What is pain-relief medicine?

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

Some pain-relief can be purchased 'over-the-counter' (OTC), meaning you don’t need a prescription from your doctor to access them.

If your pain persists, is not being adequately controlled or you are not sure how to cope with your pain, you should speak to your doctor. They may recommend different strategies for managing long-term (chronic) pain, including prescription medicines, as well as strategies that don’t involve medicine.

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. Different pain-relief options suit particular circumstances, as well.

Over-the-counter (OTC) medicines include:

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

Your doctor may also recommend a prescription medicine, such as:

• anti-epileptic 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 reduce pain that don’t involve medicines, such as stress management, meditation or exercise. Talk to your GP about which alternatives may be useful for you.

Over-the-counter (OTC) medicines

Some pain-relief medicine, for mild-to-moderate pain, can be purchased from your pharmacist without a prescription.

While OTC medicines are more easily accessed they still carry risks. These medicines can sometimes cause unwanted side effects and affect how well other medicines work, especially prescription medicines.

Your pharmacist can help you to decide if it is safe to take OTC medicines for pain relief alongside with your other medicines.

There are 2 common types of OTC pain medicines:

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

Prescription medicines

You need a doctor's prescription to access certain medicines from a pharmacist. Dentists and some authorised nurses can also prescribe these 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 on a prescription.

These medicines may not be suitable for people with stomach problems, liver problems, high blood pressure (hypertension) or asthma.

Opioids

Opioids (such as oxycodone, morphine and codeine) can be used to treat moderate to severe short-term (actute) pain, including after surgery or an injury, or for chronic pain in people with cancer. They should only be used when your doctor decides that other treatments are not able to manage your pain or you can’t tolerate them.

There is no clear evidence that opioids are helpful in managing chronic non-cancer pain.

Opioids can be addictive and may cause serious side effects such as life-threatening breathing problems. Nausea, vomiting, constipation and drowsiness may also occur.

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 time possible.

Anti-epileptic medicines

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

Carbamazepine is also an anti-epileptic 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 to treat nerve pain (neuralgia) and for 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 can be helpful for short-term pain relief (for example, in osteoarthritis).

Topical pain medicines often contain NSAID-type medicines like 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, although there is limited evidence to support this for some specific conditions.

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 supplemental omega-3 fatty acids can help chronic pain that affects large areas of your body, as well as neck and shoulder pain and period (menstrual) pain.

Other medicines

Other medicines used to help manage pain include:

• steroids, such as prednisolone or prednisone, to help manage pain caused by inflammation or arthritis
• muscle relaxants, such as orphenadrine to help treat pain caused by sprains, strains or other muscle injuries
• caffeine, which can be added to other pain-relief medicines to increase their effect
• medicinal cannabis may be effective for neuropathic pain if other medicines have not been helpful. But this must be prescribed by a doctor with specific experience with its use in pain management.

Is taking long-term pain-relief medication dangerous?

For some health conditions (such as rheumatoid arthritis), taking pain-relief medicines regularly can be an important part of managing your condition.

Your doctor or pharmacist can tell you about any side effects associated with your particular medicines, and can recommend ways to help minimise their impact.

For some health conditions and types of pain (such as chronic pain), there may be alternative, non-medicine-based ways to manage your pain effectively. Talk to your doctor to see if these methods could help you.

Do pain-relief medications cause side effects?

Most medicines can cause some unwanted effects, some of the time. You might experience side effects even if you take your pain medicines exactly as recommended by your doctor.

Some side effects can subside after you have been taking the medicine for a while. So don't stop taking your medicines or change your dosage without speaking with your doctor or pharmacist first.

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 as soon as possible.

Every medicine has its own list of possible side effects. More information about side effects of a particular medicine can be found in the consumer medicines information (CMI) leaflet.

Will I become addicted to pain-relief medicines?

Pain-relief medicines that contain opioids are potentially addictive.

After taking opioid medicines even for a short while, you can become tolerant to the medicine, meaning 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 fatal side effects.

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

Some people can become addicted to opioids, meaning they feel a compulsion to take opioids even if the medicine is having a negative effect. Symptoms of addiction include uncontrollable cravings and an inability to control opioid use — even if it's having a negative effect on personal relationships or finances.

You are not abusing opioid medicines, however, if you take them for your pain as prescribed by your doctor.

Tips for safe use of pain-relief medicines

• Make sure your doctor knows which medicines you are taking, including any medicines you bought over the counter at a pharmacy.
• Make sure you understand how to use your medicines. Always take them as recommended by your doctor.
• Talk to your doctor if your medicines are not helping you to 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. Prescription medicines in particular are supplied to an individual based on their own circumstances, and can be dangerous if used inappropriately.
• Don't abruptly stop taking prescription pain-relief medication. 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 to be disposed of safely.

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. Some pain medicines, especially opioids, can be addictive, meaning that you feel a strong need to continue taking them.

If you feel concerned 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 the NPS MedicineWise Medicines Line (1300 633 424) to talk about the medicines you are taking for your pain.
• Discuss your pain on the Pain Link telephone helpline (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.