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Over the past year I have become deeply concerned that my wife is hooked on the painkiller co-codamol. She is taking eight tablets a day - maybe more - and though I've talked to her about this, she won't cut down.Please can you tell me the dangers of taking these pills in such high doses, so I can spell out the risks to her?
Name and address supplied.
Deeply concerned: I'm worried my wife is hooked on co-codamol, a painkiller
You are right to be concerned: co-codamol is one of the most commonly abused drugs. It is a cocktail of two medicines, one of which, paracetamol, can be toxic to the liver if more than eight tablets are taken each day.
The maximum permitted dose of paracetamol in an otherwise healthy adult is 4,000mg per day; each tablet of co-codamol contains 500mg.
The other component, codeine, is a powerful painkiller that can trigger addiction. It relieves pain effectively, but the crucial point is that it must be used only in short courses - for days at a time, not for weeks, and certainly not for years.
This is because codeine, which is an opiate, and extracted from the opium poppy, is converted by the liver into morphine - and in higher doses it produces a mild sense of pleasure and calm.
This makes the painkiller addictive, as does the fact that taking large quantities of these painkillers can, ironically, trigger more headaches.
One of my colleagues, a neurologist, tells me this type of drug regularly causes these so-called analgesic headaches, and they are thought to be caused by levels of the drug falling in the body - and so can trigger a person to take one dose after another.
He believes that the fact these drugs cause such headaches - and so lead to a spiral of addiction - is reason alone to consider banning the drug.
Addiction is thought to be more of an issue with the prescription-only co-codamol pills because these contain 30mg of codeine (over-the-counter pills contain 8mg).
Withdrawal from long-term use causes symptoms similar to heroin withdrawal: cramp-like pain in the abdomen, nausea, vomiting, diarrhoea, tremor, sweats and significant changes of mood - mainly agitation.
These occur within hours after the last dose and will persist for a week or two if the drug is stopped completely.
A person who has been taking co-codamol several times each day will undoubtedly experience some of these side-effects if the tablets are stopped, so professional help might well be needed for your wife when she confronts the issue.
I have had patients who have been able to stop over four weeks by following a strict schedule of slowly cutting down and sticking to this regimen with iron discipline.
But most patients need the help of a drug rehabilitation programme familiar with co-codamol addiction - a problem that is all too common, and there are well-structured NHS facilities to deal with this. Your GP can advise and refer.
A final point that has to be taken into consideration is how to manage the pain for which she was prescribed the pills.
If she were to go to be referred to a rehab clinic, they would be able to advise on how to do this. I wish you both the best of luck.
Mrs Robinson, Yorkshire.
How distressing for your husband - but I suspect there may be an answer. From your description it sounds as if he has restless legs syndrome, a condition that causes strange unpleasant sensations in the legs.
People get an uncomfortable feeling when at rest, often starting within 20 or 30 minutes of when they go to bed.
The feeling is described as crawling, pulling or itching, and can be almost intolerable. It brings on an urge to move the legs as that causes momentary relief.
These feelings occur every ten to 60 seconds, and so the result is disturbed sleep - for both of you - and daytime exhaustion.
The cause of this disorder is unknown, and affects about 5 or 10 per cent of adults to some extent.
There is often a family history, and studies suggest it may be caused by a malfunction in the nerves in the legs, causing them to send faulty signals to the brain.
Restless legs syndrome may be associated with other disorders and if your doctor agrees that this is the diagnosis, your husband must be checked for iron deficiency (and the cause of that looked into), as well as screened for diabetes.
He should also be checked for kidney function, but you tell me in your longer letter that tests show this is fine.
There are a number of suitable medications that are effective. Your doctor may choose to refer your husband to a neurologist or sleep clinic consultant, or may be sufficiently informed to prescribe pramipexole or ropinirole tablets, which, taken on a regular and continuing basis, will ease the symptoms and allow a good night's sleep.
These drugs increase the amount of the brain chemical dopamine, which seems to ease symptoms.
They are given at low doses, so side-effects, such as nausea and constipation, are usually mild and should soon wear off.
But a patient must stay on these drugs in the long term because restless legs syndrome is a lifelong condition.
There have also been some studies that suggest regular exercise during the day (but not too close to bedtime) can ease symptoms, as can avoiding caffeine and alcohol.
I hope that my suspicions prove correct: if so, relief for you both is on the horizon.
By the way... How many hours have YOU got left?
Countdown: What will you do with the time you have left?
A year or so ago I calculated that if I were to live to the age of 100, I would have about 200,000 hours left to go.
This was a stark realisation. If, for instance, I realised I had only £200,000 to last the same amount of time and could not have a penny more, thrift would be order of the day. I would certainly not spend £2 on a cup of High Street coffee.
Yet my alarming realisation about my dwindling hours did not change my behaviour to make sure I am in good shape for this remaining time - or that I am lucky enough to see these hours through.
I still work too much, do not exercise daily and probably do not eat enough vegetables. And if I, a medical professional, cannot change my behaviour when confronted with only 200,000 hours left in my life, why should I be surprised that anyone else finds it hard to change their behaviour to improve their health?
Indeed, in this age we are bombarded with more information than ever about our health. The past 30 years have seen an incredible surge in the number of gadgets that let us track our health - and, in theory, help us change our behaviour for the better.
Increasingly, I see patients with wristbands or smartphone apps that show how many paces they walk or run each day, how many hours they sleep and how many calories they have consumed.
But will it change behaviour to have this added knowledge?
Or will we just watch passively, rather like watching football as opposed to playing it, or children listening to music but not picking up an instrument?
The trend has been towards the acquisition of knowledge, but not actually acting upon it.
And we have known for years that the risk factors for stroke and heart attack are obesity, a fatty diet, sedentary lifestyle and smoking - do we really need more technology to record our health-damaging lifestyles?
What does it take to get people to change?
Maybe just ponder those 200,000 hours . . . ever declining.
That is all you need on your mobile or wristwatch to make you consider your choices: a countdown of your remaining hours.
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