Pain relief medications

Also called painkillers or analgesics

Easy-to-read information about pain relief medications.

Medications for pain or pain relievers can be grouped into different categories, depending on how they work. The following is a summary of the common pain relievers. 

Types of pain relievers 

Common pain relievers Description
Paracetamol Paracetamol is used to treat mild-to-moderate pain.
  • It acts mainly in your brain and has an effect on many different ways you feel pain.
  • It is a mostly safe and useful medicine if it is taken at the correct dose, and can be effective for many different types of pain.
  • Read more about paracetamol.
Non-steroidal anti-inflammatories 
 NSAIDs are used to reduce mild-to-moderate pain and inflammation (swelling).
  • They work by blocking and reducing enzymes and hormones that cause pain and swelling in your body.
  • NSAIDs are not suitable if you have stomach problems because they may cause stomach bleeding. They may not be suitable if you have asthma, heart, liver or kidney problems. Before taking NSAIDs, check with your pharmacist or doctor if they are suitable for you.
  • They are also available as gels or creams that can be massaged onto the painful area.
  • Read more about NSAIDs.
COX-2 inhibitors
  • celecoxib
  • etoricoxib
 These are a type of NSAID.
  • They also reduce pain and inflammation but may be less harmful to your stomach.
  • They may not be suitable if you have heart, liver or kidney problems.
 Opioids Opioids are effective in treating moderate-to-severe pain.
  • These work by reducing pain signals in your nerves and brain.
  • Codeine is a weaker opioid for moderate pain, while morphine and oxycodone are used for severe pain.
  • Long-term use of opioids can lead to dependency, which means you will find it hard to live without them, and, in some people, this can lead to addiction.  

Other types of medicines used to relieve pain

There are other medicines that are used to relieve pain. They may be used when the pain relievers above are not effective alone or are not suitable. For example, some antidepressants and anti-epileptics can be used for nerve pain. Steroids are used to reduce swelling and inflammation. Steroids may be given as tablets or an injection directly into a painful joint.

Some examples are:

Which pain reliever?

The choice of pain relief medication can depend on many things, such as the type, severity and cause of your pain, other medications you may already be taking, any allergies you may have, and other conditions you may have.

Type of pain

Acute pain

Acute pain usually occurs because of injury, such as dental infection, bone fracture or surgery. This pain can be severe but mostly gets better quickly, within days or weeks. Treatments usually only need to be given for a short time while the injury is healing.

  • Paracetamol and NSAIDs are commonly used.
  • Opioids are useful and usually only need to be given for a few days. The dose of opioid should be reduced as healing occurs.
  • Read more about acute pain.
Chronic pain

Chronic pain can begin with an injury that doesn’t get better as expected. Common examples of chronic pain include lower back pain and pain related to arthritis. Chronic pain is difficult to treat. Most treatment options are only helpful for about 1 in 3 patients. 

  • Medicines generally, and opioids in particular, are often not very effective for chronic pain. 
  • Other non-medicine treatments may be effective, such as electrical stimulating techniques (TENS machine), acupuncture, appropriate activity,  increasing physical fitness, and psychological treatments such as cognitive behaviour therapy. 
  • Most treatments aim to help you self-manage your pain and improve what you can do.
  • Read more about chronic pain.
Nerve pain

Nerve pain is a type of chronic pain from an injury to your nerves or nervous system. Types of nerve pain include sciatica from disc prolapse, nerve injury after spinal surgery, pain after infection such as shingles, pain with diabetes, pain after amputation (phantom limb pain or stump pain) and pain with multiple sclerosis or stroke. 

  • Medicines used to treat nerve pain include amitriptyline, nortriptyline, gabapentin and carbamazepine. 
  • Read more about nerve pain.

Severity of the pain

Pain is usually grouped into mild pain, moderate pain or severe pain. The step-wise or ladder approach to managing pain is based on the severity of your pain. It is a 3-step approach.

  • Step 1: Mild-to-moderate pain
    This type of pain is best treated with paracetamol, ibuprofen and other NSAIDs.
  • Step 2: Moderate-to-severe pain
    More intense pain is treated with mild opioid pain relievers such as codeine and tramadol. These may be used together with paracetamol or NSAIDs.
  • Step 3: Severe pain
    Severe pain is treated with strong opioids such as morphine and oxycodone. These may be used together with paracetamol or NSAIDs.

Cause of the pain

Depending on the cause and site of your pain, you may need to use other things to ease the pain.

  • Muscle sprain may be relieved by R.I.C.E. (rest, ice, compression and elevation).
  • Pain caused by indigestion may be relieved by antacids.
  • People with a migraine headache may need to take triptan medicines, which are a special type of painkiller for migraine headaches. They're thought to work by reversing the changes in the brain that may cause migraine headaches.

Read more: where’s your pain?

Medical conditions 

Some types of pain medication can worsen some medical conditions and should be avoided. For example, NSAIDS can make stomach ulcers worse and if you have a history of stomach ulcers, you should avoid them. NSAIDs must also be used with caution by older adults, and people with heart disease, type 2 diabetes or kidney problems.

Medications you are taking

Before taking medication for pain relief, it is important to ask if these may interact with medications that you are already taking for another condition. If you are unsure, check with your doctor or pharmacist.

Allergies

Some allergies may prevent you from taking certain types of pain relief medicines. For example, NSAIDs can cause allergic reactions in some people. Soon after taking the medicine, you may develop flushing, itchy rashes (hives), blocked and runny nose and asthma (sometimes severe). If you have had hives (urticaria), nasal polyps or asthma, your risk of NSAID allergy is much higher compared to people without these conditions. 

What can I do to make sure I'm taking my pain reliever safely and effectively?

Ask your doctor or pharmacist for advice, or read the packaging of over-the-counter medicines, to reduce the risks of taking these medications. You can also compare the benefits and risks of commonly used painkillers.

Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 27 Oct 2017