Easy-to-read information about pain relief medications.
Types of pain relievers
Pain relievers can be grouped as:
- Simple pain relief such as paracetamol.
- Non-steroidal anti-inflammatories (NSAIDs), such ibuprofen, diclofenac, naproxen.
- Non-steroidal anti-inflammatories (NSAIDs) COX-2 inhibitors, such as etoricoxib, and celecoxib.
- Opioids, such as morphine, codeine, tramadol, oxycodone.
- Steroids such as triamcinolone are used to treat pain associated with inflammation (swelling and redness).
What are the differences?
Pain relievers that simply relieve pain such as paracetamol and opioids, are called analgesics. Pain relievers that act by reducing inflammation are called non-steroidal anti-inflammatories (NSAIDs).
- Analgesics work by reducing the pain signals at the level of the nerves and brain.
- Anti-inflammatories work by blocking the cyclo-oxygenase (COX) enzymes, which reduces inflammatory pain. These enzymes are important in the body's inflammation reaction (COX-2 enzyme), but also in maintaining the protective lining of the stomach (COX-1 enzyme). Older NSAIDs block both types of COX enzyme. Newer COX-2 inhibitors block just the inflammation pathway and not the stomach's COX=1 enzyme.
- Steroids reduce swelling and inflammation.
Which pain reliever?
The choice of pain relief medication can depend on many factors such as:
The type of pain
- Pain following injury, such as sprains and strains, can often be helped with over-the-counter NSAIDs such as ibuprofen.
- Pain from the inflammation of arthritis is usually best helped by NSAIDs, although the over-the-counter preparations of ibuprofen or aspirin may not be strong enough and you may need a prescription from the doctor.
- Non-inflammation pains, such as headache, may be best helped with paracetamol, and paracetamol can often be helpful in people with longstanding pain from neck or back trouble.
- Many people with long term arthritis find paracetamol helpful in addition to NSAIDs.
The severity of the pain
Pain severity is usually grouped into mild pain, moderate pain or severe pain. Paracetamol and NSAIDS are usually used to treat mild to moderate pain, while opioids are reserved for moderate to severe pain.
Any medical conditions that you may already have
Some types of pain medication can worsen some medical conditions and should be avoided. For example NSAIDS can make stomach ulcers worse and should be avoided in people who have a history of stomach ulcers.
Medications that you may be already taking
Before taking medication for pain relief, it is important to consider if these may interact with medications that you are already taking for another condition.If you are unsure about potential interactions, check with your doctor or pharmacist.
What are the main benefits of paracetamol?
- Paracetamol is a very effective pain reliever for many types of pain that are not directly caused by inflammation such as neck pain, back pain and headache.
- It has the advantage of avoiding any of the stomach side effects associated with other medications.
- It will not affect the kidneys.
What are the risks of paracetamol?
- The main risks of taking paracetamol are to the liver, if taken in overdose.
- An excess of paracetamol can cause severe liver damage.
- Accidental overdose is a risk because many different products such as cold and flu medication, contain paracetamol, so if taking more than one medication make sure you check the label for ingredients.
- Read more – paracetamol information sheet.
What are the main benefits of NSAIDs?
- NSAIDs are most effective in people with inflammatory pain.
- This includes almost any form of arthritis (including gout), period pain and injuries such as sprains or strains.
- Some people find one form of NSAID more effective than another so it is worthwhile trying different ones to find the one that is best for you.
- NSAIDs usually require a prescription, although some are available over-the-counter in smaller doses (eg, ibuprofen, diclofenac) and limited quantities for purchase.
What are the main risks of NSAIDs?
- The main risks of taking NSAIDs include gastrointestinal problems such as indigestion and nausea. There is also a risk of stomach ulcers. Most people, however, find they tolerate NSAIDs well with good relief of their pain.
- Also extra care is needed if you have high blood pressure, high cholesterol, diabetes, your kidneys do not work very well, you smoke, have cardiovascular disease (heart disease), or have vomiting and diarrhoea.
- NSAIDs increase the chance of a heart attack or stroke, either of which can lead to death. These serious side effects can occur as early as the first weeks of using an NSAID and the risk may increase the longer you are taking an NSAID.
- The risk appears greater at higher doses; use the lowest effective amount for the shortest possible time.
What are the main benefits of opioids?
- Opioids are very effective drugs for the management of severe pain.
- They do not cause stomach ulcers or bleeding.
What are the main risks of opioids?
- All opioids, however, have potential long term addiction problems, and may cause problems of drowsiness, nausea, itching and constipation.
- Opioids can cause severe constipation which can be very uncomfortable and distressing. Ask your health provider to prescribe laxatives while you are taking opioids.
- The short-term use of opioids are effective for acute pain control. The chronic, long-term use of opioids for pain relief must be under strict medical supervision.
What are the main benefits of steroids?
- Steroids can be given either by injection for painful inflammation such as arthritis or tendinitis, or by mouth.
- They are indicated only for people with significant inflammation as the cause of their pain, as steroids are very potent anti-inflammatories, but they do not have any other analgesic or pain-relieving effect.
What are the main risks of steroids?
- Side effects of steroids are often a cause of concern, but if used in small doses for the appropriate reason, side effects such as weight gain, thinning of the skin and easy bruising can be limited.
- It is important though that steroids be used only in situations where the inflammation requires the use of these potent drugs.
What can I do to make sure I'm taking my pain reliever safely and effectively?
- In general, advice given by your prescribing doctor, or on the packaging of over-the-counter medications, can be relied upon to reduce the risks associated with taking these medications.
- It is important to recognise that the risks are small, and do not pose a threat to everyone who uses these forms of pain relief.
- The benefits can only be attested to by the sufferer who finds relief with the use of any of the above medications.