Pain management: Pain medications

Over-the-counter painkillers

Over-the-counter (OTC) painkillers include:

• Paracetamol
• Non-steroidal anti-inflammatory drugs ( NSAIDs; aspirin, ibuprofen and naproxen)

Both paracetamol and NSAIDs reduce fever and relieve pain caused by muscle aches and stiffness, but only NSAIDs can also reduce inflammation (swelling and irritation). Paracetamol and NSAIDs also work in different ways. NSAIDs relieve pain by reducing the production of prostaglandins, which are hormone-like substances that cause pain. Paracetamol works on the parts of the brain that receive the "pain messages". NSAIDs are also available in stronger versions than those available over the counter and these can be prescribed by your doctor.

NSAIDs can be unsuitable for some patients, such as those with asthma or stomach ulcers, so if you are not sure if it is safe for you to take NSAID’s, discuss this with your GP first.

Topical pain relievers are also available without a doctor's prescription. These products include creams, gels, lotions or sprays that are applied to the skin in order to relieve pain from sore muscles and arthritis. Some of these gels and creams contain NSAIDs, such as ibuprofen, piroxicam, diclofenac and felbinac. These are absorbed into the bloodstream to some extent, so care is required for asthma and stomach ulcer sufferers.

Prescription painkillers

Prescription painkillers include:

• Corticosteroids
• Opioids
• Antidepressants
• Anticonvulsants (anti-seizure medications)

What are corticosteroids?

Prescription corticosteroids provide relief for inflamed areas of the body by easing swelling, redness, itching and allergic reactions. Corticosteroids can be used to treat allergies, asthma and arthritis. When used to control pain they are generally given in the form of pills or injections.

Prescription corticosteroids are strong medicines and may have serious side-effects, including:

• Weight gain
• Upset stomach
• Headache
• Mood changes
• Trouble sleeping
• Weakened immune system

To minimise these potential side effects, corticosteroids are prescribed in the lowest dose possible for as short a length of time as needed to relieve the pain. Efforts are underway to develop safer corticosteroids.

What are opioids?

Opioids are narcotic pain medications that contain natural, synthetic or semi-synthetic opiates. Opioids are often used for acute pain, such as short-term pain after surgery. Some examples of opioids include:

• Morphine
• Fentanyl
• Oxycodone
• Codeine

Opioids are effective for severe pain and do not cause bleeding in the stomach or other parts of the body, as other types of painkillers such as NSAIDs can. It is rare for people to become addicted to opioids if the drugs are used to treat pain for a short period of time.

Side effects of opioids may include:

• Drowsiness
• Nausea
• Constipation
• Itching
• Breathing problems
• Addiction

What are antidepressants?

Antidepressants are drugs that can treat pain and/or emotional conditions by adjusting levels of neurotransmitters (natural chemicals) in the brain. These medications can increase the availability of the body's signals for well-being and relaxation, enabling pain control for people with chronic pain conditions that do not completely respond to usual treatments.