2 Mar 2018

When codeine was up-scheduled in pharmacies, it was no longer available over-the-counter and now requires a prescription from a doctor.

This change has led many patients to ask what options are left for acute pain management, and how effective those options actually are.

What patients need to know

The main alternatives available are paracetamol, anti-inflammatory medications such as ibuprofen, and combinations of these agents.

These remain the key options used in place of codeine for short-term pain relief.

In practical terms:

  • Paracetamol is widely used for general pain relief
  • Ibuprofen is used for pain where inflammation is present
  • A combination of paracetamol and ibuprofen is also commonly used for acute pain

What does the evidence show?

Comparative research into oral analgesics for acute pain has examined how different commonly used medications perform against each other.

This includes studies comparing paracetamol, ibuprofen, combination therapy, and codeine-containing medicines, using measures such as number needed to treat (NNT) and overall pain relief outcomes.

In these comparisons, combination therapy using paracetamol and ibuprofen is included among the highest-performing options assessed for acute pain.

Key takeaway

Even after the up-scheduling of codeine, effective options remain available for acute pain management.

Paracetamol, ibuprofen, and their combination continue to be the main alternatives used in practice, supported by comparative evidence in acute pain research.


References & further reading:

  1. “Oxford Analgesic League Table”. Faculty of Pain Medicine (UK). Accessed 22/02/2018 via: https://www.rcoa.ac.uk/faculty...
  2. “Opioids and Acute Pain Management”. Faculty of Pain Medicine (UK). Accessed 22/02/2018 via: https://www.rcoa.ac.uk/faculty...
  3. “Painaustralia codeine fact sheet – October 2017”. Painaustralia. Accessed 22/02/2018 via:http://www.painaustralia.org.a...
  4. “Codeine information hub”. Therapeutic Goods Administration (Australian Government, Department of Health) 2018. Accessed 22/02/2018 via: https://www.tga.gov.au/codeine...
  5. Moore A, Wiffen PJ, Derry S, et al. “Non-prescription (OTC) oral analgesics for acute pain - an overview of Cochrane reviews”. Cochrane Database of Systematic Reviews 2015. http://onlinelibrary.wiley.com...
  6. Moore A, Derry S, Aldington D, Wiggen PJ. “Single dose oral analgesics for acute postoperative pain in adults - an overview of Cochrane reviews” Cochrane Database of Systematic Reviews 2015. http://onlinelibrary.wiley.com...