Ensure to take correct painkiller to treat your problem

Painkillers are on our minds.

One of the first things to fly off shop shelves – after pasta – was paracetamol.

It’s easy to assume the only difference between painkillers is their strength, or that any painkiller you can buy without a prescription is always safe to use, but that isn’t necessarily the case.

Remember, speak to your doctor or pharmacist if you have any concerns or queries, and anybody with existing health problems, allergies or who’s already taking other medications and supplements should check that a drug is safe and suitable for them.

“Paracetamol is probably the most commonly used painkiller,” says Sandra Gidley, president of the Royal Pharmaceutical Society.

“A good all-rounder for relieving general aches and pains, paracetamol can also help reduce a fever. It’s been used for about 100 years, but we still don’t understand exactly how it works,” adds Gidley.

“We think it helps relieve pain by decreasing the amount of a substance called prostaglandin.”

Prostaglandins are produced by the brain and spinal cord in response to injury or disease, for example. They stimulate nerve endings, causing us to experience pain.

Compared with other drugs, paracetamol isn’t associated with many side effects – providing it’s used appropriately.

“People think, ‘Oh, it’s only paracetamol’ but if you take too many, it can be dangerous,” explains Gidley. “The damage to your liver can be awful.”

If you’re taking any other medications, check the packets, as a number of other over-the-counter medications – for instance, cold and flu remedies – can also include paracetamol.

Ibuprofen, another commonly used over-the-counter painkiller, is a member of the non-steroidal anti-inflammatory (NSAID) family. These also work by altering chemical activity within the body, but also reduce inflammation, which can make them particularly good for things like joint pain and injuries.

“There are a number of other NSAIDs, but they’re not all available over the counter,” says Gidley.

“Although widely used, NSAIDs are not right for everybody. For example, for some people with asthma, NSAIDs can provoke an asthma attack.

“Some have also been found to have a negative effect on the heart and they may not be a good idea for people with high blood pressure.

“Prolonged use can also cause kidney disease.”

Another key point with NSAIDs is that they can cause stomach irritation, sometimes even leading to a stomach ulcer. This can be avoided by ensuring you take the tablets with food, as advised, and taking an accompanying medication to protect the stomach.

Opiates, meanwhile, include very strong painkillers such as morphine and at the other end of the scale codeine, which can be bought over the counter in a low-dose combination with paracetamol (co-codamol).

“They are very useful for treating short-term severe pain. They work by basically blocking pain messages to the brain and also cause a euphoria effect, which helps people forget about their pain, too,” explains Gidley.

Other opioid painkillers are only available on prescription, including tramadol and fentanyl, which often comes in patches.

While powerful, all opioid use – including co-codamol – should be very carefully managed and, says Gidley, “treated with extreme caution”.

One of the biggest risks is addiction, which can sometimes happen very quickly.

In recent years, opioid painkiller addiction has been a huge problem in the US, and there’s growing concern in the UK.

Part of the problem, Gidley explains, is that you can quickly “get used” to a certain dosage, so need more to feel the effects.

There are other side effects to be careful with, too, such as drowsiness.

“High doses can also depress your breathing and reduce your heart rate and you can lose consciousness,” says Gidley. “The depression of breathing is a particular concern for some people.”

Prescription medications such as gabapentin, pregabalin and amitriptyline are sometimes used for managing certain types of nerve (neuropathic) pain.

These drugs are traditionally used to treat conditions such as epilepsy and depression but at a certain dose, can also be effective for more severe and complex neuropathic pain, including sciatica, fibromyalgia and complex regional pain syndrome.

“Traditional painkillers either reduce inflammation at the site of injury or reduce the sensations of pain centrally in the brain,” says Phil Day, superintendent pharmacist at Pharmacy2U.co.uk, who says that in some cases, damage can make nerves “overactive”, heightening pain sensation.

“However, these medicines are different and work by suppressing the nerve signals that carry pain messages, making them very effective for treating neuropathic pain.”