Life without codeine: what now?

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]

Has the codeine change affected you?

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Written by Jason Lee

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