Pharmaceutical composition comprising (1R,4R)-6′- fluoro-N,N-dimethyl-4-phenyl-4′,9′-dihydro-3′H-spiro [cyclohexane-1,1′-pyrano- [3,4,b ]indol] -4-amine and paracetamol or propacetamol

1. A pharmaceutical composition comprising:

a first pharmacologically active ingredient which is (1r,4r)-6′-fluoro-N,N-dimethyl-4-phenyl-4′,9′-dihydro-3′H-spiro[cyclohexane-1,1′-pyrano[3,4,b]indol]-4-amine or a physiologically acceptable salt thereof; and

a second pharmacologically active ingredient which is paracetamol or propacetamol,

wherein the first pharmacologically active ingredient and the second pharmacologically active ingredient are present in the pharmaceutical composition at a weight ratio such that the first pharmacologically active ingredient and the second pharmacologically active ingredient will exert a synergistic therapeutic effect when the pharmaceutical composition is administered to a patient.

2. The pharmaceutical composition according to claim 1 , wherein the first pharmacologically active ingredient is

(1 r,4r)-6′-fluoro-N,N-dimethyl-4-phenyl-4′,9′-dihydro-3′H-spiro[cyclohexane-1,1′-pyrano[3,4,b]indol]-4-amine hydrochloride,

(1 r,4r)-6′-fluoro-N,N-dimethyl-4-phenyl-4′,9′-dihydro-3′H-spiro[cyclohexane-1,1′-pyrano[3,4,b]indol]-4-amine hemicitrate, or

(1 r,4r)-6′-fluoro-N,N-dimethyl-4-phenyl-4′,9′-dihydro-3′H-spiro[cyclohexane-1,1′-pyrano[3,4,b]indol]-4-amine maleate.

3. The pharmaceutical composition according to claim 1 , wherein the second pharmacologically active ingredient is paracetamol.

4. The pharmaceutical composition according to claim 1 , wherein a relative weight ratio of the first pharmacologically active ingredient to the second pharmacologically active ingredient is 1:30 to 1:1,000,000.

5. A method for treating pain comprising administering to a patient the pharmaceutical composition according to claim 1 .

6. The method according to claim 5 , wherein the pain is at least one of peripheral pain, central pain, musculoskeletal pain, acute pain, subacute pain, chronic pain, moderate to severe pain, neuropathic pain, psychogenic pain, nociceptive pain, mixed pain, lower back pain, visceral pain, headache pain, post-operative (post-surgical) pain, pain associated with cancer, and inflammatory pain.

7. A pharmaceutical dosage form comprising the pharmaceutical composition according to claim 1 .

8. The pharmaceutical dosage form according to claim 7 , wherein the first pharmacologically active ingredient is present at 10 to 1,200 μg.

9. The pharmaceutical dosage form according to claim 7 , wherein the second pharmacologically active ingredient is present at 100 to 8,000 mg.

10. The pharmaceutical dosage form according to claim 7 , wherein the first pharmacologically active ingredient is present in the dosage form in a dosage that is within a range of from 1:20 to 20:1 of an amount which is equieffective to a dosage of the second pharmacologically active ingredient contained in the dosage form.

11. The pharmaceutical dosage form according to claim 7 , wherein the pharmaceutical dosage form is adapted for oral administration, intravenous administration, intraperitoneal administration, transdermal administration, intrathecal administration, intramuscular administration, intranasal administration, transmucosal administration, subcutaneous administration, or rectal administration.

12. The pharmaceutical dosage form according to claim 7 , wherein the pharmaceutical dosage form provides under in vitro conditions immediate release or controlled release of at least one of the first pharmacologically active ingredient and the second pharmacologically active ingredient.

13. A kit comprising:

a first pharmaceutical dosage form comprising a first pharmacologically active ingredient selected from the group consisting of (1r,4r)-6′-fluoro-N,N-dimethyl-4-phenyl-4′,9′-dihydro-3′H-spiro[cyclohexane-1,1′-pyrano[3,4,b]indol]-4-amine or a physiologically acceptable salt thereof; and

a second pharmaceutical dosage form comprising a second pharmacologically active ingredient selected from the group consisting of paracetamol or propacetamol;

wherein the first pharmacologically active ingredient and the second pharmacologically active ingredient are present in the kit at a weight ratio such that the first pharmacologically active ingredient and the second pharmacologically active ingredient will exert a synergistic therapeutic effect when they are both administered to a patient.

14. The kit according to claim 13 , wherein the first pharmaceutical dosage form and the second pharmaceutical dosage form are adapted for simultaneous or sequential administration.

15. The kit according to claim 14 , wherein the first pharmaceutical dosage form and the second pharmaceutical dosage form are adapted for administration by the same pathway of administration.

16. The kit according to claim 14 , wherein the first pharmaceutical dosage form and the second pharmaceutical dosage form are adapted for administration by a different pathway of administration.

17. A pharmaceutical composition comprising a synergistic combination of:

(1) a first pharmacologically active ingredient which is (1r,4r)-6′-fluoro-N,N-dimethyl-4-phenyl-4′,9′-dihydro-3′H-spiro[cyclohexane-1,1′-pyrano[3,4,b]indol]-4-amine or a physiologically acceptable salt thereof; and

(2) a second pharmacologically active ingredient which is paracetamol or propacetamol.