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Community pharmacists should reconsider current management strategies for mild to moderate pain in light of a new peer-reviewed paper highlighting the escalating opioid crisis in the UK and the underutilisation of non-opioid synergistic treatments.

The paper – ‘Pain and the UK opioid crisis: time to reconsider pain management programmes and the role for specific combination analgesics’ – co-authored by pharmacist Mark Burdon, GP Dr Nisa Aslam and researcher Dr Pamela Mason, argues for the inclusion of a fixed-dose paracetamol/ibuprofen combination (3.3:1 ratio) in national pain management pathways.

The authors highlight that while opioid prescriptions have decreased by just 8 per cent in recent years, over 1 million people remain on prescription opioids, with long-term use contributing significantly to NHS costs and public health burdens. 

Data shows opioid-related hospitalisations rose by 49 per cent from 2008-2018, with drug-poisoning deaths involving opiates reaching 2,551 in 2023.

“Too often, pain management skips from monotherapy straight to opioid combinations,” says Mark Burdon. “But we now have strong clinical evidence that a fixed 3.3:1 paracetamol/ibuprofen ratio delivers a synergistic effect – more effective than either agent alone and without the risks of opioids.”

The paper was published as a new OTC analgesic, Combogesic from New Zealand firm AFT Pharmaceuticals, arrives on pharmacy shelves. Each tablet contains paracetamol 500mg and ibuprofen 150mg, providing a well-tolerated and clinically effective treatment for acute pain, says the company. 

It is available in both GSL and P pack sizes and has been shown to provide superior pain relief in mild to moderate cases without the risks associated with opioids, AFT Pharmaceuticals adds.

Dr Nisa Aslam notes: “A single dose is 80 per cent more effective than paracetamol alone and 30 per cent more effective than ibuprofen alone. It presents a compelling alternative to codeine combinations, which offer limited benefit but carry significant misuse potential.”

The authors call for updated pain management guidelines, professional training and enhanced patient education to promote safer, evidence-based options and reduce reliance on opioids.

Community pharmacists are positioned to play a key role in supporting this shift and driving change in front-line pain management practices, they add.

Combogesic is distributed by Ceuta Healthcare.