Which painkiller?

The type of medicines that you need to treat your pain depend on what type of pain you have.

Dr Alf Collins, a consultant in pain management at Musgrove Park Hospital, Taunton, says everybody who has pain should consider taking painkillers. But different painkillers work better for different types of pain.

For pain associated with inflammation, such as back pain or headaches, paracetamol and anti-inflammatory painkillers work best.

If the pain is caused by sensitive or damaged nerves, as is the case with shingles or sciatica, it is usually treated with tablets that are also used for epilepsy and depression. These tablets change the way the central nervous system works.

The aim of taking medication is to improve your quality of life. All painkillers have potential side effects, so you need to weigh up the advantages of taking them against the disadvantages.


Paracetamol is used to treat headaches and most non-nerve pains. Two tablets of paracetamol up to four times a day is a safe dose for adults. Side effects are not common and this dose can be taken regularly for long periods.

Overdosing on paracetamol can cause serious side effects, however, so don't be tempted to increase the dose if your pain is severe.

If the pain lasts for more than three days, see your GP.


So-called non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, diclofenac and naproxen, seem to work better when there is clear evidence of an inflammatory cause, for example arthritis or an injury.

They should not be used for a long period unless you have inflammation. If you take them for long periods, there's an increased risk of stomach upset, including bleeding, and kidney and heart problems. Don't take more than the recommended dose as this will increase the risk of serious side effects.


Aspirin produces the same type of side effects as other NSAIDs, but is not as effective as a painkiller, which means it's not usually prescribed for pain. It is dangerous for children under 12.


Codeine doesn’t work very well on its own. It works better when combined with paracetamol in a single pill. You can buy co-codamol (paracetamol and low-dose codeine) over the counter. Higher dose codeine has to be prescribed.

Other medium-strength prescribed painkillers include tramadol (Zydol) and dihydrocodeine.

All these painkillers can cause dependency, which means that when you stop taking them you may feel unwell for a short period. If you need more and more of these drugs, contact your GP or other healthcare professional for advice.

Amitriptyline and Gabapentin

Amitriptyline is a drug for depression and gabapentin is a drug for epilepsy. Each of these tablets can also be used to treat pain caused by nerve sensitivity or nerve damage, such as shingles, diabetes nerve pain and sciatica. You don’t have to have depression or epilepsy for these tablets to help your nerve pain.

Amitriptyline and gabapentin both have to be prescribed by a GP. Side effects include drowsiness and dizziness.


Morphine and morphine-like drugs (for example, oxycodone, fentanyl and buprenorphine) are the strongest painkillers there are. Some come as a patch, but they all work in similar ways and should only be used for severe pain.

They will only be prescribed after consultation with your GP or a pain specialist. The dose and your response will be closely monitored. These drugs should only be used as part of a long-term plan to manage your pain.

Read about the NHS help on offer if you have persistent pain.

Page last reviewed: 18/03/2012

Next review due: 18/03/2014


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The 12 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Linnex said on 22 April 2014

If it joint or muscle pain then try Linnex Heat Stick. It provides a warming effect which lasts hours.

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ses101 said on 10 November 2013

No painkillers have worked for me. I'd like to try hypnotherapy or specialist physio for my pelvic nerve pain, but I would have to pay and, as my benefits got stopped two years ago and I still can't work, I am snookered.

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Bigb94 said on 05 February 2013

This page would be useful if GPS were actually willing to prescribe them. They're so afraid of people becoming addicted that they refuse people in chronic pain any help, thinking they're preventing this from happening, but all it does is force desperate people to search for alternative sources of pain relief

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Sophisticated Penguin said on 31 January 2013

Jt42, the standard adult dose of paracetamol is 1 g (usually as two 500 mg tablets). As mentioned in the article, 4 such doses can be taken (at regular intervals) over a 24-hour period. But I am not a medical professional - people should check the information leaflet inside the pack if they're not sure, or check with a pharmacist or doctor.

It would have been better if the author of the article had specified an actual dosage - it is not sensible to refer to 'tablets' as tablet strengths can vary.

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jt42 said on 05 November 2012

The article doesn't specify what dosage is ok for paracetamol -but only "2 tablets up to 4 times a day" - any ideas what's safe?

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TallulahA said on 09 July 2012

I was prescribed the lowest dose of amitriptyline for headache. I asked three doctors about whether this was a good idea and all said it was better than taking painkillers which did not work consistently. Although it reduced the frequency of the headaches, I was advised to increase the dose to try to get rid of them completely. When I did this I lost my temper very badly at work. It felt like I had extra bad PMT. Then it dawned on me what was going on and I rang the local pharmacy who told me that amatriptyline type medication does not give you normal sleep and that this can happen. I later found that a male colleague had had the same problem. There was no warning about this from the doctors or on the information that came with the tablets. If I had been aware of this I would have tried the medication but understood what was happening to me and stopped before it was too late.

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chalkie247 said on 25 June 2012

Does anyone know of any pain killer that works as well as a 30g codeine dosage (current scrip is for solpadol), but without the drowsiness of an opiate?

My partner has recently had two teeth extracted and is in some considerable pain, but as a mechanic, being drowsy is not an option. His company do not offer company sick pay and we can't afford for him to earn only SSP!!! Bit of a night mare really!!!

Any help anyone can offer will be gratefully received!


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B4mbi85 said on 17 May 2010

Trout48, it sounds like sacroiliac joint pain, my bf has the same problem and the same incorrect diagnosis :S hope this helps :)

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barb1607 said on 27 March 2010

I have just passed a kidney stone a week ago now but I am left with what the doctor has said is sciatica which gets worse in evenings and mornings. I have been in constant pain now for 3 weeks with the kidney stone pain and now this and I cannot take much more what can I do to get rid of this pain?

I am returning to work next week as I am so fed up being off and having no life. I was told to rest this week which I have been doing but reading on here it says exercise is best so now I am confused? Have i made things drag on as I have done nothing but rest this week? I feel I have no life it is making so depressed being stuck in doors...Can anyone offer and advice????please

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Anxious Loser said on 03 February 2010

Is Tramadol dangerous? It is an opiod and I have heard many people are addicted. Is it harmful in long term use to patients with high blood pressure ?

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Jarileigh said on 17 December 2009

Is the pain in both legs? Is the pain one-sided? Is it in the front or the back? What type of pain: sharp, dull, aching, stabbing? How long has it been going on, and when was the onset? Was the onset sudden or gradual? I may be able to give you some educated guesses, but I just need more information. Hope you feel better :)

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trout48 said on 20 August 2009

i have been told by my gp i have sciatica, but on reading things on this site i am not having the same symptoms? i have pain in my groin and legs and hip but def not in my back can anyone help please, thanks

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