Brief Answer:
Several points.

Detailed Answer:
HepC is now mostly curable. Treatment for that should be considered for everyone with it.

If a drug has no effect one should stop it.

Neuropathic pain spawned an entire new set of treatments using drugs that damp down nerves.

Tramadol is one of the first that is used because it has both nerve damping down AND narcotic pain effects. It is somewhat poor at both but it has some effects on each. Due to it's narcotic effects, it is habit forming and there can be withdrawal on stopping it but since it is not very strong, the withdrawal also is fairly weak. HOWEVER, with more of it there is more withdrawal. People who do not get rid of it (due to liver problems) will have more in their systems and might have more withdrawal than the average. It is impossible to predict even with drug levels. It's pretty easy to just give less of it to get off of it with minimal withdrawal. High doses of it can cause seizures BUT less of it is not going to trigger seizures. Withdrawal from it or narcotics do not cause seizures unless you are going to have seizures anyway.

There are a lot of neuropathic pain drugs Pregabalin, gabapentin, and amitryptiline would be the top choices and the doses of pregabalin and gabapentin can be fairly high because they are pretty safe. Amitryptiline does not have nearly as good of a safety margin especially with cirrhosis. There are variations on amitryptilne that are supposed to be stronger (nortryptiline) but the safety issue is the same. Lidocaine patches are possible, capsaicin is possible (heck ben-gay is possible).

Narcotics are not generally recommended as the first choice for pain if other drugs have not been tried. They made the neuropathic pain drugs important because peripheral neuropathy generally requires truly toxic doses of narcotics. Really we try NOT to go there. Dihydrocodeine is relatively weak. It is not likely to work well. Furthermore, there is a huge genetic variation on the efficacy of codeines. In many, they just do zero. Side effects are dose dependent and the usual dose is not very likely to do much in peripheral neuropathy so, again, if a drug isn't working it should be stopped.

So, being on a moderate dose of a relatively weak narcotic for about 2-3 days and stopping it is not likely to be very harmful.

Pain managment and seriously potentially dangerous doses of narcotics watched very carefully (like a methadone clinic) are often where people with peripheral neuropathy wind up.

On the other hand, if due to liver disease and the liver were to heal up, it would take most of a year but in theory the underlying process wouldn't be there anymore.

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Brief Answer:
That would include a lot of alternatives.

Detailed Answer:
Quite reasonable questions.
We're coming up with the same viewpoints:
clearing the HepC may lead to slow improvements (but WILL forstall anything getting worse).
Trying a wide variety of nerve pills (and finding the same list).
Then, going with a moderately strong narcotic. I didn't have a lot of optimism for the codeine doing anything. Moderate dose morphine patches are pretty strong. There are potential problems with taking a moderately strong narcotic as I am sure you are aware. And, there do not seem to be alternatives that you haven't tried.

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