Persistent Non-Malignant Pain Guidelines
A stepped approach to pain management is recommended. Paracetamol is considered a 1st line option for the treatment of persistent non-malignant pain. A trial of codeine should be initiated where a weak opioid is indicated. Please see narrative below regarding specific products and refer to persistent non-maligant pain guidelines attached: 

• Codeine tablets (30mg - 60mg): GREEN
• Codeine oral solution - GREEN (treatment option if oral solution is indicated)
• Dihydrocodeine (standard release) 30mg tablets - GREEN
• Dihydrocodeine oral solution - GREEN (treatment option if oral solution is indicated)
• Dihydrocodeine sustained release tablets -  Use if standard release tablets are not tolerated or compliance is an issue. Initiate at a low dose.

Combination products (not preferred)

• Co-codamol 30/500mg:  Limited role as this product does not allow titration to most effective analgesic dose.
• Co-codamol 8/500mg:  May lead to opioid adverse effects and no evidence to show low dose combination products are more effective than paracetamol alone.
• Co-dydramol 10/500mg -  May lead to opioid adverse effects and no evidence to show low dose combination products are more effective than paracetamol alone.

Effervescent or soluble combination formulations

• There is no advantage in using this product in patients who can swallow tablets, these products contain high concentrations of sodium and are expensive. Avoid use unless patient has difficulty swallowing

Branded prescribing (Kapake, Solpadol,Tylex):

• Please prescribe generically, the branded products are considered BLACK on the traffic light system

Consider a patient agreement is completed by the patient (see below) prior to a trial of Codeine