Over-the-counter pain relief
Almost all of us will have taken over-the-counter painkillers like paracetamol or ibuprofen at some point. Janine Beezer, Advanced Clinical Pharmacist for City Hospitals Sunderland, explains how they work, plus what conditions each type of painkiller is best used for.
What painkillers can I buy?
Paracetamol is the most common analgesic (painkiller) you can buy. It is recommended for the treatment of mild pain and comes in tablet, capsule, syrup and soluble forms.
Another option is a non-steroidal anti-inflammatory (NSAID) preparation, such as ibuprofen. NSAIDs relieve mild pain and reduce swelling.
Often, they’re taken as a one-off dose, or more regularly for persistent pain, although it is important you don’t exceed the daily recommended dose. Ibuprofen can be taken alongside paracetamol.
If you have mild to moderate pain and paracetamol alone is ineffective, you can take a compound analgesic. These contain paracetamol and a mild opioid, usually codeine or dihydrocodeine. Examples are co-dydramol and co-codamol.
Which different conditions do these treat?
Over-the-counter analgesics can treat both acute and chronic pain. Acute pain comes on suddenly, resolving once the underlying cause is treated.
Generally, it lasts no longer than six months and is often present as a warning, such as toothache or a sprained ankle. Unresolved acute pain can become chronic pain.
Always follow the instructions on the packet; they tell you how much you can take and how often
This continues after the original cause has been treated, such as leg pain following DVT, or rheumatic pain following a fracture. Chronic pain can last for long periods and be challenging to manage.
Is it true that different painkillers work better for different types of pain?
Yes. Pain associated with inflammation usually responds well to NSAIDs. However, you are limited by what can be bought over the counter. Certain pain, such as that caused by nerve damage, may respond better to antidepressant or anti-epileptic medicines, for example, which require a prescription and assessment by a doctor.
Will any of these help relieve the discomfort caused by my heart condition?
They may help, but masking the pain with analgesics could be dangerous. Chest pain in particular can be very serious and shouldn’t be ignored.
If you’re worried about your heart condition, or your symptoms have worsened, see your GP. If you have been diagnosed with angina, you should use your GTN spray to relieve the pain; make sure it is in date and keep it nearby at all times.
Why do they come in different strengths? And what do these mean?
Strength is the amount of the active ingredient a medicine contains. All medicines come in different strengths and doses; the usual dose of paracetamol is 1,000mg, whereas for ibuprofen it is 400mg.
Effectiveness cannot be judged on strength (numerically), as each medicine works differently. It’s like comparing apples with oranges.
Always follow the instructions on the packet; they tell you how much you can take and how often. If you are unsure, ask a pharmacist or check with your GP.
Are non-branded painkillers as effective?
All medicines are made to a recommended standard using the same amount of active ingredient
All medicines are made to a recommended standard using the same amount of active ingredient. The efficacy (how well they work) should always be the same.
Occasionally, the other, non-active, components of the medicine may differ slightly, but this shouldn’t affect the way they work.
I’m taking regular painkillers; can I get them on prescription?
If you take over-the-counter painkillers regularly, see your GP to make sure you’re on the best one. This is vital if you’ve been taking them for an acute problem for 48 hours or more, and the pain remains.
All analgesics are available on prescription, but your GP will determine if that is appropriate for you. If you pay for prescriptions, it may be cheaper to buy them than to pay the fee.
I’ve been taking painkillers for more than six months. Is this too long?
Analgesics are generally safe if taken as intended, and it’s sometimes necessary to take them for prolonged periods, especially for chronic pain.
Never take more than the recommended or prescribed dose, as this can have serious health implications.
For example, an overdose of paracetamol can cause liver damage. Effervescent (dissolvable) painkillers contain a lot of salt, so it may be better to change to a non-effervescent equivalent if you are taking these regularly.