What is pain-relief medicine?

Pain-relief medicines are used as part of a strategy to manage short-term (acute) or long-term (chronic) pain. They work by targeting the cause of your pain or by reducing how your pain travels along the nerves to the brain.

What are the different types of pain-relief medicines?

As everyone’s experience of pain is different, individuals need different ways to help manage their pain. There are also specific pain-relief options that suit some circumstances or health conditions.

You can buy some pain-relief medicines 'over-the-counter' (OTC). This means you don’t need a prescription from your doctor to access them. Others are only available with a doctor’s prescription.

Over-the-counter (OTC) medicines include:

• paracetamol
• non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, aspirin or diclofenac
• gels and creams with medicines (such as NSAIDs and capsaicin) that are absorbed through your skin (topical medicines)

Your doctor may also prescribe a medicine, such as:

• anticonvulsant medicines, such as pregabalin, gabapentin or carbamazepine
• antidepressants, such as amitriptyline or duloxetine
• opioids, for example codeine, morphine or tramadol
• other types of medicine that treat the cause of your pain, such as muscle relaxants or corticosteroids

There are also many ways to manage pain that don’t involve medicines, such as:

• stress management
• meditation
• exercise

Talk to your GP about the options or combinations that may be useful for you.

Over-the-counter (OTC) medicines

OTC medicines are medicines that you can buy without having a doctor’s prescription. Some types of OTC pain-relief medicine are available from a pharmacy and some shops. These are usually for mild-to-moderate pain.

There are 2 common types of OTC pain medicines:

• Paracetamol is often recommended as the first medicine to try, if you have short-term pain.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) is a group of medicines that work by reducing swelling and inflammation, and relieving pain. These include aspirin, ibuprofen and diclofenac.

While OTC medicines are more easily accessed, they still carry risks. These medicines can sometimes cause unwanted side effects. If you take other medicines or substances, OTC pain-relief medicines can affect how your body responds to them. Your doctor or pharmacist can advise you on if it is safe to take OTC medicines for pain relief together with your other medicines.

Prescription medicines

You need a doctor's prescription to access certain medicines from a pharmacist. Dentists, some authorised nurses, and some other registered health professionals can also prescribe some medicines.

Prescription NSAIDs

Some NSAIDs, which you can buy over the counter in low doses, are available in higher strengths on a prescription (such as diclofenac and naproxen). Other NSAIDs (such as meloxicam) and COX-2 inhibitors (such as celecoxib) are only available with a prescription.

These medicines may not be suitable for people with:

• some stomach problems
• liver problems
• high blood pressure (hypertension)
• asthma

Opioids

Opioids (such as oxycodone, morphine and codeine) can be used to treat moderate to severe short-term (acute) pain. Your doctor might prescribe them for pain relief after surgery or an injury, or for chronic pain in people with cancer.

Only use opioids that are prescribed for you, and for the pain condition your doctor prescribed them — never share opioid medicines.

There is no clear evidence that opioids are helpful in managing chronic non-cancer pain. Opioids can be addictive. They may also cause serious side effects such as life-threatening breathing problems.

Common side effects of opioids include:

• nausea
• vomiting
• constipation
• drowsiness

The longer a person takes opioids, the more likely they are to experience unwanted side effects. It’s best to take opioids for the shortest period of time possible.

Anticonvulsant medicines

The anticonvulsant medicines gabapentin and pregabalin are commonly prescribed medicines for people with nerve pain (neuralgia) or for people with fibromyalgia.

Carbamazepine is also an anticonvulsant medicine that can help manage a type of severe pain in the face called trigeminal neuralgia.

Antidepressants

Antidepressants work by changing the way you experience pain. Antidepressants are sometimes prescribed to help manage certain types of chronic pain. For example they can help treat nerve pain (neuralgia) or pain caused by fibromyalgia.

Topical products

Some pain-relief medicines can be applied directly to the skin, at the site of your pain. These are called topical medicines, and examples include gels and creams. They can be helpful for short-term pain relief (for example, in osteoarthritis).

Topical pain medicines often contain NSAID-type medicines such as ibuprofen, diclofenac or piroxicam. They work by decreasing inflammation and swelling.

Capsaicin is an extract from chilli peppers that is also sometimes used in topical pain-relief medicines.

Small amounts of medicine can be absorbed into your bloodstream from topical products, so it is important to use the right amount. Always read the instructions on the package before use. You can also talk to your pharmacist or doctor if you are not sure what to do.

Supplements

Some people find that taking supplements can help them manage their chronic pain. Ask your pharmacist if there is evidence to support taking a supplement for your pain condition.

For chronic pain caused by osteoarthritis, some people find that taking glucosamine or chondroitin can help them.

There is also some evidence to suggest that taking an omega-3 fatty acid supplement can help:

• some forms of arthritis
• period (menstrual) pain

Other medicines

Other medicines used to help manage pain include the following:

• Corticosteroids like prednisolone or prednisone can relieve pain caused by inflammation or arthritis.
• Medicinal cannabis may be effective for neuropathic pain, if other medicines have not been helpful. This should only be prescribed by a doctor with specialised training in pain management with medicinal cannabis.

Is taking long-term pain-relief medicines dangerous?

Regularly taking pain-relief medicines can be important in managing certain health conditions, such as rheumatoid arthritis.

Your doctor or pharmacist can tell you about any side effects associated with your specific medicines. They can also recommend ways to help minimise any unwanted effects. This may involve taking a medicine at a particular time of day, or with food.

Some types of pain and health conditions, like chronic pain, may have non-medicine strategies that can help. Talk to your doctor to see if these methods could help you.

Do pain-relief medicines cause side effects?

Most medicines can cause some unwanted effects. You might experience side effects even if you take your pain medicines exactly as your doctor recommends.

Some side effects can settle down after you have been taking the medicine for a while. Speak to your doctor or pharmacist before you stop taking your medicines or change your dosage, so you fully understand what to expect.

Other medicines, such as opioids, can cause serious side effects at any time during their use. This includes potentially life-threatening breathing problems.

If you experience side effects that concern you, talk to your doctor or pharmacist as soon as possible. Every medicine has its own list of possible side effects. More information about side effects of each medicine can be found in the consumer medicines information (CMI) leaflet in the package.

Can I become addicted to pain-relief medicines?

Most pain-relief medicines are not addictive. However, the risk of side effects may increase the longer you use them.

Opioid addiction

Pain-relief medicines that contain opioids carry a risk of addiction.

After taking opioid medicines even for a short while, you can become tolerant to the medicine. This means that over time, you need higher doses to achieve the same level of pain relief. The higher the dose of opioids you take, the greater the risk of unwanted and potentially dangerous effects.

It's also possible to become dependent on opioid medicines. This means that if you stop taking them you may experience withdrawal symptoms and start craving opioids.

Some people can become addicted to opioids. This means that they feel a compulsion (very strong urge) to take opioids even if the medicine is having a negative effect. Symptoms of addiction include uncontrollable cravings (being unable to control your opioid use), even if it's having a negative effect on personal relationships or finances.

How can I use pain-relief medicines safely?

Here are some tips to help you use pain-relief medicines safely:

• Make sure your doctor knows which medicines you are taking. This includes any medicines you bought over the counter at a pharmacy, or that another health practitioner has prescribed.
• Make sure you understand how to use your medicines. Always take them as recommended by your doctor. Ask your pharmacist if you’re not sure.
• Talk to your doctor if your medicines are not helping you manage your pain, or if you are having problems with side effects.
• Never share your medicines with other people, or try another person's medicine. Your doctor will chose the specific prescription medicines that is right for you, based on your circumstances. Medicines can be dangerous if used inappropriately.
• Don't stop taking prescription pain-relief medicine suddenly. Ask your doctor or pharmacist about how to stop or reduce your medicine.
• Keep medicines in a safe place — out of children's reach.
• Return any unused pain-relief medicines to a pharmacy for safe disposal.

When should I see my doctor?

If you have been managing short-term pain with over-the counter (OTC) medicines but your pain persists — or you are not sure how to cope with your pain at home — you should speak to your doctor.

You should also talk to your doctor if your medicines are not helping you control your pain, or if you're experiencing side effects.

If you need urgent advice, but your doctor is not available, speak with your local pharmacist.

If you are worried that you or someone you know is becoming addicted to pain medicine or is using it in a way that their doctor has not recommended, speak with your doctor or encourage them to seek help.

Resources and support

• Call 1300 MEDICINE (1300 633 424) to talk about the medicines you are taking for your pain.
• Discuss your pain on the Pain Link helpline on 1300 340 357, which is staffed by volunteers with personal experience of chronic pain.
• Go to Painaustralia to find pain services and programs in your area.
• Call healthdirect on 1800 022 222 at any time to speak to a registered nurse (known as NURSE-ON-CALL in Victoria) for more information and advice.