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Managing Pain- I

Managing Pain- I

Today, Thursday the 1st of February 2018, is a date that many health professionals will remember forever. If you have ever suffered from pain and used Codeine containing products over the counter (OTC), I am sure you are aware of the schedule changes. If not, here it is; As of today all codeine containing products will no longer be available over the counter, in Australia. This means a doctor's prescription is required to obtain any pain killers that contain codeine.

In the last few days at the pharmacy, I have noticed customers stocking up on these pain killers.Many have raised concerns about the extra costs and 'time wasted'   in seeing a doctor for something they have always used.

It is understandable that this change may come as an inconvenience to many who have been using these over the counter codeine products to effectively manage their pain. However, there is consequences, other than addiction, that may occur due to long term/on going codeine usage.

While there has been lots of debate about the pros and cons surrounding the up-scheduling of codeine containing products,  it is important to note that Australia is one of the last countries  to make this change and come in line with Japan, the United states and most of Europe. The up scheduling of codeine is a public health issue and I doubt this decision will be reversed. 

For those genuinely concerned about managing pain, here is some information that you may or may not already be aware of.  

What is pain?

The International Association for the Study of Pain (IASP) defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage.

This means pain is not just a physical sensation. It is influenced by factor such as attitudes, beliefs, personality and social factors. Pain can also affect both emotional and mental wellbeing of a person.

Since there are many different factors that influence pain. Two people may have the same pain condition, however, their experience of living with pain can be vastly different.

The two main types of pain that I would like to mention are; Acute pain and chronic pain.

What is acute pain?

Acute pain lasts for a short period of time. It occurs following surgery, trauma or other conditions. It acts as a warning to the body to seek help. It usually improves as the body heals, though it may not in some cases.

What is chronic pain?

Chronic pain lasts beyond the expected healing time following surgery, trauma or other conditions. It can also exist without a clear reason at all. Although chronic pain can be a symptom of another disease, it can also be a disease in its own right, characterised by changes within the central nervous system.

How does codeine work and what harm does it cause?

This is just a brief explanation. 

Codeine is an opioid medicine and needs to be converted to it's active form morphine, in the body. Codeine works by stopping pain signals from travelling along the nerves to the brain.

Studies show that OTC codeine containing products provide very little extra pain relief compared with medicines that do not contain codeine. (I understand your personal experience may state otherwise)

Some of the risks associated with codeine include:

  • Tolerance: where higher and higher doses are needed to feel the same relief from symptoms.
  • Withdrawal symptoms: where symptoms such as headaches, muscle aches, mood swings, insomnia, nausea and diarrhoea occur when the medicine is stopped. These symptoms may easily be confused for the need to take higher doses of codeine containing products.

There is also the issue of poisoning from  paracetamol or ibuprofen that were previously available in OTC products. This would be as a result of taking more than the recommended dose of the ingredients in the combination medications.

Most acute conditions such as headaches, migraines,period pain, sprains etc can easily be managed with over the counter products that do not contain codeine.

Non Steroidal Anti Inflammatory drugs can be used to manage the above conditions for most people. A good example of a readily available anti-inflammatory is Ibuprofen. Ibuprofen is an effective pain reliever. The recommended dose of Ibuprofen is 400 mg up to three times a day. Ibuprofen may cause side effects such as nausea, vomiting, stomach upset. In this case, it is best to take them with food if they upset your stomach. Ibuprofen may also increase blood pressure and lead to stomach ulcers over prolonged use and hence be used with caution in those with high blood pressure and stomach ulcers. 

Paracetamol is also an effective pain reliever when taken at the correct dose of 1000 mg up to four times a day. Paracetamol is also safe to use over long periods of time and therefore has a significant role in the management of chronic pain conditions such as arthritis. Since paracetamol is only a pain killer and does not have any anti-inflammatory properties it may not be sufficient in treating pain conditions with inflammation. However, it is safe and effective to be taken at the full dose for a long period of time( months-years)for those suffering with chronic pain conditions. It helps to keep the pain at base level. When there is a flare up, anti-inflammatories can be added into the pain management picture.

Combination of paracetamol and ibuprofen can provide added benefit in situations where either one alone is effective. The combination tablets come as 200mg of ibuprofen and 500mg paracetamol. The dose for this combination is 2 tablets three times a day. Some combinations contain different strengths and therefore it is important to always clarify the dosage with your pharmacist when purchasing the products.

Of course, if these products are not adequetly managing the pain, one should see a doctor or a pain specialist.

In addition to these over the counter products there is numerous other products such as gels, complementary medicines, TENS machine which have their own place in the management of both acute and chronic pain. Keep reading my blog and I will soon be posting on some of these products. 





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