Tabner, A. and G. Johnson (2015). "Codeine: An Type of study: Two case histories Case 1 pain occurred after one dose 1 g paracetamol – recognized and easily treated cause of acute and 60 mg codeine orally 2 trial of acute abdominal pain secondary to oral abdominal pain." American Journal of Emergency codeine that resolved after the administration of Case 2 pain occurred after 1 dose of 30mg codeine – Medicine 33(12): 1847.e1841-1847.e1842. intravenous naloxone. orally Codeine is a well-recognized but underappreciated Known effect of codeine and morphine (see Lenti et al cause of acute severe abdominal pain mediated poster above). through sphincter of Oddi spasm. It is thought to be of particular significance in patients who have previously undergone cholecystectomy. Administration of naloxone in low doses carries little risk and has the potential to be both diagnostic and therapeutic. Early recognition and management of this treatable condition has the potential to reduce unnecessary investigations and prevent possible progression to pancreatitis. Table B4. Harms from low-dose codeine combination medicines use - alternatives to use of codeine in adults and children Reference Description Evaluator comment / conclusion Bandieri, E., et al. (2016). Multicenter, 28-day, open-label randomized controlled The authors note: Type of study: "Randomized of low-dose study The study demonstrated that, compared with morphine versus weak opioids in Purpose: The WHO guidelines on cancer pain management step II opioids, low-dose morphine provided an moderate cancer pain." Journal of recommend a sequential three-step analgesic ladder. However, earlier and a more adequate level of analgesia for Clinical Oncology 34(5): 436-442. conclusive data are lacking as to whether moderate pain should be moderate cancer pain, with a fairly good treated with either step II weak opioids or low-dose step III strong tolerability profile and a positive impact on opioids. overall wellbeing. Oncologists, family physicians, and internists may prefer to prescribe weak opioids in many
Tabner, A. and G. Johnson (2015). "Codeine: An and easily treated cause of acute abdominal pain." American Journal of Emergency Medicine 33(12): 1847.e1841-1847.e1842. Type of study: Two case histories 2 of acute abdominal pain secondary to oral codeine that resolved after the administration of intravenous naloxone. Codeine is a well-recognized but underappreciated cause of acute severe abdominal pain mediated through sphincter of Oddi spasm. It is thought to be of particular significance in patients who have previously undergone cholecystectomy. Administration of naloxone in low doses carries little risk and has the potential to be both diagnostic and therapeutic. Early recognition and management of this treatable condition has the potential to reduce unnecessary investigations and prevent possible progression to pancreatitis. Case 1 – pain occurred after one dose 1 g paracetamol and 60 mg codeine orally Case 2 – pain occurred after 1 dose of 30mg codeine orally Known effect of codeine and morphine (see Lenti et al poster above). Table B4. Harms from low-dose codeine combination medicines use - alternatives to use of codeine in adults and children Reference Description Evaluator comment / conclusion Bandieri, E., et al. (2016). "Randomized of low-dose morphine versus weak opioids in moderate cancer pain." Journal of Clinical Oncology 34(5): 436-442. Type of study: Multicenter, 28-day, open-label randomized controlled study Purpose: The WHO guidelines on cancer pain management recommend a sequential three-step analgesic ladder. However, conclusive data are lacking as to whether moderate pain should be treated with either step II weak opioids or low-dose step III strong opioids. The authors note: The study demonstrated that, compared with step II opioids, low-dose morphine provided an earlier and a more adequate level of analgesia for moderate cancer pain, with a fairly good tolerability profile and a positive impact on overall wellbeing. Oncologists, family physicians, and internists may prefer to prescribe weak opioids in many trial recognized