192076 - Management of moderate acute pain and the role of combination analgesia

This activity follows a male patient who presents with a four day history of acute pain as a result of a sporting injury. The patient’s pain is not controlled with non-pharmacological measures or paracetamol.

The activity explores the importance of a comprehensive pain assessment to identify the nature and severity of the patient’s pain, the current recommendations for stepped care including the appropriate use of combination therapies. The risks and benefits associated with different analgesics used for moderate pain are reviewed with particular emphasis on the use of opioids.

The activity also discusses the overuse of common analgesics in the community and the importance of educating patients to be conscious of the cumulative doses they may be consuming when taking prescribed and/or over-the-counter preparations.

When pain is not controlled with non-pharmacological measures or simple analgesics, guidelines suggest it may be necessary to use combination therapy.

Combining analgesics with different modes of action may produce analgesia at lower and more tolerable doses than either drug alone but can also pose certain risks. Having been recognised by Australian and international bodies as a serious safety issue, codeine-based products became prescription only in February 2018.

Despite this, a 2019 survey found that many Australians have exceeded the maximum daily dose of ibuprofen + codeine. As such, prescribing these with care is vital for GPs.

This education highlights the importance of a comprehensive pain assessment, the stepped care approach suggested by current guidelines for the use of combination therapy and the importance of patient education to reduce the risk of double dosing.

D1. Communication skills and the patient-doctor relationship

D2. Applied professional knowledge and skills

D3. Population health and the context of general practice

D4. Professional and ethical role

D5. Organisational and legal dimensions

• Adult health
• Pain management