The type of drugs 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 acute back pain or headaches, paracetamol and anti-inflammatory medicines 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 may need to weigh up the advantages of taking them against the disadvantages.
Paracetamol, anti-inflammatories and aspirin
Paracetamol
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. If the pain is severe, do not increase the dose.
If the pain lasts for more than three days, see your GP.
Anti-inflammatories
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. When taken 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
Aspirin produces the same type of side effects as other anti-inflammatories, but is not as effective as a painkiller, which means it is not usually prescribed for pain. It is dangerous for children under 12.
Codeine and other medium-strength painkillers
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 nerve pain.
Amitriptyline and gabapentin both have to be prescribed by a GP. Side effects include drowsiness and dizziness.
Morphine
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.
