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Pain relief for adults

There are three main types of pain-relief medicines for adults (age 18 and older): paracetamol, anti-inflammatories (NSAIDs), and opioid pain relievers.

Paracetamol

Paracetamol is easy to buy from a pharmacy or supermarket, without prescription. Because it is so common, many people underestimate how effective it can be. But as long as you take it at the correct dose it is safe and works well to relieve pain.

The usual dose of paracetamol for adults is two 500 mg tablets every four to six hours, but no more than eight tablets over 24 hours. At this dose, paracetamol is safe, but if you take more it can cause permanent damage to your liver.

Many combination products, such as cold and flu medicines, contain paracetamol. If you take these at the same time as a full dose of paracetamol, you may take an overdose.

You can buy small amounts of paracetamol with low-dose codeine, which is an opioid pain reliever (see below), from a pharmacist. This can help with more severe pain.

Anti-inflammatories (NSAIDs)

Ibuprofen, naproxen, and diclofenac are all non-steroidal anti-inflammatory drugs (usually called NSAIDs). Although they are often very effective for pain, they do have significant risks and aren't suitable for everyone to take. They are useful for treating pain and conditions where there is some inflammation, such as arthritis or muscle sprains.

If you think you need to take an NSAID regularly for more than a week or two, you should tell your GP. They can assess you to see if you are safe to continue using it, and monitor you for any problems or side effects. You should not take NSAIDs if you have had a stomach ulcer, problems with your kidneys, or heart disease.

Important information about blood pressure, heart medication, and anti-inflammatories

If you take an ACE inhibitor or angiotensin receptor blocker (for example cilazapril, losartan, or candesartan) and a diuretic (for example furosemide or bendroflumethiazide), taking a non-steroidal anti-inflammatory drug (NSAID) (for example ibuprofen or aspirin in high doses) could harm your kidneys. The term for this is "triple whammy". Read The Triple Whammy – Safe use of NSAIDs for more details. Check with your doctor, practice nurse, or pharmacist if you aren't sure whether you are taking an ACE inhibitor or angiotensin receptor blocker and a diuretic.

Opioid pain relievers

Codeine, morphine, oxycodone, and tramadol are strong pain relievers that are available only on prescription, but which can help with more severe pain.

Codeine and tramadol are weaker opioids than morphine and oxycodone.

Opioids are often effective for short-term, severe pain and are useful in palliative care. However, they have several serious side effects if you use them long-term. Generally they become less effective if used for longer than seven days, as your body becomes used to them and needs higher doses for the same effect. This is called tolerance. So it's best to use these medicines for short-term pain, such as after a major injury, rather than for treating long-term, persistent pain.

Becoming addicted to opioid pain relievers (also called dependence) can be a potential problem, but it does not happen to most people. People who have had addiction problems in the past are most at risk of becoming addicted. If you are prescribed an opioid, your GP will need to see you regularly, so they can monitor how well the medicine is working and keep track of any problems.

Other pain relievers

Other medicines, such as some antidepressants and anti-epileptic medications, can be used to treat nerve (neuropathic) and persistent pain.

Pain relief and other medicines

Some pain relief can interact with other medicines that you might take. This can cause reactions, or reduce how well one or other of the medicines work. Always check with a doctor, nurse, or pharmacist before taking pain relief with other medicines.

  HealthInfo recommends the following pages

On the next page: Pain relief after an injury

Written by HealthInfo clinical advisers. May 2017.

See also:

Drug overdose

Medication & treatment for persistent pain

Medications in pregnancy

Pain relief & professional treatment for back pain

Pain relief for long-term joint pain & arthritis

Sources

Page reference: 370908

Review key: HIPRF-370907