Pain and The UK Opioid Crisis: Time to Reconsider Pain Management Programmes and The Role for Specific Combination Analgesics

Pain is a complex experience that is both distressing for individuals and challenging for healthcare professionals (HCPs).It can range from mild to moderate or severe.Various pain relief options are available, including paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen, and opioids.In a survey of 1,000 consumers, 22 per cent reported taking painkillers two to three times a day.Opioids are linked to significant adverse effects, including dependency, and are frequently overused both in the community and in hospitals.The UK has been facing an opioid epidemic, with the highest global rate of opioid consumption recorded in 2019.Although opioid use in the UK has declined slightly since then, further efforts are needed to reduce it.The various pain pathways for mild to moderate pain identify paracetamol, NSAIDs such as ibuprofen and naproxen, salicylate NSAIDs such as aspirin and weak opioids such as codeine, dihydrocodeine and tramadol as suitable for mild to moderate pain management.Combination analgesics are identified in various pain pathways, but they do not include a combination of paracetamol/ ibuprofen in one dose.Paracetamol and ibuprofen reduce pain via different mechanisms of action, and in combination they act across the pain pathway and provide proven effective pain relief for mild to moderate pain at every recommended dose.Combogesic is a patented double action formula containing paracetamol 500 mg and ibuprofen 150mg which work together in complementary ways to help relieve pain.A single dose of Combogesic is clinically proven to be 80 per cent more effective than paracetamol alone and 30 per cent more effective than ibuprofen alone.By contrast, the addition of codeine 60mg to paracetamol 1,000mg has been shown to provide only modest additional pain relief.This paper includes a brief resum of pain, an in-depth commentary of the high use of opioids with a focus on the UK, the adverse effects caused by the 'opioid epidemic' and the need to reduce their use in both the community and hospital settings.In addition, we review the management of mild to moderate pain and the clinical evidence around a specific combination of paracetamol and ibuprofen that could be put into place as a therapy option and included in recommendations for mild to moderate pain, with the potential to reduce the need for opioid use.