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We asked NPS Medicine Wise some questions about medicines for chronic pain on 12 November 2013 in "Pharmacist Hour" via FaceBook. NPS MedicineWise helps Australians make the best decisions about their medicines and medical tests. It is independent, not-for-profit and evidence based.

NPS

FAQ about medicines, and answers.

Question: We've heard that some people don't metabolise codeine. Could you explain what this means please?

Answer: For codeine to be effective it needs to be metabolised into morphine. Approximately 6% to 10% of Caucasians and 1% to 2% of Asians are poor metabolisers of codeine to morphine, and have no or little analgesic effect from codeine due to deficiency in the required enzyme.

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Question: Is there a way to find out if you are a codeine 'non-metaboliser'? Is it worth doing this if you are taking a medication with codeine in it and it isn't having any effect?

Answer: That's a good question: People who are poor metabolisers of codeine and are deficient in the specific enzyme can be identified with a blood test. You should discuss the value of this test with your doctor, as there are many other analgesics available for the treatment of pain if codeine is not effective.

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Question: What is meant by an 'opiate' medication, and what should people be aware of if they have been prescribed this type of medication?

Answer: An 'opiate' medication is the term used to identify a class of medications which act specifically on the opioid receptors in the body. As with all medicines there are side effects to consider along with the benefits of taking the medication. A list of side effects can be obtained from the Consumer Medicines Information leaflet from your pharmacist or sometimes within the box of medication. If you experience any new or unusual symptoms while taking an opiate you should discuss this with your pharmacist or doctor for investigation. For more information on pain and treatment options see the NPS Pain Hub http://www.nps.org.au/.../nervous-system-problems/pain

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Question: What alternatives are there to opiate based pain relief.? I react badly to opiates and always need antihistamines to stop scratching myself to pieces.

Answer: It depends on the type of pain you are treating. Other options include paracetamol for simple pain relief and for use in conjunction with other analgesics. Non Steroidal Anti Inflammatory Drugs (NSAIDS) are also useful options for the management of pain. For neuropathic pain there are more specific options available .

Not all medicines are appropriate for each individual and you should discuss your options with your doctor or pharmacist. For more information on types of medicines to treat pain see our Pain hub ://www.nps.org.au/.../nervous-system-problems/pain

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Question: What's the difference between Panadol and Panadol Osteo?

Answer: Panadol and Panadol Osteo both contain the same active ingredient, paracetamol. The difference between the 2 products is in the amount of paracetamol contained in each tablet. Panadol contains 500mg paracetamol, whereas Panadol Osteo contains 665mg per tablet. We suggest always checking with your pharmacist when purchasing paracetamol, to ensure that you know the maximum daily dose and how often a dose should be taken.

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Question: If you have been told to take ibuprofen for arthritis pain in your wrist by your doctor, should you stop after it has stopped hurting and only take it when the pain is really bad? Can you become immune to the relief of ibuprofen if you take it too often? I know some people who hold off taking it until they cant stand the pain because they are concerned about either becoming immune to its effect or stomach ulcers. Any advice?

Answer: In the management of athritis pain, ibuprofen is useful for symtpom relief and can be taken on an as needed basis. Due to the potential side effects of ibuprofen such as stomach ulcers, its use should be restricted where possible, while balancing the need for adeqaute pain relief.

You do not become immune to the analgesic effects of ibuprofen, but some pain conditions can be progressive and worsen with time. If you have a chronic pain condition it is important to discuss with your doctor regarding an appropriate pain management plan.

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Question: What are the risks of various pain meds having had a Coronary Artery Bypass Graft and on Aspirin, plavix, etc... Is doxylamine OK ?

Answer: In order to provide you with the safest and most appropriate information for your question, we need to gather further information about you and your medicines. Please call our NPS Medicines Line on 1300 633 424, we will be able to do this in a much more efficient way. Look forward to hearing from you, and helping you with your question.

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Question: One last question from us! It's sometimes suggested that opiate medications should be 'rotated', but people can become anxious if they're getting pain relief from their current medication. What does rotating medications mean and what is the benefit of doing this?

Answer: Current guidelines do not recommend routine rotation or change in pain medicines if a patient is tolerating and responding well to their current medication. Opioid rotation or change to treatment with a different opioid is an option when there is intolerance of adverse effects or concerns about tolerance. If a patient is concerned about their current pain management plan we encourage them to discuss this with their doctor or pharmacist.

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Question: What is the difference between pregabalin (Lyrica) and gabapentin? Gabapentin is often suggested as an alternative to pregabalin, but many people say that it's not.

Answer: Pregabalin and gabapentin are both medicines which are options in the treatment of neuropathic pain. They appear to be similar in efficacy but individuals may respond to one better than the other.

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Question: NPS is your medicines hotline open 24/7? It sounds like a good resource to direct patients to.

Answer: Thanks for the support. Our Medicines Line (1300 633 424) is available 9am-5pm Monday to Friday AEST. Please share this link online, and to read more about the service: http://www.nps.org.au/medicines-line

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Comment: Great initiative NPS. Fellow pharmacist here and I think that you are tackling a great topic today. Chronic pain is misunderstood for many reasons, through shedding light on treatment options and promoting questions it iis a great way to engage people in managing their pain. Keep up the great work.

Response: Thanks very much for your support. We agree, pain management as a whole is an important topic, and knowing more about your medicines and other options is key for proper management.

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