What are the indications for Panadeine (paracetamol (acetaminophen) and codeine)?

From the Guidelines

For the management of pain, I strongly recommend using paracetamol as the first-line oral analgesic, as it is frequently used for the treatment of mild to moderate pain and is the recommended long-term oral analgesic if successful, according to the EULAR recommendations 1. When considering pain management, it's essential to assess the intensity of pain and treatment outcomes regularly, using tools like visual analogue scales, verbal rating scales, or numerical rating scales 1. For mild to moderate pain, paracetamol and/or a non-steroidal anti-inflammatory drug (NSAID) are effective treatments, at least in the short term and unless contraindicated 1. Some key points to consider in pain management include:

• Using the oral route of administration for analgesic drugs as the first choice 1
• Prescribing analgesics on a regular basis, rather than on an 'as required' schedule, for chronic pain 1
• Considering the use of rescue doses of medications for breakthrough pain episodes 1
• Starting analgesic treatment with drugs indicated by the WHO analgesic ladder, appropriate for the severity of pain 1 It's also important to note that individual titration of dosages and regular assessment of pain and treatment outcomes are crucial in effective pain management 1. In terms of specific medications, the choice of opioid, such as morphine, oxycodone, or hydromorphone, depends on various factors, including the severity of pain, patient tolerance, and potential side effects 1. Ultimately, the goal of pain management is to improve the patient's quality of life, reduce morbidity, and minimize mortality, while also considering the potential risks and benefits of different treatment options 1.

From the Research

Pain Management Options

• Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line treatment options for most patients with acute mild to moderate pain 2
• Topical NSAIDs are recommended for non-low back, musculoskeletal injuries 2
• Adjunctive medications may be added as appropriate for specific conditions if the recommended dose and schedule of first-line agents are inadequate 2

Non-Pharmacological Interventions

• Non-pharmacological interventions, such as psychological interventions and physical practices, hold promise in offering relief for people with chronic pain 3
• Techniques like exercise, massage, acupuncture, and yoga can be used to reduce pain 3, 4
• Digital therapeutics is an emerging approach for managing chronic pain 3

Evidence-Based Strategies

• Evidence-based nonpharmacologic strategies are critical adjunctive or stand-alone interventions for chronic pain conditions 4
• Therapies like acupuncture therapy, massage therapy, and mind-body behavioral interventions have been shown to be effective in managing pain 4
• Combination therapy using a small amount of opioid together with a nonopioid pain reliever has been shown effective and reduces opioid consumption 5

Acute Pain Management

• Acetaminophen and NSAIDs often provide adequate analgesia for acute pain, although these agents are not without risks 5
• The short-term use of opioids under close clinical supervision may be appropriate, but even here, combination therapy or nonopioid therapy may be preferred 5