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Combination analgesics and chronic pain
Last reviewed: 08.07.2025
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For the treatment of chronic pain syndrome (CPS) of various myologies, combination drugs based on acetaminophen in combination with small, drug-safe doses of weak opioid analgesics - codeine or tramadol - are of particular interest. These combination drugs are more effective than pure paracetamol and are not classified as narcotic drugs.
The combination of paracetamol (500 mg), codeine (8 mg) and caffeine (30 mg) improves the quality of analgesia achieved with the isolated use of the same dose of paracetamol. The drug is available in the form of tablets and soluble tablets. A single dose is 1-2 tablets (0.5 - 1.0 g based on paracetamol), daily up to 6-8 tablets (maximum 4 g of paracetamol, 64 mg of codeine and 240 mg of caffeine).
An effective combination is the non-opioid analgesic paracetamol (325 mg) and the opioid tramadol (37.5 mg). The former provides a rapid onset of the analgesic effect, while the latter enhances and prolongs it. A single dose is 1-2 tablets, maximum (650 mg paracetamol and 75 mg tramadol), daily - maximum 8 tablets (2.6 g paracetamol and 300 mg tramadol). In patients over 75 years of age, the interval between single doses of the analgesic should be at least 6 hours. The drug is effective in acute and chronic pain syndromes of moderate intensity of various origins. Contraindications to the use of the drug are liver and respiratory failure, epilepsy, pregnancy, breastfeeding, simultaneous use of alcohol (increases the toxic effect on the liver), sedatives, drugs containing paracetamol and tramadol. All the drugs considered in this section are classified as "non-narcotic". It should be emphasized that different drugs of this series, used for pain relief, have a different spectrum of side effects, which allows the doctor in a specific clinical situation to select and prescribe the safest of them to the patient, taking into account the individual characteristics of the body and concomitant diseases.
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