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6. Pain


Non-opioid analgesics Preparations Comments
Paracetamol 500mg tablets
500mg dispersible tablets
250mg/5ml oral suspension
Co-codamol † (codeine phosphate/ paracetamol) 8/500, 30/500 tablets BNF indicates these preparations are less suitable for prescribing. They reduce the scope for effective titration of individual components in the management of pain of varying intensity. The advantages of using compound preparations with low dose opioids have not been substantiated. Low dose opioids can often lead to opioid side-effects such as constipation but may not provide additional pain relief.
A full dose of opioid component (e.g. 60mg codeine phosphate) effectively augments analgesic activity but is associated with full range of opioid side-effects, including risk of dependence.
Co-dydramol † (dihydrocodeine/ paracetamol) 10/500 tablets


Non-steroidal anti-inflammatory drugs (NSAIDs) Preparations Comments
For short term use in the management of acute pain. Consider co-prescribing a proton pump inhibitor in those at risk of developing GI ulceration with a non-selective oral NSAID e.g. lansoprazole 15 to 30mg daily
Use with caution in elderly, in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, Crohns disease and ulcerative colitis.
NSAIDs are contra-indicated in severe heart failure, patients with history of hypersensitivity to aspirin or NSAID, coagulation defects, active GI ulceration or bleeding, history of recurrent GI ulceration or haemorrhage, history of GI bleeding or perforation related to previous NSAID therapy.
Ibuprofen 200mg and 400mg tablets
100mg/5ml oral suspension
5% topical gel 
Topical gel is a useful alternative to oral NSAIDs for relief of musculoskeletal pain. 
Naproxen  250mg and 500mg tablets   


Opioid analgesics  Preparations  Comments 
Codeine phosphate  15mg, 30mg and tablets
25mg/5ml syrup 
Dihydrocodeine tartrate  30mg tablets
10mg/5ml oral solution 
Morphine sulphate  10mg 20mg, 50mg tablets
10mg/5ml oral solution 
Tramadol  50mg capsules   CD


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