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There are three main types of pain relievers: nonsteroidal anti-inflammatory drugs (NSAIDS), acetaminophen, and opioids. Every pain reliever works in a different way. Most people only need to take painkillers for a few days or weeks. However, some people need them for a longer period of time. Some painkillers are available at pharmacies without a prescription, including some NSAIDs, acetaminophen, and some weaker opioids (codeine or dihydrocodeine). If you buy painkillers containing weak opioids and you have to take them for longer than three days, you should discuss this with your pharmacist or doctor.
What Are Painkillers?
Painkillers are drugs used to treat pain. There are a large number of pain relievers available, and they all come in different brand names.
They can be taken:
- By mouth as a liquid, tablet or capsule
- Via an injection
- Anal in the form of a suppository
Some pain relievers are also available as creams, ointments, or patches.
While there are a large number of pain relievers available, there are only three main types of pain relievers (each of which works in a different way). The three main types are:
- Non-steroidal anti-inflammatory drugs (NSAIDS). Examples of NSAIDs are ibuprofen, diclofenac and naproxen. Aspirin is also an NSAID. However, it is mainly prescribed (in low doses) to help prevent blood from clotting - for example, for people who have had a heart attack in the past.
- Weak opioids and strong opioids (also called opiates). Examples of weak opioids are codeine and dihydrocodeine. Although often described as 'weak opioids', they are highly effective pain relievers and are often used to treat severe pain. However, they can also lead to addiction and negative effects, so they should certainly not be underestimated. Examples of strong opioids include morphine, oxycodone, and pethidine tramadol. Many people who need strong opioids are in hospital.
Different types of painkillers are sometimes combined in one tablet - for example paracetamol plus codeine (co-codamol).
In addition to the above, some antidepressants and anti-seizure medications such as Lyrica can be used to treat neuropathic pain. However, the rest of this article does not address these types of medicines. You can find more information about this on this page.
How do painkillers work?
NSAIDs work by blocking (slowing down) the effect of chemicals (enzymes), the so-called cyclo-oxygenase (COX) enzymes. COX enzymes help make other chemicals called prostaglandins. Some prostaglandins are involved in the production of pain and inflammation in areas of injury or damage. Reduction in prostaglandin production reduces both pain and inflammation. Not all NSAIDs are exactly the same and some work in a slightly different way.
Paracetamol is a pain reliever that nobody knows exactly how it works. It is also thought to work by blocking COX enzymes in the brain and spinal cord (central nervous system). Paracetamol is used to treat pain and to lower a high temperature. However, it doesn't help with inflammation.
Opioids work by binding to certain receptors (opioid receptors) in your central nervous system, your intestines, and other parts of your body. This leads to a decrease in the way you feel pain and your response to pain. In addition, it also increases your tolerance to pain.
Which pain reliever is usually prescribed?
The type of pain reliever your doctor will prescribe will depend on:
- The type of pain you have
- Any other health problems you may have
- How severe your pain is
- The possible side effects of the pain reliever
Paracetamol is normally prescribed if your pain is not too severe and you do not have inflammation.
NSAIDs are generally prescribed for people who have pain and inflammation - for example, if you have pain in your joints (arthritis) or muscles (back pain). This is because some inflammation is likely to be present and NSAIDs work well to treat both pain and inflammation. NSAIDs have a number of possible side effects and are not suitable for everyone. For example, they are not suitable for people who have or have had stomach ulcers. In this case, a doctor can prescribe a safer medicine (paracetamol), even if it does not always work well. NSAIDs can be used in heat and ice treatment for joint, muscle or ligament injuries.
Weak opioids are usually prescribed for more severe pain, or if you have tried paracetamol and / or ibuprofen and they have not worked.
Stronger opioids are normally used to treat severe pain - for example, cancer-related pain, pain after surgery, or if you have had a serious injury.
Anti-inflammatory medicines used as creams (topical pain killers) are mainly used to treat pain in your soft tissues and muscles.
How should I take painkillers?
People who are in constant pain are usually advised to take painkillers regularly. For example, if you are prescribed acetaminophen, you will normally take it four times a day, every day until the pain subsides. Otherwise, you only need to take painkillers when you need them.
If you are taking an NSAID such as ibuprofen or diclofenac, take it with or after food. This is because they can irritate the lining of your stomach and sometimes cause bleeding in your stomach.
What is the usual duration of treatment?
Like all medicines, pain killers should be taken for as short a time as possible. It is best to start with the lowest dose. This is to help prevent any side effects. Most people only need to take painkillers for a few days (for a toothache, for example) or weeks (after a muscle strain). However, some people have painful conditions and need to take painkillers for a long time. Examples include people with rheumatoid arthritis, osteoarthritis or chronic back pain.
What are the possible side effects?
It is not possible to list all possible side effects of each pain reliever in this article. However, as with all medicines, there are a number of side effects that have been reported with each of the different painkillers.
Most people who use anti-inflammatory drugs have no or only minor side effects. When taken properly, the benefit usually far outweighs the potential harm. In particular, many people take a short course of an anti-inflammatory for a variety of painful conditions. However, side effects and sometimes very serious possible side effects can also occur. This includes bleeding in the stomach and intestines and cardiovascular problems.
This is a safe medicine and side effects are rare if you do not take more than the recommended maximum dose. However, paracetamol can be very dangerous if you take it too much. Paracetamol overdose can happen accidentally, but some people take an acetaminophen overdose on purpose. The main problem with taking an acetaminophen overdose is that it can permanently damage your liver and cause you to die.
The most common side effects are:
- Being sick (nausea and vomiting) - especially at the beginning of treatment
- A dry mouth
Opioids can also cause drowsiness and confusion. Some people may develop tolerance to opioid painkillers (they need more and more to get the same effect). This can make them dependent. This also applies to opioids that are for sale in pharmacies. If you think you are dependent on opioids and you have to keep taking higher doses, talk to your pharmacist or doctor.
Some painkillers can interact with other medications. This can cause reactions or reduce the effectiveness of any of the treatments. So, when you are prescribed a pain reliever, tell a doctor if you are taking any other medicines.
Where can I buy painkillers?
You can buy a variety of painkillers from a regular pharmacy without a prescription, including acetaminophen and some NSAIDs (for example, ibuprofen, aspirin, and servroxen). Weaker opioids, such as codeine, can be purchased in our online pharmacy. It is only possible to purchase a few days supply of the weaker opioid combination tablets. If you need to take it for more than three days, you should discuss this with your doctor or pharmacist.
This includes weaker opioids that are not prescribed in combination with acetaminophen - most NSAIDs (e.g. indometacin or diclofenac), as well as stronger opioids (e.g. morphine, diamorphine and tramadol) and opioid patches.
Who Can't Take Painkillers?
It is rare for someone to be unable to take some type of pain reliever. The main reason you may not be able to take a pain reliever is if you have had a serious side effect or allergic reaction to a particular type of pain reliever in the past. Even if this happens, your doctor will usually be able to prescribe a different type of pain reliever for you to use.
Aspirin cannot be taken by children under 16 years of age as there is a risk that the child will develop Reye's syndrome (very rare).