What types of painkillers are there?
Most pain-relieving medications fall into one of the following groups:
- Non-opioid analgesics – e.g. paracetamol (widely available over the counter from pharmacies and supermarkets)
- Non-steroidal anti-inflammatory drugs (NSAIDs) – e.g. aspirin, ibuprofen (widely available over the counter); naproxen, diclofenac (only available on prescription)
- Compound analgesics – e.g. co-codamol, which combines paracetamol with a dose of an opioid analgesic such as codeine (compounds containing lower doses of codeine are available over the counter from pharmacies)
- Opioid analgesics – e.g. codeine, tramadol, morphine (only available on prescription).
Usually, your doctor will suggest you try non-opioid analgesics and/or NSAIDs first. If these don’t help, or if you sometimes need stronger pain medications, then compound analgesics will usually be the next step for moderate pain, followed by opioid analgesics for very severe pain. The reason for this approach is that the stronger medications tend to have more side-effects and can sometimes cause dependency.
The drugs covered in these pages will help with the symptoms of pain and/or inflammation but won’t cure arthritis or other long-term pain conditions. Depending on the condition you have, you may need other drugs alongside your pain relief medications to control the disease itself.
You don’t need to wait until your pain is severe to use painkillers. Analgesics often won’t be as effective as they could be if you don’t take them soon enough or often enough. Follow the instructions your doctor gives you or the instructions on the packet.
You can also take painkillers before you exercise so you can carry on without too much discomfort.
What are approved and brand names?
Painkillers may be available under several different names. Each drug has an approved name but manufacturers often give drugs their own brand name too.
Examples of approved and brand names
The approved name should always be on the pharmacist’s label even if a brand name appears on the packaging, but check with your healthcare professional if you’re not sure. We’ll use the approved names in the sections that follow.
Paracetamol is the most common of a group of drugs known as simple non-opioid analgesics.
Paracetamol is available over the counter and is often the first treatment people try for mild to moderate pain, for example following a minor injury, or for headaches and muscular pains. There are limits to the number of tablets you can buy at any one time.
Paracetamol doesn’t have an anti-inflammatory effect, which means it’s usually less helpful for inflammatory types of arthritis such as rheumatoid arthritis. For inflammatory arthritis paracetamol may be taken in combination with a non-steroidal anti-inflammatory drug (NSAID).
How do I take it?
Paracetamol is usually taken in doses of two 500 mg tablets, up to four times a day. It’s also available in a liquid form for children.
Side-effects and risks
Side-effects are rare, though a few people may develop a rash.
Paracetamol can damage your liver if you take more than 4,000 mg (eight tablets) per day. Be aware that many other products, for example cold and flu medicines, also contain paracetamol.
There’s been some concern that long-term use may affect your cardiovascular system and kidneys. Your doctor may suggest stopping it from time to time to see if it’s still necessary and helpful.
Paracetamol must be used in lower doses than usual if you have kidney problems and should be used with caution if you have liver problems or drink a lot of alcohol – speak to your doctor if in doubt.
Compound analgesics are made from a combination of two different drugs – usually a standard painkiller such as paracetamol, aspirin or ibuprofen plus a low dose of an opioid analgesic such as codeine or dihydrocodeine.
Compound analgesics containing low doses of codeine are available over the counter from pharmacists, but stronger ones are only available on prescription.
What are they used for?
You can use them:
- for moderate pain caused by injuries and osteoarthritis
- as an addition to non-steroidal anti-inflammatory drugs (NSAIDs)
- instead of NSAIDs if you can’t take them for any reason.
Side-effects and risks
Normally you’ll be advised not to take medicines containing codeine for more than a few days at a time. This is because they are potentially addictive and hard to stop.
Compounds made from codeine can cause:
- difficulty concentrating.
Older people may be advised to take less than the maximum dose.
Ask your doctor’s advice if you’re pregnant or breastfeeding.
Opioid analgesics can be more effective for pain relief than simple non-opioid analgesics, so they’re used for moderate to severe pain, usually when other analgesics haven’t worked. Pain is considered to be severe if it’s disabling, meaning it interferes with your daily life and/or you have to take more frequent rests or can only walk or move awkwardly.
Commonly used opioids include codeine, morphine and tramadol.
Opioid analgesics are only available on prescription from your doctor. This is because they tend to cause more side-effects than simple analgesics and can lead to dependency and addiction. Your doctor will monitor you more closely when you’re taking them.
How do I take them?
Opioid analgesics come in a tablet or patch. Your doctor will advise on which type is best for you depending on:
- how severe your pain is
- your age
- any other medication that you’re taking.
In many cases opioid analgesics are used for short periods of time or alongside other painkillers when necessary. This is to reduce the risk of side-effects and dependency.
Side-effects and risks
The most common side-effects with opioid painkillers are:
- nausea and vomiting (some people are more prone to this than others, but it often settles with time)
- drowsiness and dizziness, which is increased when combined with alcohol – be careful when driving and using electrical equipment
- reduced concentration or confusion
- reduced ability to breathe (respiratory depression) – make sure your doctor knows if you have long-term breathing problems like chronic obstructive pulmonary disease (COPD) or asthma.
If you experience any side-effects, talk to your doctor. All side-effects are more common in older people, so you may be given a lower dose.
Effects on other treatments
Many people with arthritis and other long-term pain conditions will need to take additional medicines. It’s usually fine to take a combination of painkillers and non-steroidal anti-inflammatory drugs (NSAIDs). And depending on the condition you have, you may need other drug treatments as well. For example:
- For inflammatory types of arthritis (e.g. rheumatoid arthritis) you might also need disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate. As the name suggests, these alter the way the condition develops rather than just relieving the symptoms. DMARDs won’t have an immediate effect on your pain, but once they do start to take effect you may be able to reduce your pain relief medications.
- If you have a long-term pain condition such as fibromyalgia or pain resulting from nerve damage then the painkillers described here may be less helpful and your doctor may suggest a low dose of an antidepressant such as amitriptyline (at low doses, this has pain-relieving rather than antidepressant effects) or an anticonvulsant such as gabapentin. Although these are not classified as painkillers they can be helpful for some types of pain.
- If you’re taking medications for other conditions besides your arthritis you should speak to your doctor or a pharmacist about possible drug interactions.
There’s no particular reason to avoid vaccinations if you’re taking painkillers.
It’s usually fine to drink alcohol if you’re taking painkillers.
However, alcohol can sometimes increase the risk of side-effects from your medicines. For example, opioid analgesics can sometimes cause drowsiness or dizziness, which may be worse if you drink alcohol as well. If you’re affected in this way, then it’s a good idea to limit your alcohol intake.
Fertility, pregnancy and breastfeeding
Paracetamol and opioid analgesics may be used during pregnancy.
However, regular or prolonged use is probably best avoided during pregnancy because of a possible increased risk for the baby of wheezing or childhood asthma, or of an undescended testicle in boys.
Paracetamol is considered a good choice if you’re breastfeeding. Caution is advised with drugs containing codeine as its metabolism is unpredictable and there’s a possibility that the baby’s central nervous system (which controls breathing and heart rate) could be affected.
It’s not thought that painkillers are likely to be harmful if taken by men wishing to father a child.