Codeine-free pain relief is better: expert

Australians are being encouraged to trial a combination of paracetamol and anti-inflammatory drugs to treat acute pain before the start of codeine restrictions.

Australia's top pain medicine body is urging patients to start considering alternative pain relief to codeine berfore the ban on over-the-counter sales of the drug early next year.

Dr Chris Hayes, Dean of the Faculty of Pain Medicine (FPM), says anti-inflammatory drugs or paracetamol provide better pain relief without the risk of codeine addiction.

"For acute pain most of the studies show that the combination of paracetamol and anti-inflammatories works as well, if not better, and without the risks of codeine," Dr Hayes told AAP.

"In the chronic pain situation, codeine doesn't work well anyway," he added.

From February 2018 codeine will only be available at pharmacies with a prescription.

The Therapeutic Goods Administration's (TGA) announced last year that the medication will change from Schedule 2 or 3 to Schedule 4 because consumers frequently became addicted to codeine.

Codeine is a "weak" opioid pharmaceutical that has been found to be highly addictive.

"Codeine is converted by the liver to morphine in the body, so essentially it's getting a low dose of morphine and that acts on opioid receptors in the brain and throughout the nervous system to change our perception of pain," Dr Hayes explained.

When combined with other pain relieving drugs it can have serious and potentially life-threatening side-effects such as stomach ulcerations and renal failure, warned Dr Hayes.

With opioid-related deaths on the rise, Dr Hayes says Australians need to consider more holistic approaches to treating chronic pain.

This involves making long-term lifestyle changes that can "wind down" the nervous system's response to pain over time, says Dr Hayes.

"Pain relief isn't just about medication alone. Simply relieving pain by medication is not a solution. It's also about self-managing your condition through thinking well, eating well and making sure you stay socially connected with friends and family," he said.

A report recently released by the National Drug and Alcohol Research Centre showed the rate of accidental deaths due to opioids had more than doubled among Australians aged 35 to 44 since 2007, with more than two-thirds of the deaths due to pharmaceutical opioids rather than heroin.

People suffering acute pain, like a terrible headache, are advised to trial a combination of paracetamol and anti-inflammatory, which will continue to be sold over-the-counter when codeine will no longer be available.

"That would be the simplest pharmacological thing, and if that doesn't work then the advice would be to discuss more complicated strategies with the GP," said Dr Hayes.

The anaesthetist says medication has its place in pain management but there should be a clear plan on when to stop their use, especially with opioids.

"There's reasonable evidence to say with certain types of pain that if you go on for a week or more with opioids therapy then that leads to worse outcomes," Dr Hayes said.

Anyone who believes they may have a problem with codeine or other opioid addiction should seek help from a pain specialist.

Source AAP

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