The Role of Medication
In trials 20-25% of people benefit from medicines which on average only provide a 30% (one third) reduction in pain. All medicines have possible side effects, so you need to weigh up the advantages of taking them against the disadvantages.
Pain medicines should only be taken if they help improve your quality of life and function. It is important to start at a low dose as side effects often get worse when doses increase. Start low, go slow, and use the minimum dose for maximum benefit.
Set goals to achieve as a result of starting a new medicine such as increasing activity or returning to work.
If your pain medicines do not work, then speak to your GP/nurse/pharmacist about slowly reducing and stopping them.
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What types of medications can be used to manage pain?
The type of medicine that may help to treat your pain depends on the kind of pain you are experiencing. Click on the boxes below to read more about the different types of medication and the related side-effects (always read the information that comes with the medication).
Paracetamol
A safe and commonly used medicine for many types of persistent pain, although regular use can lead to headaches.
Non-steroidal anti-inflammatory drugs
These work best for pain linked to inflammation and can be useful for managing flares of pain when taken short term e.g. 3 days. These are also available in a topical gel.
Opioids for moderate pain
Codeine is commonly used and can be prescribed with Paracetamol. About a third of the population may experience no benefit or severe side effects with codeine.
Tramadol is another example although care needs to be taken when taking this with anti-depressants and, as with all opioids, can be addictive and so should be used for managing flares of pain for as short a time as possible.
Opioids for severe pain
(Morphine, Diamorphine, Fentanyl, Oxycodone, Buprenorphine)
These can be effective in short term pain or cancer pain but have not been shown to have the same effect in long term pain. New evidence shows a number of serious side effects and harm can be caused by these medicines such as changes in hormones and immune system and shortening of lifespan as well as addiction. They should therefore be taken following specialist advice and stopped if they do not improve pain and function within 3 months.
Remember to speak to your GP, Nurse or Pharmacist before adding any over the counter, herbal or homeopathic remedies to your prescribed medication.
Nerve pain
Pain affecting nerves may not be helped by ‘normal’ pain medication. Click on the box below to find out more.
Medicines that act on nerves
Pain affecting nerves may not be helped by ‘normal’ pain medication. Medicines that act on nerves such as anti-depressants (amitriptyline/nortriptyline/duloxetine) and anti-epileptics (gabapentin/pregabalin) can help with this type of pain. These are prescribed at much lower doses for pain than to treat epilepsy or depression. These drugs would be started at a low dose and slowly increased and if you did not experience any benefit they would need to be slowly reduced and stopped. Medications such as Lidocaine (local anaesthetic) gel or plasters and capsaicin (chilli pepper) cream can also help with nerve pain. Heat and cold can also be useful for some pains including nerve pain and pain in the joints and muscles.
Click below to find out more: