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Ovid: Oxford Handbook of Palliative Care

Editors: Watson, Max S.; Lucas, Caroline F.; Hoy, Andrew M.; Back, Ian N. Title: Oxford Handbook of Palliative Care, 1st Edition Copyright ©2005 Oxford University Press > Table of Contents > Symptom Management > Chapter 6a – The management of pain > Step 2: Weak opioid ± non opioid ± adjuvants Step 2: Weak opioid ± non opioid ± adjuvants Start treatment with a combined preparation of paracetamol with codeine or dihydrocodeine. Use of dextropropoxyphene and paracetamol (co-proxamol) is being phased out in the UK in 2005. Many combined preparations are available and are some of the most widely used medicines in the community. NB Studies have shown that there is no additional analgesic benefit from preparations which contain only 8mg of codeine combined with paracetamol as opposed to paracetamol alone. It is important to stipulate the dose of codeine required in the preparation e.g. ‘paracetamol 500mg/codeine 30mg’. Patients need also to be clearly advised to take these tablets regularly and not to assess efficacy after only a couple of doses.

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