Moderate analgesics

Moderate analgesics include:

• codeine - methylated morphine
• dihydrocodeine - more potent
• dextropropoxyphine - often with paracetamol as coproxamol or distalgesic

The problems with this group are that although they are effective they are also slightly sedating, constipating and habituating.

Other problems include overdose, particularly of paracetamol - respiratory depression may require high doses of naloxone for reversal, or even respiratory support.

The other major group here is the NSAIDS. These are effective in relieving pain after relatively minor surgery, e.g. day-case, in conjunction with opioids.