Paracetamol is no longer recommended for back pain, so when do painkillers work best and what do you need to know about taking them?

Painkillers

Pain’s job is to warn and protect us, but it sometimes feels more like the enemy. As well as producing unpleasant sensations (musculoskeletal, dull or cramping internal organ pain and nerve damage), how bad it feels can vary with activity, posture, digestion or stress levels.

Weighing up the pros and cons, including non-drug options (see box, right), can find the best solution for you – whether it’s tablets, liquid, patches or injections. If you’re planning to be or are pregnant, are taking other medicines, or have other conditions (including heart/lung/kidney/liver disease, indigestion or raised blood pressure), check with your GP or pharmacist before taking new medication.

Over-the-counter/prescription drugs

Paracetamol reduces fever as well as many types of pain such as tension or migraine headaches, strains, sprains, toothache, period pain, arthritis or post-operative pain (although NICE, the National Institute for
Health and Care Excellence, no longer recommends it for back pain).

It is often combined with other painkillers, caffeine, or cold remedies; make sure you stick to the recommended dose for your age/size, as even a small overdose can be fatal.

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are a good option, but can cause stomach irritation, wheezing or kidney damage, and have been linked to a higher risk of cardiac arrest, so seek medical advice if you need them for more than two or three days. NSAID rub-in gels often work well, with fewer side effects.

Prescription-only painkillers

Codeine and tramadol are both morphine-derived painkillers that can be prescribed alone or with NSAIDs/paracetamol. They can be effective for moderate to severe pain, but can cause drowsiness, nausea, constipation or dizziness. Morphine, and similar-strength drugs such as fentanyl and oxycodone, are used for severe pain, eg, broken bones.

Their side effects are stronger, too, and, like codeine and tramadol, they can be addictive, but are safe if monitored carefully.

Neuralgia

This is caused by nerve damage/malfunction, eg, a trapped nerve (such as sciatica), after shingles (post-herpetic neuralgia), after an injury/surgery, or conditions such as trigeminal neuralgia – spasms of facial pain. Regular doses of the antidepressant amitriptyline, or epilepsy drugs such as carbamazepine and gabapentin, can block pain signals so the brain doesn’t feel them, as can capsaicin cream, which is derived from peppers.

10 Non-drug options

1 Finding the underlying cause  – getting a diagnosis may lead to a cure (eg, surgery).

2. Putting up with it – only if the cause isn’t serious or progressive and you can manage with occasional painkillers.

3. Keeping a pain diary (what helps, how your pain is affected by food, activity, sleep and mood) can give hints as to the best way to prevent/relieve pain.

4. To relieve an acute injury, rest, an ice pack, a support bandage and elevating the affected part can help.

5. A TENS (transcutaneous cutaneous electrical nerve stimulation) machine, which delivers electrical impulses via pads on the skin, can help.

6. Anaesthetic injections (such as an epidural for back pain) or nerve-blocks for cancer pain.

7. Exercise boosts feel-good endorphins, while physiotherapy can strengthen supportive tissues, and relieve musculoskeletal pain, including arthritis.

8. Heat – a warm bath, hot-water bottle or heat pad can block nerve signals (but be careful not to burn yourself).

9. Relaxation techniques such as mindfulness, cognitive behavioural therapy (CBT), a pain management programme, or joining a support group can reduce your pain’s impact.

10. Find more information and advice at britishpainsociety.org.