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This area of the website provides general information on drugs and medication, please speak to your doctor or pharmacist before starting any medication.
Many analgesics can be bought at pharmacies and supermarkets without a prescription, and so they are said to be Over-The-Counter analgesics, or OTC analgesics for short. These are the first thing that most people try when they have a headache, so you will probably be very familiar with them. They include the “simple” analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) (e.g. aspirin and ibuprofen) and paracetamol, and compound analgesics. The names of compound analgesics begin with “Co-", and they are often called "extra" or "plus". They include:
(Note: There are some brands/strengths of co-codamol and co-dydramol that are prescription only medicines.)
To be most effective, if your pain lasts longer than a few hours, you should take analgesics ‘by the clock’, i.e. at the dose intervals recommended, at regular intervals. If the dose needs to be increased, this should be in gradual steps, but only on the advice of your doctor, as it can be dangerous to take a large dose of analgesics. If possible, analgesics should be taken as tablets, capsules or caplets. However, soluble versions may work better than tablets for some pain, such as migraine headaches.
The availability of OTC analgesia means that you do not have to wait to see a doctor to gain control of mild to moderate pain. However, you should follow the instructions on the packet carefully. This is because these medications do have some side effects if not taken correctly. Always see your doctor before increasing the dose.
Like all medicines, some OTC analgesics can cause serious side effects if used regularly. These are rare, but you should get advice from your doctor if you find that you need regular OTC analgesics. 1
If you keep to the dose stated on the packet or the dose recommended by your doctor, OTC analgesics are safe medicines. However, if you take too much, you could overdose, which can very occasionally be fatal. Remember that OTC medicines for colds and flu usually contain analgesics, such as paracetamol and aspirin, and you should not take these at the same time as other analgesics, unless your doctor has said it is okay.
Aspirin and ibuprofen are non-steroidal anti-inflammatory drugs (NSAIDs) that can be bought over-the-counter (OTC). They have a triple action – they act as painkillers (analgesics), they reduce fever, and they reduce the redness and swelling of inflammation. Another common OTC analgesic is paracetamol, which is not an NSAID but does reduce fever as well as pain (just like the NSAIDs).
While NSAIDs reduce the pain by decreasing production of hormone-like substances called prostaglandins, paracetamol may decrease pain by stopping the function of an enzyme in the brain involved in pain signals. 2
You will probably need to use trial and error to find which analgesic works best for you, as people’s responses to analgesia are very individual. You may also find that different analgesics work better for different types of pain. For example, some women may prefer to take aspirin when they have a headache and paracetamol when they have period (menstrual) pains. Ibuprofen is effective against period pains, and also inflammation.
If you are still in pain after using OTC analgesics, doctors will assess your pain to decide on the next stage of treatment. If they decide to prescribe you stronger medication, they will use a guideline for pain management. The guideline that doctors often use is the World Health Organization's (WHO) three-step analgesic ladder, which was originally written for the management of cancer pain. 3
Click here for the WHO analgesic ladderThis bases treatment on the severity of the pain. The more severe your pain, the higher up the ladder you go. On the bottom rung are non-opioids such as non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol. These are used to treat mild pain. On the second rung are weak opioids such as codeine, which are used to treat moderate pain. On the third and final rung are strong opioids such as morphine, which are used to treat severe pain. You may also be given OTC painkillers at the same time. The effects of opioids vary greatly between patients and so individual responses cannot be predicted. 4
You need to tell your doctor if you continue to experience pain.
If your pain is not relieved by your treatment, no matter what rung you are on, your doctor may move you up a rung. There is usually no point in switching to another medicine at the same level if the previous one has failed.
At any point in this process, non-drug options may be included. This might involve physiotherapy, surgery, electrical nerve stimulation (TENS), alternative therapies such as osteopathy or acupuncture, or other treatments that depend on the type of pain you are suffering from, and its cause. Your doctor may also treat any associated problems, such as anxiety, which can help you to cope with the pain.
See Also: Complementary therapies
