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There are three main types of painkiller : non-steroidal anti-inflammatory drugs (NSAIDS), paracetamol and opioids. Each works in a different way. Most people only need to take painkillers for a few days or weeks at the most, but some people need to take them for a somewhat longer duration. You can buy some painkillers from pharmacies ; this includes some NSAIDs, paracetamol, and some weak opioids (codeine or dihydrocodeine). Painkillers are medicines that are used to treat pain. There are a large number of painkillers available and they all come in various different brand names. They can be taken : orally as liquids, tablets, or capsules; by injection (intramuscular); via the back passage (rectum) as suppositories; and, some painkillers are also available as a creams or ointments for easy, local application.

Even though there a large number of painkillers available, there are only three main types (each works in a different way). They are :

1. Non-steroidal anti-inflammatory drugs (NSAIDS), e.g., ibuprofen, diclofenac and naproxen etc. Aspirin is also an NSAID. However, it is also prescribed (in low doses) to help to keep the blood from clotting.
2. Paracetamol.
3. Weak & strong opioids and strong opioids (sometimes called opiates), e.g., codeine and dihydrocodeine. Examples of strong opioids include morphine, oxycodone, pethidine & tramadol.

Different types of painkillers are sometimes combined together into one tablet - for example, paracetamol plus codeine (co-codamol), or, fairly commonly, paracetamol and ibuprofen. In addition to the above, some antidepressants and anti-epileptic medicines can be used to treat neuropathic pain.

How do painkillers work ?

NSAIDs work by blocking (inhibiting) the effect of chemicals (enzymes) called cyclo-oxygenase (COX) enzymes. COX enzymes help to make other chemicals called prostaglandins. Some prostaglandins are involved in the production of pain and inflammation at sites of injury or damage. A reduction in prostaglandin production reduces both pain and inflammation. Not all NSAIDs are exactly the same, and some work in slightly different ways from others. See separate leaflet called Anti-inflammatory Painkillers for more details.

Paracetamol -  is also thought to work by blocking COX enzymes in the brain and spinal cord (central nervous system). Paracetamol is used to treat pain and to lower a high temperature. However, it does not help with inflammation.

Opioids work by binding to certain receptors (opioid receptors) in your central nervous system, your gut and other parts of your body. This leads to a decrease in the way you feel pain and your reaction to pain, and it increases your tolerance for pain.

NSAIDs are generally prescribed for people who have pain and inflammation - for example, if you have pain in your joints (arthritis) or muscles (back pain). This is because there is likely to be some inflammation present and NSAIDs work well to treat pain as well as inflammation. NSAIDs have a number of possible side-effects and they are not suitable for everyone. For example, they are not suitable for people who have or have had stomach ulcers. In this case a doctor may prescribe a safer medicine (paracetamol) even though it may not work as well. Weak opioids are usually prescribed for more severe pain, or if you have tried paracetamol and/or ibuprofen and they have not worked. Stronger opioids are normally used to treat severe pain - for example, cancer-related pain, pain after an operation, or if you have had a serious injury. Anti-inflammatory medicines used as a cream (topical painkillers) are mainly used to treat pain in your soft tissues and muscles.

People who are in pain all the time are usually recommended to take painkillers regularly. For example, if you have been prescribed paracetamol you will normally take it four times a day, every day until the pain is better. Otherwise, you only need to take painkillers when you need them. If you are taking an NSAID such as ibuprofen or diclofenac, you will need to take this with or after food. This is because they can irritate the lining of your stomach and sometimes cause bleeding in your stomach. Like all medicines, painkillers should be taken for the shortest period of time possible, in the lowest dose that controls your pain. This is to help avoid any side-effects. Most people only need to take painkillers for a few days (for example, for toothache) or weeks (having pulled a muscle). However, some people have painful conditions and need to take painkillers on a long-term basis. Examples include people with rheumatoid arthritis, osteoarthritis, or chronic back pain.

Most people who take anti-inflammatories have no side-effects, or only minor ones. When taken appropriately, the benefit usually far outweighs the potential harms. In particular, many people take a short course of an anti-inflammatory for all sorts of painful conditions. However, side-effects, and sometimes very serious possible adverse effects, can occur. These include bleeding into the stomach and gut, and cardiovascular problems.

Paracetamol : is a relatively safe medicine and side-effects are rare if you do not take more than the maximum recommended dose. However, paracetamol can be very dangerous if you take too much (overdose). Overdoses of paracetamol can happen by mistake, but some people intentionally take an overdose. The main problem with taking an overdose of paracetamol is that it can damage your liver permanently and you can die from this.

Opioids : nausea, vomiting, particularly at the start of treatment. Constipation. Dry mouth. Can also cause drowsiness and confusion. Some people can become tolerant to opioid painkillers (needing to take more to get the same effect) and then depend upon them. This includes opioids that can be bought in pharmacies. If you think you are depending on opioids and need to take higher and higher doses, discuss this with your pharmacist or doctor.

Some painkillers may interact with other medicines that you might take. This may cause reactions, or reduce the effectiveness of one or other of the treatments. So, when you are prescribed a painkiller, you should tell a doctor if you take other medicines.

Who cannot take painkillers ?

It is very rare for anyone not to be able to take some type of painkiller. The main reason why you may not be able to take a painkiller is if you have had a serious side-effect or an allergic reaction to a particular type of painkiller in the past. Even if this happens, your doctor will usually be able to choose a different type of painkiller, which you will be able to take. Aspirin cannot be taken by children under the age of 16 years, because there is a risk of the child developing Reye's syndrome (very rare).