Driving functions in a video simulator in chronic non-malignant pain patients using and not using codeine

Eur J Pain. 2011 Apr;15(4):409-15. doi: 10.1016/j.ejpain.2010.09.008. Epub 2010 Oct 13.


Background and aims: A considerable number of Europeans suffer from chronic pain and are using opioids, particularly of the weak type. It is a clinical impression that many of these are driving or wish to drive a car. The aims of this study were to investigate if codeine influences driving ability in a simulator, and to examine if chronic pain per se might impair such functions.

Methods: Twenty patients with chronic pain on long-term codeine therapy were compared to 20 chronic pain patients not using codeine in a video driving simulator test. The chronic pain patients were then compared to 20 healthy controls. The primary outcome measures were reaction time and number of missed reactions.

Results: The patients using codeine 120-270 mg (mean 180 mg) daily showed the same driving skills as patients not using codeine, and the codeine level did not affect the results. This was the case both 1h after intake of a single dose of 60 mg codeine and five or more hours after the last codeine intake. The reaction times were significantly slower for the chronic pain patients, in both rural and urban driving conditions, compared to the healthy controls (difference 0.11s. and 0.12s., respectively). The chronic pain patients missed almost twice as many reactions to traffic signs. There were no difference between the groups in steering precision.

Conclusion: The main finding in this simulator study was that codeine does not impair driving-related abilities over and above what is associated with chronic pain per se.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Analgesics, Opioid / adverse effects*
  • Analgesics, Opioid / blood
  • Analgesics, Opioid / therapeutic use
  • Automobile Driving / psychology*
  • Chronic Disease
  • Codeine / adverse effects*
  • Codeine / blood
  • Codeine / therapeutic use
  • Computer Graphics
  • Computer Simulation
  • Environment
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pain / drug therapy
  • Pain / psychology*
  • Personality / physiology
  • Personality Tests
  • Psychomotor Performance / drug effects
  • Psychomotor Performance / physiology*
  • Quality of Life
  • Reaction Time / drug effects
  • Socioeconomic Factors
  • Young Adult


  • Analgesics, Opioid
  • Codeine