Change afoot in pain relief medicines


Pain is a signal that something is not right in our body and may be caused by injury, illness, disease, hormonal changes, emotional upset or stress. The first step is finding out and understanding the cause of the pain. If it is a one-off headache or the pain is from a physical injury such as muscle strain, then treatment can be straight forward. There are pain relief medications available in the pharmacy and your pharmacist can determine which is the most suitable for you.

We currently have paracetamol, ibuprofen, combinations of these with codeine and other anti-inflammatories available in pharmacy for acute pain. Due to changes worldwide in the classification of codeine and the increase in people dependent on it, the Medicine Classification Committee has called for codeine combination products to only be available on prescription from January 2020. Between the late 1990’s and mid 2000’s, we have seen prescribing rates of opioids double in New Zealand and demand increase for over the counter packs. Increased use has led to increased dependence and deaths from misuse. Problems occur with the combination products when a person becomes tolerant to the codeine in the tablet and requires a higher dose to be effective. If they increase the dose above recommended levels, then the dose of paracetamol or ibuprofen can cause liver, kidney or gut damage. In New Zealand, there is talk about licensing small packs of codeine on its own for over the counter use as an alternative to the combinations for stronger pain relief.

Research has also been done into the effectiveness of codeine combinations with mixed results. Products with paracetamol and ibuprofen together are available as an alternative and have been found to be useful for acute pain management.

On the other hand, chronic pain is pain that has continued for three months or longer and is present most days of the week. It may be caused by ongoing injury or disease or it may continue after an injury has healed or illness has passed. In either case, it should be monitored by your doctor. Complimentary therapies and medicines can play a role alongside prescription medicines. Fish oils and boswellia have been shown to reduce inflammation in osteoarthritis or rheumatoid arthritis, while glucosamine and chondroitin can help to repair damaged cartilage in the joints of osteoarthritis sufferers.

However, if chronic pain is not caused by ongoing injury, the pain may persist because of lasting changes to the nervous system. This seems bizarre, but our nervous system is capable of adapting and changing and this may affect us in a positive or negative way. It is important to understand that in chronic pain, the aim of treatment is to improve function despite the pain and reduce the level of pain by a third to a half. This should make it easier to be more active and, in time, be able to enjoy the things you used to. Surgery and medications can help some people as does a positive outlook and reducing stress. Adopting a healthy diet and lifestyle can be beneficial - avoid smoking and alcohol while improving food choices and activity levels.



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