There are different types of painkillers, and some are more effective in treating some types of pain than others. Dihydrocodeine is more effective than many over-the-counter pain relievers, but what are the differences between it and other drugs such as codeine, tramadol, and ibuprofen?
Understanding Dihydrocodeine strength can help patients choose the right treatment for moderate and severe pain conditions. In this guide, we will help you understand the strength of Dihydrocodeine in comparison to other painkiller.
Dihydrocodeine is a painkiller from the opioid family, and it’s made using codeine. For many years, people in the UK and Europe have used it to help with pain that’s from moderate to pretty bad, especially when typical over-the-counter medicines just aren’t enough.
You can also find it in some cough syrups, and sometimes doctors use it to help with shortness of breath for certain medical issues. Due to its strength, many patients often ask whether it is an appropriate option for managing severe pain, including cancer-related pain and other long-term conditions.
It can be taken as immediate-release tablets (usually 30mg) or slow-release tablets (DHC Continus 60mg–120mg), which act by blocking the activity of opioid receptors in the brain and spinal cord, so that the signals for pain are lessened.
The analgesic potency is usually expressed as the amount of a drug that is equivalent to one dose of the reference drug, in this case, oral morphine, in terms of its analgesic effect. The higher the equivalence, the more powerful the opioid.
Non-opioids such as paracetamol and ibuprofen act on different mechanisms and do not have a morphine equivalency, but are firmly at the bottom of the World Health Organisation (WHO) ladder of pain relief.
Different medicines work differently. One of the most common questions patients ask is: Is Dihydrocodeine stronger than Codeine? Patients need to understand the strength of painkillers to avoid mishaps. In this section, we are going to compare Dihydrocodeine to other popular pain relievers on the following key measures in the table below:
| Pain Killer | Type | Strength Level | Typical Use |
| Paracetamol | Non-opioid analgesic | Mild | Headaches, mild pain, fever |
| Ibuprofen | NSAID | Mild-Moderate | Inflammation, muscle pain |
| Codeine | Opioid | Moderate | Mild-to-moderate pain |
| Dihydrocodeine | Opioid Semi-synthetic | Moderate-Strong | Moderate-to-severe pain |
Paracetamol is effective for treating mild pain and fever. Unlike Dihydrocodeine it is not an opioid receptor agonist. It is significantly stronger, in comparison to around twice the pain-relieving effect in moderate pain conditions, as is Dihydrocodeine .
If paracetamol is not providing enough pain relief, the doctor may use a low-dose opioid or increase the dose to Dihydrocodeine .
Ibuprofen belongs to a class of drugs called non-steroidal anti-inflammatory drugs (NSAIDs). These are especially helpful for inflammatory pain, like arthritis or sprains, or dental pain.
It is not anti-inflammatory, but offers greater central pain relief than Dihydrocodeine . But in practice, they work on different pain mechanisms — sometimes they are used in combination with each other to provide “full coverage.”
When comparing Dihydrocodeine vs Ibuprofen, it is important to remember that both medicines work through completely different mechanisms.
Here’s where things get pretty interesting clinically. In this Dihydrocodeine vs Codeine comparison, many patients are surprised to learn that Dihydrocodeine is generally considered stronger.
Other medicines, known as prodrugs, require changes to the body to convert them into another effective chemical. One of these is codeine, which has to be converted to morphine before it can act.
The important part of that is that Dihydrocodeine acts more directly as an opioid. This increases its effectiveness in the bodies of those with less efficient codeine metabolism, and those who do not have their bodies at all.
Tramadol works in a couple of ways. It is an opioid, but it is unique in the sense that it also blocks the uptake of serotonin and noradrenaline. Tramadol and Dihydrocodeine are in the middle range of pain relievers for moderate to severe pain. But there are some disadvantages to tramadol, such as an increased likelihood of seizures and a side effect known as serotonin syndrome, particularly when used in combination with other medications.
Other physicians believe that Dihydrocodeine acts more simply and has fewer side effects than other opioids, and that its side effects are easier to predict. The debate around Dihydrocodeine vs Tramadol often depends on the type of pain being treated and the patient’s medical history.
Dihydrocodeine is usually used when first-line treatments, such as paracetamol, ibuprofen or low-dose codeine, have not been effective enough. It is frequently prescribed after surgical procedures, for chronic musculoskeletal pain, cancer-related pain, and when someone has severe dental or injury pain. Slow release should be used with chronic pain, where the pain is required to be present all day.
The UK Government safety update highlights important safety concerns around the long-term use of opioid painkillers such as Codeine and Dihydrocodeine, particularly the risks of dependence, tolerance, and misuse.
As with all opioids, Dihydrocodeine can be physically addictive if taken over a long period. Take as directed; follow the recommended dosage and duration. Avoid concomitant use with alcohol and other CNS depressants — may have CNS depressive effects.
Dihydrocodeine may impair your driving or operating skills. Not appropriate for all individuals: Contraindicated in some respiratory diseases, liver disease, and should be used carefully in the elderly.
Do not abruptly discontinue Dihydrocodeine use after prolonged use; wean off under medical supervision.
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Each painkiller works on a different pathway to manage pain. Others help to reduce inflammation, and some, such as opioids, directly modulate the brain’s pain signals, leading to distinct strengths and impacts.
Occasionally, doctors prescribe two or more different kinds of medication to achieve better pain relief. This should only be done under medical supervision to prevent side effects or unsafe interactions.
Doctors do not choose medication on their own. Medicine prescription is not about the strength, but what kind of pain, how severe it is, and how a patient has reacted to previous pain treatments.
Sources:
https://www.nhs.uk/medicines/dihydrocodeine/how-and-when-to-take-dihydrocodeine
https://nhssomerset.nhs.uk/wp-content/uploads/sites/2/ICB-tapering-dihydrocodeine-v1approved.pdf
https://bpac.org.nz/bpj/2008/december/docs/bpj18_who_ladder_pages_20-23.pdf
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