All analgesics have problems, so why take away one that's so effective?

IN JANUARY the government announced that, on the advice of its Committee on Safety of Medicines, the painkiller co-proxamol was to be withdrawn by the end of this year. That time is rapidly approaching, yet a substantial number of doctors and thousands of patients are unprepared for the loss of what many see as a vital treatment in the relief of chronic pain.

The government's position is clear: co-proxamol is involved in around 300-400 self-poisoning deaths each year. Even taking a few tablets over the recommended dose can be fatal and research seems to show that it is not much more effective than paracetamol. Get rid of co-proxamol, lives will be saved.

This is not, however, accepted by many doctors or patients. Co-proxamol has been around for 40 years and every year millions of prescriptions are issued. While even one death is unacceptable, those intending to kill themselves will use some other drug, so getting rid of co-proxamol will not help. Would it not be better to research why so many of us feel so desperate that we want to end our lives?

Specialists have been lining up to complain about the loss of what they see as a useful drug. For example, writing in the British Medical Journal earlier this month, Professor Peter Whorwell, a consultant gastro-enterologist in Manchester, describes co-proxamol as being unique in not disturbing the gut. Anti-inflammatories such as ibuprofen often irritate the stomach, and alternatives containing codeine tend to constipate. Consultant rheumatologist Matthew Grove of North Shields says that alternative painkillers have more side-effects, may be less effective in the treatment of rheumatoid arthritis and, perhaps, are even more dangerous than co-proxamol. This is because co-proxamol contains two painkillers, one of which is paracetamol - a relatively small overdose of which can cause fatal liver damage, yet there is less paracetamol in co-proxamol than in an equal number of paracetamol tablets.

I am not alone in finding all this very confusing. The research showing paracetamol to be equally effective a painkiller as co-proxamol should be conclusive, yet many patients vehemently tell me otherwise. I have tried to change their medication only to have people begging to have their co-proxamol prescription restored. Some were successfully moved to Vioxx, a new painkiller that did not cause stomach irritation. Unexpected side-effects, though, have resulted in that drug being banned, too.

While overdose deaths are unacceptable, so, too, is the concept that many thousands of people suffering the agony of chronic unrelenting pain should have a mainstay of their treatment whipped away from them. It's time for a rethink.

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