Navigating conversations about relief of multiple pains, multiple people
Published: 28 January 2025
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Overview
- Access to paracetamol has been further restricted due to the potential serious effects of overdosing.1
- Choosing an inappropriate pain reliever can lead to inadequate pain relief, which may increase the risk of unintentional overdosing.2
- Since acute pain is often inflammatory, patients may benefit from using a non-steroidal anti-inflammatory drug (NSAID) for pain relief, with ibuprofen offering effective acute pain relief with the same low risk of gastrointestinal side effects as paracetamol (in patients without contraindications or precautions).3-7
The self-select analgesic category has changed considerably over the last few years
There has been a long history of changes to the scheduling of pain medications in Australia.9 In 2010, codeine-containing analgesics were upscheduled from S2 to S3, and their pack sizes were restricted due to increasing reports of misuse.9 However, this did not reduce codeine-related harms. Consequently, in 2016, it was announced that codeine would be upscheduled again in 2018 to S4.9 Following that, a review by the Therapeutic Goods Administration (TGA) resulted in modified-release (MR) paracetamol being upscheduled from S2 to S3, due to MR paracetamol being associated with increased harms following overdose.3,10 Now, in 2025, immediate-release (IR) paracetamol has also faced restrictions, reducing unscheduled and S2 pack sizes, limiting access to larger pack sizes with pharmacist consultation (S3).1
There can be serious consequences for patients who navigate pain management incorrectly
The inability of patients to manage their pain safely and effectively can have serious consequences. The discussion surrounding the role of paracetamol in pain management has been ongoing for several years,11 alongside investigations into the modifiable risks associated with its use. While paracetamol is generally well tolerated at recommended doses, overdose or repeated use above the therapeutic level can lead to liver toxicity and even death.9 In fact, paracetamol is currently the substance most commonly involved in overdoses in Australia and the leading cause of acute liver injury in Australia.9,12
