Types of pain medicines

Paracetamol

Paracetamol is used for pain relief and to reduce temperature. They are available to buy.

Anti-Inflammatories

Anti-Inflammatories are sometimes known as Non-steroidal anti-inflammatory drugs  (NSAIDS).

They are used for pain relief, to reduce swelling and to reduce temperature. Some are available to buy.

Examples include ibuprofen, naproxen, diclofenac.

Opioids

Opioids are used for moderate to severe acute pain.

Examples include codeine, co-codamol, morphine, oxycodone.

Most opioids are prescription only, 

Adjuvants

Adjuvants are medicines used to treat nerve pain. They include gabapentin, which was designed to treat epilepsy and other medicines that were designed as antidepressants but were found to have a pain benefit.

Examples include amitriptyline and duloxetine.

Other things people use to help their pain

Some people may choose to try vitamins and supplements. Evidence around benefit in pain reduction is limited. If you do take any, make sure to inform your healthcare professional.

Medicines in acute pain

Most pain medicines can be helpful in acute pain depending on the cause of your pain. It is important to follow directions and read the patient information leaflet to check whether they are right for you and what side effects you may experience. Your local community pharmacy may be able to help you through the Pharmacy First Service

Medicines in chronic pain

Medicines can have a role in helping you manage long term pain but we know they are often not as effective. They also have the potential to cause harm through side effects or development of dependency or addiction. They may benefit only a quarter of the people who take them and that benefit will on average be a 30% reduction in your pain and not 100% pain relief that people hope for. This can leave people feeling disappointed or frustrated and thinking their medicine is not working. Your healthcare professionals will work with you to identify the right medicines for you that are effective, and importantly, safe for you to use.

What to expect when starting medicines

When you start a pain medicine it is important to understand the following:

• How they should work and what is the dose
• How long to trial them for and what benefit you should see ·
• What side effects you may experience and how to manage

It should be made clear to you if you are being prescribed medicines that can cause dependency so that you can make a shared decision whether to trial or not. It is important to store pain medicines safely and not share them with friends or family. Get your medicines reviewed at least annually to assess ongoing benefit and risk and return any unused pain medicine to your local pharmacy for destruction.

Problems with pain medicines – balancing benefits and risks

All medicines have the risk of side effects, some more harmful than others. You have to weigh up the benefits of pain relief and function you are getting against the side effects or inconvenience of taking them. Common side effects are noted below but please check the patient information leaflet you receive with your medicines. Some side effects settle after taking the medicine for a few days. If they persist or are causing a problem, discuss with your healthcare professionals.

Pain medicines and pregnancy

Some pain medicines can have an impact on conception and the baby's development during pregnancy. It is important if you are taking pain medication and are considering pregnancy or discover you are pregnant, to seek advice from your GP, Pharmacist, Midwife or Pain Specialist. Seek advice - do not suddenly stop your medicines. Drug Liaison Midwifery support is also available via the midwifery service.

Paracetamol

Most common side effects: Few noted.

Risk of dependency: No

NSAIDS

Most common side effects:

• heartburn/ stomach pain.
• increased blood pressure

Risk of dependency: No

Opioids

Most common side effects:  

• drowsiness
• nausea and vomiting
• constipation
• memory issues

Risk of dependency: Yes

Gabapentinoids

Most common side effects:  

• drowsiness
• nausea 
• memory issues
• headaches
• mood change
• weight gain
• ankle swelling

Risk of dependency: Yes

Antidepressants (e.g. amitriptyline / duloxetine)

Most common side effects:  

• drowsiness
• dry mouth
• palpitations

Risk of dependency: Possible physical dependency

Taking medicines when ill

If you have a short term illness such as a stomach upset with nausea and vomiting or diarrhoea which may cause you to be dehydrated it can make you more at risk of some of the side effects.

Please read this Sick day rules leaflet.

Symptom management

Sometimes we don’t realise the symptoms we are feeling are caused by our medicines.

The Opioid side effect lottery is a good leaflet by the Live Well With Pain Team to help you decide. 

Please read the Opioid side effect lottery leaflet

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