Published on 17 June 2026

Working in a government clinic in a small South African town, I often care for patients with chronic illness and multi-morbidity. Chronic pain is frequently part of the picture.

Recently, I saw an elderly woman with a gynaecological complaint who also requested renewal of her chronic medication. She had a long history of lower back pain and had previously been prescribed paracetamol and tramadol at our clinic. As I usually do when reviewing chronic pain treatment, I asked about her current medication use and how often she was taking it.

She explained that she was mostly not using the clinic prescription but rather obtaining pain medication from a local GP with whom she had a long-standing relationship. The trade name of the medication was unfamiliar to me, so I looked up the ingredients. It was a combination analgesic containing paracetamol, codeine, meprobamate, and caffeine — a Schedule 5 medication requiring a doctor’s prescription.

She reported taking the tablets four times daily for many years.

When I gently expressed concern about the prolonged use of this medication at such high dosages, she made it clear that she wished to continue treatment with her GP. It was late in the day, and under time pressure I followed the path of least resistance: I simply removed the clinic pain medication from her repeat prescription.

Yet afterwards I was left with an uneasy feeling — concern about the possible long-term effects on her quality of life, and reflection on my own ethical responsibility to “do no harm.”

Later that evening, I used an AI programme to explore the potential long-term risks and complications associated with this medication. My concerns were confirmed. I also learned that after prolonged use, medications containing codeine and meprobamate should ideally be tapered gradually over many months to reduce the risk of significant withdrawal symptoms. The AI tool also assisted me in generating a patient information pamphlet.

Having had time to reflect, I realised that my next conversation with her needs to be less about “correcting” treatment and more about understanding her experience.

When I see her again, I hope to begin by acknowledging the burden of living with chronic pain and exploring her concerns about changing medication.

Perhaps with a question such as: “What worries you most about changing it?”

I also want to provide information in a way that does not undermine her long-standing relationship with her GP. Perhaps something along the lines of: “At the time the medication may have been started because your pain was severe. Since then, we’ve learned much more about the long-term risks of some of these medications.”

Family medicine often places us in these ethically complex spaces — balancing evidence, relationships, continuity of care, patient autonomy, and the realities of human suffering.

I am looking forward to my next conversation with her.