Long Term effects of Codeine usage? mother/unborn child

What would the potential long term effects of high codeine usage be? Not only for me but for my baby as well?

I am currently having to take 6+ panadeine forte and 6+ mersyndol day strength each day just to keep my wisdom teeth pain down to a dull ache. This has been happening regularly for the past 5.5 months - every couple of weeks I am able to start weaning off the codeine and even get to have some day where I don't need to take it, and then the pain will flare up again and I'll be right back on square one.
The oral surgeon told me today that I have to wait until August next year after the baby is born to have my surgery to remove my wisdom teeth as they (the surgeon and any anesthetists apparently) won't put a pregnant woman under GA - even though my local hospital will put me under GA even though I am pregnant so that they can put a camera down my throat to try and find out what is causing all my stomach pain and discomfort since DD was born.

I don't want to risk my babies future health, but I also can't function without the painkillers either (not in an addiction kind of way), I can't even look after my kids if I don't have painkillers regularly because the pain gets so bad I can't even sit up or talk and I get the shakes really bad.



All help and advice will be greatly appreciated.

If your levels of pain are that high it might be worth seeking out a second opinion. It's a bit of a worry that no other options have been suggested. That is quite a lot of pain relief you're taking, and the codeine is a worry because it can be addictive, and people can develop rebound pain when they try to come off it which makes stopping it even harder. Even if the 2nd dr can't do any different they might be able to advise on a more effective pain regimen for you.

FWIW I've had a complicated wisdom tooth extraction done in the chair without sedation or ga, twice. It wasn't pleasant but it wasn't awful either, there was no pain involved at all.

This is going to be blunt, but Jenna, I'm really worried by the amounts of both paracetamol and codeine. Does your health care provider know how much you take of each?
There are other far more beneficial medications, but TBH Upping the dosage is not going to make any difference to your pain. Too much paracetamol can damage your own liver. I really think it's a good idea to speak to someone about a long term pain management plan.
Can your teeth not be taken out with a local anaesthetic in the chair?

I also don't think you should be managing your pain meds on your own. Eventually prolonged use is going to mean that you'll need more and more to achieve the same effect. I also agree with a PP about feeling rebound pain coming off the meds. You may not be addicted, but you do sound dependant. Which is not good for you or the unborn bub, but also for your DD and DS who you are caring for I'd definitely speak to a doctor about pain management.

Huuuge hugs, teeth pain is not fun at all, but I too would be concerned for both you and bub with that amount of medication. I would definitely be talking to your GP about the effect and some other pain management options.

Just a quick story of my own, which you don't have to read, as I know it's not answering your original question!

I have a major dentist phobia, and thankfully have never needed anything done, except my regular clean.

I then needed all 4 wisdom teeth out. I had always said I wanted to be knocked out in hospital for it to occur.
It became a bit of a joke, as anytime teeth removal was bought up, I would squirm, cringe, freak out, and this is when it wasn't even for me!
Unfortunately, I needed it done, when DS was about 12 weeks old so couldn't do the whole hospital, GA thing and look after him. I felt too guilty being knocked out, when it wasnt a necessity.
So I bit the bullet and had them out in the chair, with a local.
It was perfectly fine, I had some painkillers that day, and that's all I needed.
This from the girl that walked into the dentist crying my eyes out, because of the pain coming from one of these wisdom teeth, and the thought that they might take 1 out.

Good luck, I really hope you can sort it out soon, and have some relief.



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My SIL developed ulcerative colitis and has had to have a significant portion of her bowel removed due to long term self-medication using codeine. It gets trapped in the little pockets of the bowel and irritates it causing it to ulcerate.

I would personally be second second, third and fourth opinions on this.

I don't know much about the codeine because I've never had to take it. But I'd follow up with a doctor.

As for teeth:

I had one wisdom tooth taken out at 28 weeks pregnant, in the chair, with a local. It took 10 minutes, and I caught the bus home. Too easy. AND I got to eat chocolate mousse and jelly for two days.

Also, I have another one that moves up and down a little bit. Last visit, my dentist said that if my oral hygiene isn't spot on, I might feel it move a little bit more, and it will cause me more pain, and I have definitely noticed that it's the case. So make sure you are brushing, flossing and rinsing twice a day, and it may help.

Hon, get a second opinion. You're in intense pain! I have a severe dental phobia and had a tooth out in the chair when pg. I am so scared I was sent to a dental surgeon who I does met pre-pregnancy when he had to sedate me to even get near me! When he took the tooth out when I was pg, he offered and suggested I have it done under GA. I was in 3rd trimester at the time. If you're in Melbourne I can give you his details.

Mg

I think you really need to find an alternative as soon as possible. I agree with the pps that your dosage is well beyond what is recommended.
Codeine is an opioid and is addictive when used long term. When used heavily in pregnancy it can cause respiratory problems in newborns and babies can suffer from withdrawal.

I really think you need to see a doctor about an alternative.


http://www.tga.gov.au/rtf/forms/otc-...pi-codeine.rtf

Thank you for the honest answers guys.

To clarify and answer questions here - my appologies now if they are a bit disjointed - as I have posted asking advice in the teeth and dental sections as well regarding my issues with my teeth but haven't explained here because I didn't think I would be allowed to - I have 4 impacted wisdom teeth, 2 of which have cavities the size of peas thanks to hyperremesis gravidarum wearing away the thin layer of enamel they had left (I was told the enamel was thin last time I saw an emergency dentist when they first started emerging 4 years ago and that I had to be careful when brushing my teeth not to brush for too long or too short a time).
The roots of my wisdom teeth are sitting right on top of the nerves in my jaw - the 2 with the cavities are causing swelling my gum (one wisdom tooth even has a recurring abcess under it too) which is also putting added pressure on the nerves.
Local anesthetic isn't an option either - though I am getting so desperate I am seriously considering it - as it only numbs the surface layer and not the areas near the nerves, I had16-30 injections per tooth for local for 4 baby and 2 adult molars as a 15yr old for braces due to overcrowding showed that local asn't an option for future extractions, my dentist and orthodontist both said that I'd need surgery under GA back then (this was 2003) to remove my wisdom teeth if they still didn't come through properly.

I have been going through the Royal Dental Hospital of Melbourne which has a short waiting list and low fees ($25 to be seen) as our local dental group has an 18 month waiting list for emergency work, including surgery, and usually costs about $100, and we can't afford the $800 to go private (which would be a better option if we were able to as the hospital where they do it is just around the corner from our house).

My GP and the oral surgeon know exactly how much pain relief I'm on but won't offer me any alternatives - the oral surgeon actual told me flat out yesterday that I would just have to keep taking that amount of pain relief until August next year when I would be "allowed" to go under GA for the surgery - and I hate having to take all these tablets, I don' know what it's like to be completely pain free anymore and I don't want to hurt my baby, but it's either I take the pain meds or I cant even get out of bed in the morning and that scares me.

I have been very confused about their stance on the GA as I have just been put on the waiting list to go under GA at my local hospital to have a camera put down into my stomach to find out why I get so much stomach pain (possible sever indigestion or silent reflux) since DD was born - and they know that I am pregnant and the general surgeon I saw said it would be ok to do and they would just monitor my baby while they did it.

I am planning on calling the dental hospital again in the morning but I wanted more information first so that I can try and get them to realise how serious this issue is, the only reason I got in to see them yesterday is because I rang up to inform them I was pregnant 2.5 weeks ago.

The horrible thing is that brushing my teeth is a major trigger for the hg - every time I brush I throw up while doing it and for 10 minutes afterwards, not a pleasant experience but I do brush after every meal because I know if I don't the pain will be worse the next day.
I am attempting to wean myself down again from all the meds - we went to the chemist today asked them for advice and they have given me panadeine extra insead of the mersyndol as I don't have any panadeine forte in the house, I have only had to take 3 today and 3 paracetamol so that is an improvement, the pharmacist told me that I can take 1 more of each before bed tonight. If I can keep it at that and still function then I might be able to make it through the pregnancy.
I see my GP again tomorrow regarding my pregnancy, so I will ask him to give the dental hospital a call as well, he has been giving me panadeine forte as I need it after each time I go to emergency when the pain is at it's worst and they send me back to him, maybe the dental hospital will be more willing to push the surgery through if my GP has a talk to them?

Are you sure the local anaesthetic not working was just a one off? Maybe just because it wasn't very effective at 15 years old, doesn't mean it won't work now? Or, you could try it with just PF? I'd be really concerned about going under GA when preg for teeth extraction. Huge I have a thing with mouths and dentistry that makes me feel a kittle dizzy, so I can understand where you're coming from.

When they put the cameras into the digestion system, i think it is a different type of GA. You are kind of awake, but you are given medication so that you don't remember it after the procedure. This may be why the hospital is ok about doing that procedure during pregnancy but the dental hospital would usually do a full GA for their procedures.

If this is going to be a long term issue, then ask the GP for a referral to a pain specialist. They can look at your meds, and may be able to offer alternatives. Would you consider alternative medicine ideas like hypnosis, accupuncture or visualisation to help with the pain so you might be able to cut down on your meds?

Hope your GP has some ideas for you.

take care

What a horrible situation to be in! I just wanted to give you a - you poor thing!!

I really hope the gp can help get things moving to fix it - you won't know yourself when it's all fixed up!!


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PZ - thanks hun, they used local when I had one of the temporary fillings put in on the right bottom wisdom tooth and it still doesn't work, they gave up after 10 injections this time and just did the basic clean out instead of the full clean out. Makes me feel so.... frustrated and even a little bit angry that my body won't accept something like that to make things easier.

HotI - the way the general surgeon explained it was that I would be put completely under and they would then do a full exploration of my throat and stomach with the camera, if it is with another type that is safe for pregnancy then that would be a bonus and I can ask the dental hospital about it. My GP even said today that GA would be possible with constant monitoring of the baby, like what they would do with gall bladder surgery on a pregnant women (his words), but that if the dental hospital had a another alternative that didn't need constant monitoring then that would be better.
I don't think we have a pain specialist down this way, and alternatives aren't currently a usable option due to funds (lack there of really, we're really struggling right now), Hypnosis doesn't work on me anyway even though I would give it another try, last time I tried it was to quit smoking and he couldn't get me hypnotized, I don't know if maybe he wasn't doing it right or not, but it was a total failure (this was 5 years ago now).

My GP said if they refuse to do the surgery then I'll just have to wait, today has been a really good day pain wise thankfully, I've only had to take 2 panadeine extra, so I think pain is going to die down for a bit and give me a break as such for a week or so, hopefully a bit longer, my GP didn't have any other pain relief options for me either, he said the codeine is the strongest pain relief I can take while pregnant and if I can't have the teeth removed before this baby is born then I will have to stop taking it approx 2 weeks before he/she is due to be born, or if labour happens spontaneously for the first time ever for me then to try and not have it before or during labour - which is a good thing as Pethideine and gas are my drugs of choice during labour (I can't go completely natural tried with DD and failed) and any extra wouldn't be a good idea.
I completely forgot to call the dental hospital today, between the heat, being exhausted, going to the doctors and having my brother drop by for a surprise visit and react in a completely horrid manner to the news he's going to be an uncle for the 3rd time I just haven't been thinking very straight and everything is topsy turvy right now.

I will call our local dental service after hours line in the morning before I head off (I'll get DH to remind me yet again) and see if they can squeeze me in for a second opinion. I do like the idea of the sedation first - it would make things easier as I do tend to panic a lot when in severe pain. I'll bring it up with our local dental service too and see what they say about if it's an option do do that first so I'm not "aware" of things happening until it's too late and I can't panic about it and work myself up about it beforehand.

Thank you again everyone for all the information, I am trying so hard to not take too much of the panadeine/mersyndol/paracetamol, some days I can manage on a minimum of pain relief (paracetamol) but others I can't even manage with the maximum you're supposed to take which hurts me emotionally so much. I hate being like this

Just remember that panadeine and mesyndol both contain paracetamol so you can't take it at the same time as paracetamol and you have to make sure you are not taking over the recommended limit for paracetamol in 24hrs. It will be harmful for both you and baby. I also think you need a pain relief review ASAP as what you are taking is quite a lot short term let alone long term. Does your GP actually know how much and all of what you take? Or do you take extra to what he recommends?

Hope you can get this sorted soon.

the other reason the dental hospital may be so reluctant to give you the GA whilst pregnant is because they may not have the resources to deal with any complications.

There are lots of different combinations that can be given during surgery and the kind you are going to have for the gastroscopy still won't be a full GA. We do lists at work where an anesthetists is required and the patient receives a deeper sedation that the normal "twilight" sedation...but it's still not a full GA.

JJ reading all that my heart really went out to you. I've had to deal with a *lot* of dental pain over the last couple of years for several reasons, and I think it's hard to deal with not only because it's strong pain but also because it's so close to where you're trying to think and function But I'm still not convinced there's nothing more that can be done. I think you need to keep asking questions until you get a solution. For example you could ask at the Dental hospital whether it's possible to be referred on to a specialist in a tertiary hospital where they may have facilities to help you sooner.

FWIW when I was dealing with the pain I had, both the oral surgeons and the endodontist I saw told me the most effective pain relief for the majority of dental pain is nurofen + panadol (apparently this is a newer recommendation) so I'm surprised no one has mentioned this. Can you take nurofen during pregnancy? If so, worth talking to your dr/dentist about it, because adding nurofen could mean you need a lot less of everything else, and can save the strong codeine meds for occasional breakthrough pain. Also, do they have you on any antibiotic treatment for the abcess? My endo explained that hot food or drinks can set off that severe pain because the decay lets off gas which is trapped in there but it expands with the heat pressing on the nerves. Also, since the pain seems to be strong early in the morning, is it possible that you're grinding while you're asleep and that's making it worse? Maybe wearing a mouth guard overnight might help with that?

I had the exact same thing happen to me, braces previous teeth removed, pain relief / anethestic not working and then to top it off four impacted wisdom teeth and because I left them for my pregnancy with ds and didn't get seen to..... Two more rotten molars to boot.

I went to the dentist in extreme pain, only using the clove oil the chemist recommended as I don't take ANY pain relief ever. I don't believe in drugs to take away headaches etc. I also wouldn't take anything whist pregnant as my MIL is a acquired brain injury specialist and would never let me live it down, as she knows, has seen and deals with the effects everyday of brain injury because of drugs, medication etc.... Anyhow.....

go get them out now, Book into a different dentist, complain to the one you are seeing now, you cannot be forced to wait when you are pregnant and taking medication because of the pain. ....

I was 14 weeks pregnant with my daughter when I had mine taken out. Only three needles of local, ( they wanted to use ten but I insisted I didn't want it, and I had the four impacted ones cut out, and another removed. At the same time, in the chair and although I felt shaking ( temporarily went into shock I think ) after ten minutes I drove home, was fine and they didn't hurt me again, seriously as soon as they are out they stop hurting....

My nerves were also in a difficult place and risked paralysis etc.... But the pain isn't worth living with, it stops you from being the parent you want to be, and will certainly affect your baby taking all that medication for relief.