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Pain relief medicines

Also called pain relievers or analgesics

Key points about pain relief medicines

Pain relief medicines are best used for short-term pain usually because of surgery, injury or infection. They are usually only needed for a short time while the injury, surgery or infection is healing.
There are a variety of medicines to relieve pain which can be grouped into different categories, depending on how they work.
The choice of pain relief medicine can depend on many things, including the type, severity and cause of your pain, other medicines you may be taking and other health conditions you may have.

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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's a mostly safe and useful medicine, if it's taken at the correct dose, and can be effective for many different types of pain. For most types of acute or short-term pain, paracetamol is best used when needed – only when you feel pain. However, for some types of chronic or long-term pain, taking paracetamol at regular times (every 6 hours) is likely to be most helpful. Read more about paracetamol.
Non-steroidal anti-inflammatories Ibuprofen Diclofenac Celecoxib Naproxen Ponstan Tenoxicam	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 can be used for short-term pain such as when you have an injury or a flare-up of symptoms. NSAIDs are not suitable if you have stomach problems because they may cause stomach bleeding. They may also not be suitable if you have asthma, heart, liver or kidney problems. Before taking NSAIDs, check with your pharmacist or doctor whether they are suitable for you. NSAIDs are also available as gels or creams that can be massaged onto the painful area. NSAIDs may not be useful for chronic or long-term pain as they treat inflammation and this is not often the cause of chronic pain. If they are used long-term they can have harmful side effects. If long-term NSAIDs are thought to be your best option, you will need to have blood tests and regular check-ups with your doctor. Read more about NSAIDs.
Opioids Codeine Tramadol Morphine Oxycodone	Opioids can be used for moderate-to-severe short-term pain such as after an injury or surgery, or for ongoing pain due to cancer. They're not recommended for other types of ongoing pain such as nerve pain because they don’t greatly improve pain levels or help you to be able to do the things you want to do. For about 20–30% of people, they can cause unpleasant side effects, such as constipation, nausea, dizziness and sleepiness. Ongoing use can lead to dependency and addiction. Codeine, dihydrocodeine and tramadol are weaker opioids for moderate pain, while morphine and oxycodone are used for more severe pain.
Steroids Prednisone Triamcinolone Dexamethasone	Some steroids are used for pain relief by reducing swelling and inflammation when other pain relievers are not effective alone or are not suitable. They may provide short-term pain relief, but do not improve joint function or stiffness. They are most useful for treating flare-ups of pain. These types of steroids may be given as tablets or an injection directly into a painful joint.
Antidepressants Amitriptyline Nortriptyline	Tricyclic antidepressants are usually used to treat depression but low doses can relieve some types of chronic pain such as nerve pain. They have also been found to improve sleep and help with relaxation. To work effectively, tricyclic antidepressants must be taken every day, even when you do not have pain. Taking them only when you need pain relief will not work as well. Your doctor will start you on a low dose and increase the dose slowly if you need it. Antidepressants do not start working immediately — it can take a few days for you to notice the pain relief effects. If tricyclic antidepressants help your pain, you can continue to take them for as long as you need to, but do not take any more than the amount prescribed without talking to your doctor first. If you do not feel any improvement in your pain after 6–8 weeks, speak to your doctor. Many people experience side effects with tricyclic antidepressants, including drowsiness, constipation and dry mouth. If these are troublesome, talk to your doctor.
Gabapentinoids Gabapentin Pregabalin	Gabapentin and pregabalin can provide pain relief in some people with nerve pain. They do not work for everyone. To work effectively, gabapentinoids must be taken every day, even when you do not have pain. Taking them only when you need pain relief will not work. Your doctor will start you on a low dose and increase the dose slowly, to allow your body to get used to the medicine. It can take a few weeks for you to notice the full pain relief effects of gabapentinoids. If gabapentinoids help your pain, you can continue to take them for as long as you need to. If you do not feel any improvement in your pain after 6–8 weeks, speak to your doctor. Do not stop taking these suddenly without your doctor's advice.
Muscle Relaxants Orphenadrine	Orphenadrine is also called Norflex®. It may be helpful for short-term use when pain is related to muscle spasms but has harmful side effects when used on an ongoing basis.

What is acute pain?

Acute pain usually occurs because of surgery, injury or infection, such as a dental infection or bone fracture (break). It often comes on quickly, lasts for a short time and goes away as the underlying cause resolves. 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.

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. Read more about paracetamol and 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. Read more about opioids.

Image credit: Courtesy of BPAC(external link)

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 tricyclic antidepressants (amitriptyline, nortriptyline) and gabapentinoids (gabapentin, pregabalin).
If these medicines help your pain, you can continue to take them for as long as you need to. If you do not feel any improvement in your pain after 6–8 weeks, speak to your doctor.
Read more about nerve pain.

Chronic pain, also called persistent pain or long-term pain, is pain that lasts longer than 3 months. It is often described as pain that does not go away as expected after an injury or illness.

Chronic pain is thought to occur when nerves become over-sensitive and send warning messages to your brain even when there is no injury, or the original injury causing pain has healed. In other words, the fire has been put out, but the fire alarm is still going off.
Chronic pain is complex and can be difficult to treat. The aim of treatment is to find ways to support you and reduce the impact of the pain on your life.
Medicines generally, and opioids in particular, are often not very effective for chronic pain because they do not greatly improve chronic pain levels or help you to be able to do the things you want to do. However, medication can be used in some situations alongside other strategies, such as physiotherapy, exercise, diet, relaxation, different ways of thinking and responding to pain (mindfulness and cognitive behaviour therapy), or other non-medicine treatments such as electrical stimulating techniques (TENS machine) and acupuncture.
Read more about chronic pain and medicines for chronic 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, so 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.

All medicines have side effects and risks. Sometimes the risks may be small and the benefit to your health may outweigh the risks, while in other cases the risks may be a problem and other medication may be safer. The best choice depends on your situation and the advice of your healthcare professional. Below is a list of the benefits and risks of different pain relief medicines.

Paracetamol

Benefits and risks
Benefits Paracetamol is a very effective pain reliever for many types of pain such as neck pain, back pain and headache. It avoids the stomach side effects that happen with some other pain relief medications. It will not affect your kidneys. Risks The main risk of taking paracetamol is to your liver if you take too much. Too much paracetamol can cause severe liver damage. Accidental overdose is also a risk because many other medicines, such as cold and flu medicines, have paracetamol in them. Make sure you check the label of any cold and flu medicines for ingredients or ask your pharmacist about this. Read more about paracetamol.

Benefits and risks

Benefits

Paracetamol is a very effective pain reliever for many types of pain such as neck pain, back pain and headache.
It avoids the stomach side effects that happen with some other pain relief medications.
It will not affect your kidneys.

Risks

The main risk of taking paracetamol is to your liver if you take too much. Too much paracetamol can cause severe liver damage.
Accidental overdose is also a risk because many other medicines, such as cold and flu medicines, have paracetamol in them. Make sure you check the label of any cold and flu medicines for ingredients or ask your pharmacist about this.
Read more about paracetamol.

Non-steroidal anti-inflammatory drugs (NSAIDs)

Such as ibuprofen, diclofenac, naproxen and celecoxib.

Benefits and risks
Benefits NSAIDs are most effective if you have inflammatory pain. This includes arthritis (including gout), period pain and injuries such as sprains or strains. Some people find one type of NSAID better than another, so you may need to try different ones to find the one that is best for you. NSAIDs usually need a prescription, but some you can buy over the counter in smaller doses (eg, ibuprofen, diclofenac). Risks The main risks of taking NSAIDs are gastrointestinal problems like indigestion and nausea. There is also a risk of stomach ulcers. Most people can take NSAIDs and get good relief of their pain. Extra care is needed if you have high blood pressure, high cholesterol, diabetes, if 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. These serious side effects can happen even in the first weeks of using an NSAID and can increase the longer you take it. The risk appears greater at higher doses, so use the lowest effective amount for the shortest possible time. Read more about NSAIDs.

Benefits and risks

Benefits

NSAIDs are most effective if you have inflammatory pain.
This includes arthritis (including gout), period pain and injuries such as sprains or strains.
Some people find one type of NSAID better than another, so you may need to try different ones to find the one that is best for you.
NSAIDs usually need a prescription, but some you can buy over the counter in smaller doses (eg, ibuprofen, diclofenac).

Risks

The main risks of taking NSAIDs are gastrointestinal problems like indigestion and nausea. There is also a risk of stomach ulcers. Most people can take NSAIDs and get good relief of their pain.
Extra care is needed if you have high blood pressure, high cholesterol, diabetes, if 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.
These serious side effects can happen even in the first weeks of using an NSAID and can increase the longer you take it. The risk appears greater at higher doses, so use the lowest effective amount for the shortest possible time.

Opioids

Such as morphine, codeine, tramadol and oxycodone.

Benefits and risks
Benefits Opioids are very effective for treating severe pain. They do not cause stomach ulcers or bleeding. Risks All opioids can have long-term addiction problems and can cause drowsiness, nausea, itching and constipation. Severe constipation can be very uncomfortable and distressing. Ask your healthcare professional to prescribe laxatives while you are taking opioids. The short-term use of opioids is effective for acute pain control. The long-term use of opioids must be carefully monitored by your doctor. Read more about opioids.

Benefits and risks

Benefits

Opioids are very effective for treating severe pain.
They do not cause stomach ulcers or bleeding.

Risks

All opioids can have long-term addiction problems and can cause drowsiness, nausea, itching and constipation.
Severe constipation can be very uncomfortable and distressing. Ask your healthcare professional to prescribe laxatives while you are taking opioids.
The short-term use of opioids is effective for acute pain control. The long-term use of opioids must be carefully monitored by your doctor.

Steroids

Such as prednisone and triamcinolone. These may be given as tablets or an injection directly into a painful joint.

Benefits and risks
Benefits Steroids can be given either by injection, for painful arthritis or tendinitis, or as tablets. They are best used when inflammation is the main cause of pain. They are potent anti-inflammatories, but they do not have any other pain-relieving effect. Low doses of steroids may give relief from pain and stiffness for people with conditions such as rheumatoid arthritis. Short-term use of higher doses may help you with a severe flare-up of arthritis. Risks Side effects such as weight gain, thinning of your skin and easy bruising can happen with high doses and long-term use (for a few months to several years) of steroids, but if used in small doses or for a short time, these side effects are less likely.

Benefits and risks

Benefits

Steroids can be given either by injection, for painful arthritis or tendinitis, or as tablets.
They are best used when inflammation is the main cause of pain. They are potent anti-inflammatories, but they do not have any other pain-relieving effect.
Low doses of steroids may give relief from pain and stiffness for people with conditions such as rheumatoid arthritis. Short-term use of higher doses may help you with a severe flare-up of arthritis.

Risks

Side effects such as weight gain, thinning of your skin and easy bruising can happen with high doses and long-term use (for a few months to several years) of steroids, but if used in small doses or for a short time, these side effects are less likely.

Non-medicine treatments for pain
Opioid medicines overview
Paracetamol
Paracetamol and codeine
Pain topics
Types of pain
Ways to describe and document your pain
Where is your pain?
Chronic pain | Mamaenga roa
Nerve pain
Pain management apps