Ask the pharmacist: Pain medicine

Here are some of the most frequently-asked questions pharmacists are asked about pain-relieving medicines, all answered by our expert pharmacy panel

Meet our expert panel

Our pharmacists answering your questions in this issue are:

ISB: Inderpal Singh Birdi, Arms Chemist, east London

ER: Elizabeth Roddick, New Life Pharmacy, Glasgow

SG: Shalina Ghai, Vanas Pharmacy, Essex

DA: Dave Astbury, Claughton Pharmacy, Birkenhead

Q What are the most common medicines used to relieve pain and how do they work?

A When you look at a pharmacy shelf it may be confusing to see such a vast array of painkillers. However the majority of these are usually combinations of paracetamol, aspirin, codeine / dihydrocodeine and ibuprofen or a similar anti-inflammatory.

Painkillers work either by inhibiting the release of certain chemicals at the site of the pain or by blocking the pain receptors in the brain. If in doubt always ask your pharmacist which is the best product for you to take as many of the expensive branded medicines may have a cheaper unbranded version which will be just as effective. SG

Q Can anyone take painkillers, for instance can pregnant women take them safely? 

A If you are pregnant and need medication for short-term pain relief, paracetamol is recommended. As with any medication taken during pregnancy, use paracetamol at the lowest effective dose for the shortest possible time.

If paracetamol doesn't control your symptoms, then speak to your GP. Taking ibuprofen during pregnancy may in some instances be appropriate, depending on which stage of pregnancy you're at (ie. which trimester), but you should only take them if they're prescribed by your GP.

For children with minor aches and pain, liquid paracetamol is recommended. The dosage will be clearly stated on packaging and should never be exceeded. Ibuprofen is effective against pain and temperature in children, but it is not recommended if a child has asthma and should always be taken after food. DA

Q Which types of pain relief are best for which types of pain? 

A For mild to moderate pain, paracetamol is a good painkiller as it is suitable for adults and children and is fairly gentle on the stomach. It is also good for reducing high temperatures.

Aspirin and ibuprofen are more suitable for muscle injuries where swelling and/or inflammation has occurred, although ibuprofen can be given alongside paracetamol in high temperatures if paracetamol alone is not sufficient.

For moderate to severe pain it may be useful to use a medicine containing codeine. For more specific pain – migraine headache pain, for example – there are medicines available that contain muscle relaxants to ease tense muscles or ingredients to deal with the nausea often experienced with migraine.

Always ask for advice to determine which medication is most suitable for your particular type of pain. If you are taking any other medication, ask your pharmacist which painkiller would be most suitable for you. SG

Q Are prescription painkillers really a lot stronger than over-the-counter ones? 

A Your doctor may well give you a much stronger painkiller on a prescription if you have already tried over-the-counter medicines and not found relief. Always let your doctor know what you have taken since it may be that you'll have to delay taking your new prescription medicine for up to four hours if some of the ingredients are the same.

Some prescription-only medicines (POMs) can contain up to four times the strength of active ingredient as over the counter remedies. Depending on the type of pain – nerve pain, for example – you could be prescribed a medicine that is normally used for epilepsy or depression. Stronger strengths of anti- inflammatory painkillers such as ibuprofen are also only available on prescription. ER

Q What's the difference between chronic pain and acute pain and what's the best way to treat them?

A Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Acute pain is pain that comes on quickly and can be severe but lasts for relatively short period of time. Chronic pain is one which persist or progresses over a long period of time.

Popular over-the-counter analgesics (painkillers) include NSAIDs (non-steroidal anti-inflammatory drugs) which are used to relieve pain, inflammation and fever. However they are associated with number of risk factors including stomach ulceration. To avoid stomach problems, they must be taken with or after food.

Aspirin is a drug belonging to the NSAID group that is used in treatment of pain and fever. It is also used to treat rheumatism and to thin the blood and prevent abnormal blood clotting. Children under 16, however, shouldn’t take aspirin.

Paracetamol is an antipyretic (that is, it reduces a fever) and an analgesic, but unlike aspirin has little anti-inflammatory action. Codeine meanwhile belongs to the opioid analgesics group of drugs, and is used to treat mild to moderate pain.

Always ask your pharmacist the correct dose and how to take a particular painkiller. Never increase the dose without seeking advice, and never take analgesics prescribed for another person. ISB

Q Are any pain medicines addictive?

AYes, medicines containing codeine have been found to be addictive. Codeine belongs to a group of medicines called opioids that mimic the effect of naturally occurring pain-reducing chemicals called endorphins.

These are very effective painkillers, but because they potentially cause addiction the Medicines and Healthcare Regulatory Agency (MHRA) has asked pharmacists to advise the public only to take codeine-containing preparations for a maximum of three days at a time. This warning also appears on all packaging containing the medicine. ER

Q Are heat pads good for treating some kinds of pain – joint or muscle pain, for instance?

A Yes, heat pads are indicated for symptomatic relief of muscular pain and stiffness, including backache ,sciatica and rheumatic pain. Heat pads will promote blood flow to the area where they are applied and this can reduce certain types of pain. Using heat pads can also relax cramping muscles in the area where they are applied.

You can also use a hot water bottle to apply heat, but the heat pads that you can buy from pharmacies are more practical, as they are very discrete and you can wear them under your clothing while out and about.

If you have poor circulation, diabetes or any other serious medical condition please talk to your pharmacist before using heat pads. Also ask your pharmacist for advice if you suffer from skin conditions such as eczema or have sensitive skin or are pregnant. DA