Anyone who is in pain can counteract it with appropriate remedies. But what if patients receive a painkiller that is risky for them? In Germany, this is more often the case, as can be found in the Barmer drug report published on Wednesday. In the wrong combination, painkillers could have dangerous interactions, it says. In many cases, pain therapy does not correspond to medical guidelines. These are recommendations for action that are intended to help doctors and patients make decisions.

The health insurance company had the medical pain therapy of outpatient Barmer policyholders aged 18 and over without tumor disease examined. Extrapolated to Germany, around 17.1 million people with statutory health insurance received such pain therapy in 2021. However, around 526,000 insured people were prescribed painkillers such as ibuprofen or diclofenac despite heart failure, even though medical guidelines advise against them. Even short-term use of these medications can significantly worsen the performance of the heart. This can increase the number of hospital stays, as well as the risk of death.

According to the report, avoidable errors also occur in therapy with opioids, i.e. very strong painkillers such as morphine. In 2021, around 2.7 million people with statutory health insurance without cancer received an opioid. Three out of ten of those affected did not receive any laxatives at the same time, even though the guidelines stipulate this. This increases the risk of intestinal obstruction fivefold. Five out of 10,000 patients on opioid therapy are hospitalized for this complication each year.

According to the report, there are additional risks when using very strong painkillers. Opioids should not be used together with sedatives, so-called tranquilizers, because there is a risk of serious side effects and even increased deaths. Nevertheless, around one in ten Barmer insured people with an opioid prescription also received a sedative. Patients would be put at avoidable risk here, explained study author Daniel Grandt from the Saarbrücken Clinic.

“The combination of supposedly harmless painkillers in particular can have fatal consequences,” warned Barmer boss Christoph Straub. The therapy, which is usually prescribed by several doctors, is hardly manageable without digital support. Straub called for the mandatory use of digital helpers in medication supply in order to keep track of the overall medication and all side effects and interactions.