & a half bottles in, and he’s still taking it. I wonder if there was any discussion at smoko re glucomsamine – those blokes on job sites have a lot of knowledge & authority about many things… the G.O. had a bottle of Swisse Men’s 50+ mulit-vitamin pills sitting around for over a year but heard about Male Max Men’s 50+ MV at smoko, and he’s a bottle and a half into that also 😉


  6. Smart of you to research the medications. It’s always good to exercise a dose of skepticism with anyone. I had surgeons insist I had to have a very painful surgery for my spine called fusion. I did my own research and refused. I wanted a disk replacement and I ended up finding the right doctor to do that for me. And I’m so much more mobile for it. 🙂 Go skepticism!


    1. Thank you, and I too am glad you made an informed decision. As time has passed, I know we’re getting smarter but I also think those “snake oil salesman” have just acquired different occupations…. caveat emptor 🙂


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