Physiotherapist explains codeine changes

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Medications that contain codeine now require a prescription. The changes were made earlier this month with the aim being to reduce addiction and misuse of the drug. 

Worryingly, the National Drug Strategy Household Survey found that about one-third of people who had misused pharmaceuticals had used over-the-counter, codeine-containing analgesics including paracetamol and anti-inflammatories. 

As a health professional who treats patients with acute and chronic musculoskeletal pain, it has certainly been a topic of interest. These changes will have an impact on thousands of people who use codeine to manage painful conditions such as low back pain, arthritis and nerve-related pain. 

The Journal of Pharmacology found that about 56 per cent of sales recorded for codeine-containing analgesic products were bought over the counter. While codeine is still available, its appropriateness, suitability, dosage and duration will be managed by a GP or medical specialist. 

When comparing low-dose codeine medications (such as the ones previously available over-the counter), it has been shown that there are very few benefits when compared to similar medications without codeine. For managing acute pain, alternatives have included products containing Panadol or ibuprofen (anti-inflammatory) or sometimes both. 

Pain, both acute and chronic, can be incredibly challenging with many factors influencing the  pain experienced by an individual.

Changing codeine to a prescription-only drug means that patients living with pain due to musculoskeletal conditions will be encouraged to seek alternative treatments. 

When treating patients with chronic pain, a multi-faceted approach is required. A one-size-fits-all model does not work, and individual treatment plans are necessary. 

Pain management strategies that I commonly utilise on patients include medication (over-the counter or prescription), physiotherapy, lifestyle changes and self-management strategies such as exercises and relaxation.

For example, chronic low back pain is a condition I treat on a daily basis and it generally  involves a team approach. I commonly liaise with a patient’s GP or medical specialist to identify a suitable pain medication (if required). 

Physiotherapy treatment then focuses on identifying factors or triggers that increase pain, with the aim being to reduce or eliminate these factors, if possible. 

A big part of treatment focuses on explaining pain and the factors that influence pain, which I will expand on in a future article. Commonly, this involves in-depth conversations to change long-held misconceptions about the reasons for and causes of low back pain. 

I will utilise short-term pain-reducing strategies such as massage, joint mobilisations or dry needling. These passive treatments and techniques, just like pain medication, are designed to reduce pain in the short term to allow the patient to exercise and perform daily tasks more comfortably. 

Most importantly, a range of strengthening and mobility exercises need to be introduced to build strength and gradually reduce pain levels in the long term. Depending on my patient’s goals and aims, these can be performed within the clinic, in a group environment, or even independently at home. 

So what do the codeine changes mean to you?  If you have commonly relied on these medications for pain relief, I strongly encourage you to speak to your doctor, chemist or other trusted health professionals. 

A comprehensive and targeted treatment plan can reduce pain in the short term and improve pain levels in the long term. Speaking openly to your health professional will ensure that you  develop a comprehensive and holistic plan that does not involve taking unnecessary or inappropriate medications. 

Jason Lee APAM
B. Physiotherapy
Malvern East Physiotherapy

Jason is happy to answer any questions you may have. Simply send an email to [email protected]

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Total Comments: 6
  1. 0

    That article really only tells what we already know

  2. 0

    The government spent a year telling us not to go to the doctor so often!
    Physio can not fix a tooth ache or a broken bone. If you are suffering on a Friday night it is going to be a very long weekend. People who take codeine products usually aren’t taking it for physio related issues.
    …and yes, Rocky, we do.
    Physiotherapy is a wonderful aid but it is for those who can afford it. A session starts at $100 and they always want a return visit.

    • 0

      I am taking a low dosage paracetamol and codeine tablet which has been a wonder drug for me by easing chronic pain without breaking the bank. I was only taking it for a few weeks before the ban came into force and now it costs me over $100 for a doctors visit to get a prescription plus the cost of the tablets so I can live without constant pain for a few hours a day.
      There are things physio cannot fix and can also make worse.

    • 0

      Yes, Rosret, I agree. Can you try and find a doc who will bulk bill you? I would not go to the doc at all if I could not bulk bill. I think it is wrong to have to have money to go to see a GP. Also I am told only very very gentle massage and no chiropractors.

  3. 0

    The article suggests “I will utilise short-term pain-reducing strategies such as massage, joint mobilisations or dry needling”. Nice if you can afford it. With a damaged hip joint, knee and major muscular damage from an accident, the aggravation and muscle spasms would also lead to a tension headache by end of day. Instead of taking the 1 or 2 codeine tablets (not every day) to relieve this that I use to take, which carried no risk at that level of use, because of the codeine over the counter ban I now have to start shoving large doses of other pills in my mouth as soon as I wake up and all day long every day consisting of large doses of paracetamol, anti-inflammatories and aspirin all day from morning to night to try and prevent pain that will prevent me from sleeping and moving. These pills carry a much higher risk of permanent damage to my health than the single codeine tablet that I only used to occasionally take, including internal bleeding, stomach ulcer and infection that can turn cancerous, liver failure and arterial damage. Thanks for that Department of Health! – you critically misguided people. I think it was a dumb idea to take codeine off the shelf because it will harm more people than it will help.

  4. 0

    all sounds quite sensible. Most of which I already knew, yes…but I am thinking more GP’s need to send people to pain management clinics. A multi pronged approach is needed in many cases, yes, I agree with that. I have had back injuries since 12 and constant pain since 21. I am now 60. I use many many methods and tricks to keep myself mobile. Many of us have learnt what to do, some havent yet. I certainly cant afford a physio or other provider, as I am not working and have no pension. ….My back is not suitable for surgery as it has too many problems in too many spots. Quality of life is another issue. If you are in too much pain all the time, life is not worth living. It is better to take the pills and have a shorter life but one where the pain is managed.



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