If you get your health news from Netflix dramas such as Painkiller and The Pharmacist, you could be mistaken for thinking it’s America that has the world’s biggest problem with opioids. But in 2019 – when the most recent global data was compiled – it was the UK that held the dubious distinction of having the highest prescribing rates of these highly addictive medicines.
Despite a concerted effort to curtail their use, the Department of Health and Social Care estimates that in England alone there are still more than half a million people who have been taking opioids continuously for a year or more. So it’s perhaps not surprising 75% of healthcare professionals believe the UK is still in the grip of an opioid epidemic, according to research by the makers of Combogesic, a new OTC pain relief medicine with paracetamol and ibuprofen working together to provide effective pain relief.
CHRONIC
The research also reveals one in 10 people suffer pain on a daily basis. And that’s likely to get worse because of obesity, sedentary lifestyles and an ageing population. Dr Nisa Aslam, a GP and adviser to Combogesic, says: “Pain management is a huge problem. NHS Digital data shows around a third of adults are affected by chronic pain and this is rising. We can offer effective treatments for mild and severe pain, but there is a real gap in the options we have for mild to moderate pain, suffered by a significant proportion of the population.
“There are also challenges around how to provide the best care for people who have relied on opioids.”
Pharmacist Mark Burdon adds: “There has been a lot of good work raising awareness of opioid risks but there is still an urgent need for better awareness of pain management and use of non-opioid treatments.”
So, what can we do about a nation in pain? Here’s the latest evidence and expert advice:
PAIN NATION
Some form of pain is common, with the research revealing 86% of adults experience pain at least once a month and 16% have it “most of the time”. Over-60s were most likely to report constant pain, with 20% saying it was a daily challenge, compared to just 9% of adults aged 18-44. Research also revealed a gender divide, with women twice as likely to report pain every day, 12%, compared to 7% of men.
GP and TV medic Dr Hilary Jones says: “This raises important questions for healthcare providers as there is clear evidence women’s pain is routinely downplayed and under-treated.”
OVER-THE-COUNTER OPTIONS:
Broadly speaking, there are two types of painkillers which can be bought without a prescription. Paracetamol and NSAIDs, short for non-steroidal anti-inflammatory drugs. Dr Jones says: “This family of analgesics targets inflammation and this is achieved by inhibiting release of cyclooxygenase, or COX, enzymes which are needed to produce prostaglandin and other inflammatory chemicals associated with pain.”
But these enzymes also help maintain mucus that protects the lining of the stomach, so they can cause nausea and potentially serious side effects such as gastric bleeding.
A BMJ study published last year warns that, as a result, they are a significant cause of avoidable harm in higher-risk older adults. Paracetamol works by blocking pain pathways in the brain, so have none of these risks, but it is associated with liver and kidney damage, hence advice to take no more than eight 500mg tablets in 24 hours.
However, contrary to President Trump’s claims, there is no evidence pregnant women who take it increase the risk of having a child with autism.
TWICE AS EFFECTIVE?
Pharmacist Mark Burdon says: “Some medicines combine everyday analgesics such as ibuprofen with an opioid – but the efficacy of these formulations is patchy. And as these formulations include an opioid, they all come with the same inherent risks associated with opioid-only analgesia and should be used with supervision.”
For acute short-term pain such as toothache or earache, doctors may suggest alternating paracetamol and an NSAID such as ibuprofen, and studies show when used together they provide more rapid and effective relief than either taken alone. A big plus with this is that it allows for a lower dose of ibuprofen, which reduces the risk of gastric side effects, but the efficacy depends on the specific ratio of paracetamol and ibuprofen.
Studies show that a 2.5:1 ratio is effective in short-term pain, but won’t help patients with chronic pain problems, and at even lower ratios, the synergistic benefits of combining paracetamol and ibuprofen are lost.
But clinical trials confirm the patented 3.3:1 ratio used in Combogesic – 500mg of paracetamol and 150mg of ibuprofen – finds the sweet spot. This is found between the maximum amplification of pain-relief properties of both while using the lowest dose of ibuprofen to achieve synergistic benefit and reduce the risk of gastric side effects.
A randomised double-blind placebo-controlled trial – the gold-standard measure of efficacy – found this combination was superior across multiple measures for patients recovering from dental surgery.
Similarly, a study in the Journal of Pain Research, concluded that compared to either paracetamol or ibuprofen alone, the unique ratio used in Combogesic “provides increased tolerability and safety”.
Dr Jones adds: “Trials have also shown this combination reduces need for more potent opioids, which suggests they may play a part in reducing the use of addictive medicines.”