Pain relief after surgery Most patients go home with an SMS eScript token (QR code/link) on their phone.
How to use it:
show the token to any pharmacy
keep it private
you can ask the price before it is dispensed
Schedule 8 medicines usually require ID
Typical medicines after surgery (layered pain relief):
regular paracetamol
an anti-inflammatory if safe
a small amount of stronger pain medicine only if needed for breakthrough pain
Pain relief ladder
Regular paracetamol
Anti-inflammatory (celecoxib/etoricoxib or ibuprofen if safe)
Breakthrough medicine only if needed
Pain relief at home Paracetamol: take regularly for the first 7–14 days after surgery (maximum 6 tablets in 24 hours). Anti-inflammatory: take once daily with food if prescribed; avoid other anti-inflammatories unless advised. Breakthrough medicine: only if pain is not controlled; side effects include drowsiness, nausea and constipation.
When to reduce the medicines Reduce in this order: stop the breakthrough medicine first; then stop the anti-inflammatory; reduce paracetamol last. If pain flares, step up one level for a day and then reduce again.
Storage and disposal Store out of reach of children and return leftover opioids to pharmacy.
Download pain relief plan (PDF) Coxib version: https://static1.squarespace.com/static/68afe51edcc7b51a5990b8ca/t/69ae3f409cc5f2034826095c/1773027136560/Combi+Standard+Coxib+Regular+Pain+relief+medicines+0-14+days+copy.pdf
Top up pain relief plan: https://static1.squarespace.com/static/68afe51edcc7b51a5990b8ca/t/69ae403ef23fbd751eb7c040/1773027379666/Combi+Standard+Top+up+pain+relief+medicine+copy.pdf
Costs (private prices) and effectiveness These are typical prices if the medicine is supplied privately; Medicare and private insurance may not cover it.
Paracetamol (Panadol Osteo / pharmacy brand): cheap and effective as a base.
Ibuprofen (Nurofen / pharmacy brand): low cost, but avoid if kidney risk, stomach ulcers, or anticoagulants.
Etoricoxib or celecoxib: COX-2 selective; often better tolerated GI-wise than ibuprofen, but avoid with aspirin-intolerant asthma, previous reaction to NSAIDs, or cardiac risk.
Tapentadol: more expensive than codeine/tramadol but can be tolerated better by some patients.
Short-course breakthrough pain medicine (Schedule 8) has stricter rules. Safety note: avoid mixing opioids with alcohol or sedating medicines; do not drive until fully alert and off short-acting opioids for at least 24 hours.
Why I often prescribe tapentadol first [Add Tapentadol infographic image block here]
Simple explanation: tapentadol can provide similar pain relief to traditional opioids but tends to cause fewer gastrointestinal side effects.
How tapentadol works Tapentadol has a dual mechanism of action: mu-opioid receptor agonism and noradrenaline reuptake inhibition. This combination can lower the required opioid load for some patients.
Lower opioid burden Many patients achieve adequate pain control with less nausea and fewer bowel side effects compared with classic opioids.
Safety considerations Tapentadol still has the typical opioid risks: drowsiness, nausea, constipation, dependence and respiratory depression. Use only for short periods after surgery and reduce promptly. Tapentadol has fewer clinically relevant drug–drug interactions than some other opioids, and no active metabolites; variability is often less pronounced.
Why hospitals often start with tapentadol It can support early mobilisation and physiotherapy in the first few days after major joint replacement, then be stepped down quickly.
Why I sometimes prescribe buprenorphine for breakthrough pain [Add Buprenorphine infographic image block here]
Simple explanation: longer duration of action can give steadier pain control. Use only small backup amounts.
How buprenorphine works Buprenorphine is a partial mu-opioid receptor agonist and kappa antagonist, with high receptor affinity. It provides analgesia with a ceiling effect for respiratory depression.
Longer duration of action The longer analgesic duration can reduce peaks and troughs compared to short-acting opioids; this often translates to fewer dose escalations.
Safety profile The ceiling effect reduces the risk of severe respiratory depression at standard doses, but sedation and nausea are still possible. Combining with other sedating medicines can still be dangerous.
Lower risk of complications In high-risk groups (older adults, sleep apnoea, kidney impairment) buprenorphine is often chosen for breakthrough pain because of a more favourable safety profile than many short-acting opioids.
Why use as small backup I prescribe it as a small, short-course backup so patients can “top up” if they fall behind pain-wise without pushing into high-dose opioid use.
Why I only occasionally prescribe oxycodone
Simple explanation Oxycodone is reserved for situations where pain is significant despite first-line measures. If you have a major joint replacement, the pain is often well-controlled with the layered approach described above.
Rapid onset of pain relief Oxycodone is short-acting and can provide faster relief than buprenorphine. It is sometimes useful for physiotherapy sessions.
How oxycodone works It binds to mu-opioid receptors, providing strong analgesia but with a higher risk of classic opioid side effects compared with tapentadol or buprenorphine for some patients.
Metabolism and variability Oxycodone is metabolised by CYP3A4 and CYP2D6 enzymes, so blood levels can vary depending on genetic differences and drug interactions (e.g. certain antifungals, antibiotics, antidepressants).
Safety considerations Because of its potency and rapid onset, oxycodone carries a higher risk of drowsiness, nausea, constipation and respiratory depression. It should be used with caution and reduced as soon as possible.
How this fits into my pain management approach Oxycodone is a second-line option; the preference is to use it only briefly for physiotherapy or breakthrough spikes and then step down immediately once pain permits.