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Pain management frequently asked questions

MANAGING PAIN
MORE INFO

How do we describe pain?

Pain is often described according to where it occurs in the body, such as a headache or lower back. It can also be more widespread, for example arthritis pain or the general aches and pains associated with the flu.

Pain ranges from mild to extreme discomfort and can feel like everything from a sharp stab to a dull ache. Doctors will sometimes ask you to rate the severity of the pain on a 1 to 10 scale.

One of the most common ways to classify pain is by the length of time the person has had it. Using this system, there are two classifications:

Acute pain

This is a normal response to trauma or damage to the body. It starts suddenly and tends to be short-lived, but may last up to 3 months.

Chronic pain

Pain that continues beyond the normal time of healing. It is described as being pain that is experienced most days of the week for at least 3 months. It is sometimes called 'persistent pain'.

While it might not make you feel any better, you are not alone: one in ten people are experiencing acute pain at any time, and one in five Australians report having chronic pain.

What is a pain reliever?

Pain relievers are also known as analgesics, painkillers and pain relief medicines

Pain relievers are medicines that work on the body's nervous system to reduce the feeling of pain.

Pain relievers provide temporary pain relief—they do not treat the cause of the pain.

Pain relievers have different active ingredients in them that make them work. It's important to know what these are and which one(s) you are taking, particularly if you are taking more than one medicine.

What are the risks associated with using pain relievers?

Over-the-counter pain relievers can interact with other medicines, such as warfarin, low-dose aspirin, ACE inhibitors (used for high blood pressure or heart failure) and aldosterone antagonists (used for heart failure). See our chronic conditions section for more information.

Talk to your doctor or pharmacist about all the medicines you are currently taking so they can advise you which pain relievers you can take safely. Make sure you include all pain relievers, both prescription and non-prescription, on a medicines list.

If pain relievers are overused (taken for more than 10–15 days a month for a number of months), a 'medication-overuse headache', also known as 'drug-induced headache' may result.

Medication-overuse headaches are constant, spread out, dull headaches and don't affect everyone, but it can explain headaches that have no other cause.

You can read risks specific to using paracetamol, NSAIDs and codeine.

What is paracetamol?

Paracetamol is one of the most common active ingredients in pain relievers and has been used since the 1950s. It is widely available on its own in pain reliever brands like Panadol and Herron, or in combination with other active ingredients, such as codeine or caffeine. Paracetamol is also a common ingredient in some cold and flu medicines.

Paracetamol is effective for mild to moderate pain when used correctly, and it is also used to relieve fever.

What are the risks associated with using paracetamol?

There are risks associated with all pain relievers.

When the correct dose of paracetamol is taken, side effects are rare.

The dose recommended depends on the preparation and whether it is used for a child or an adult.

When more than the recommended dose of paracetamol is used, liver injury and even death can occur. When combined with caffeine, too much can lead to difficulty sleeping, restlessness and headaches. See our Medicine Update on Panadol Extra (paracetamol and caffeine).

Remember: taking more paracetamol than recommended on the package will not provide better pain relief.

If taking paracetamol regularly does not control your pain, NSAIDs (where suitable) may be used in combination with paracetamol. Ask your doctor or pharmacist for advice.

It's not only pain medicines that can contain paracetamol. Many different types of medicine, such as tablets and drinks to relieve the symptoms of a cold, the flu or a sore throat, can also have paracetamol in them.

Check the packaging of all of your medicines to make sure you're not doubling up on the same active ingredient.

What is a nonsteroidal anti-inflammatory drug (NSAID)?

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a group of related pain medicines that have different active ingredients. Aspirin, ibuprofen and diclofenac are all different NSAIDs. Others include mefenamic acid, naproxen, piroxicam, methyl salicylate, benzydamine and ketoprofen.

NSAIDs temporarily relieve pain (in pain like headache and period pain), reduce inflammation or swelling (in conditions like arthritis and muscle and bone injuries) and lower a raised temperature.

In addition to relieving pain, aspirin is also used in low doses by people who have, or are at risk of, cardiovascular disease.

NSAIDs are available on their own or in combination with other active ingredients, such as codeine.

What are the risks associated with using NSAIDs?

There are risks associated with all pain relievers.

NSAIDs should be used with caution, especially by people over the age of 65, those at risk of stomach or heart problems, or those with asthma. See our chronic conditions section for more information.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are more likely than paracetamol to cause side effects, especially for certain people. Before taking any NSAID, including those purchased over the counter, ask your doctor or pharmacist about your risk of developing side effects.

Common side effects with NSAIDs include nausea, heartburn and indigestion. Other side effects may be more serious, including stomach bleeding or kidney problems.

Signs of gastric (stomach) bleeding include mild to severe abdominal pain, blood in the stools and dark coffee-coloured vomit. If you have any of these signs or symptoms, speak to your doctor immediately.

Recent studies have also raised concerns that certain NSAIDs increase the risk of heart attack and stroke in healthy individuals without known cardiovascular disease.

Problems with NSAIDs are more likely to occur if you:

  • are taking certain medicines, such as blood thinners (like warfarin) or corticosteroids (like prednisolone)
  • have or have had certain medical conditions such as a gastric ulcer, gastric bleeding, high blood pressure, heart problems, diabetes or kidney damage
  • are over 65 years of age
  • are taking another medicine at the same time that also contains an NSAID
  • drink alcohol
  • take more than the recommended dose
  • take an NSAID for more than a few days at a time.

If you have any of the risk factors above you should talk to your doctor or pharmacist before buying or taking an NSAID.

Aspirin and other NSAIDs can also trigger asthma in some people. If you have asthma and need a medicine for pain relief, talk to your doctor first.

Children under 12 years should not be given aspirin, unless advised by a doctor, due to the rare occurrence of Reyes Syndrome, which is potentially fatal.

In general, using NSAIDs occasionally, rather than every day, and at the lowest dose that controls your pain, lowers your chances of developing more serious side effects.

Follow the dosing instructions for NSAIDs carefully. The dose recommended depends on the type and severity of pain, the preparation and strength of the medicine and whether it is used for a child or adult.

What is codeine?

Codeine is from the group of medicines called opioids. Codeine is sold in combination with other active ingredients like paracetamol, ibuprofen or aspirin.

What are the risks associated with using codeine?

There are risks associated with all pain relievers.

In Australia, preparations containing codeine were re-classified in 2010 and are now 'pharmacist-only'; this means they are only available to purchase in limited quantities after talking with a pharmacist.

There are two main reasons for this re-classification:

  • Codeine can be addictive
  • If medicines containing codeine are taken in doses higher than recommended, more of the other active ingredients in the medicine are also being consumed, which can cause serious side effects.

The risks of these side effects far outweigh the small additional benefit that codeine has in managing most types of pain.

Side effects of codeine include nausea, constipation and dizziness. Taking more than the recommended dose of codeine can cause serious side effects, such as difficulty breathing.

Medicines containing a combination of codeine and aspirin may be less effective than aspirin alone and cannot be recommended.

What formulations do pain relievers come in?

Remember: whatever the formulation an over-the-counter pain reliever has, it is still a medicine.

Medicines come in a number of different preparations or formulations: for example liquids, solid oral dosage forms, suppositories, gels and creams.

Liquids

These include syrups and drops. They usually enter the blood stream more quickly than tablets and suppositories. However not all medicines, including pain medicines, are available as a liquid.

Liquids can be unpalatable and may also be inconvenient for some people to take.

Capsules and tablets

Solid oral dosage forms include capsules and tablets. Caplets are tablets in the shape of a capsule. Tablets may be dissolvable or dispersible (often called 'soluble tablets') and some capsules contain liquid instead of powder (often called 'liquid capsules' gel-caps or 'soft gel capsules').

Capsules and tablets are generally similar — much of the choice comes down to your personal preference. For some, caplets, with their elongated shape and smooth surface, are easier to swallow than traditional tablets. Others prefer capsules, but if you suffer from a dry mouth, capsules or large dry tablets can be sticky and difficult to swallow.

Suppositories

These are in the form of a tablet that is inserted into the rectum. They can be especially useful for people who can't take pain relievers by mouth, for example, because they feel or are being sick.

Suppositories melt in the rectum and are then absorbed into the bloodstream through the rich supply of blood vessels in this area.

Gels and creams

These are useful for people who can't take pain medicine by mouth because they feel or are being sick, or suffer gastrointestinal side effects.

The active ingredient is absorbed through the skin and enters the blood stream, working in the same way as the other forms of pain relievers.

Date published: 2011-02-25 00:00:00

Reasonable care is taken to provide accurate information at the date of creation. This information is not intended as a substitute for medical advice from a qualified health professional. Health professionals should rely on their own expertise and enquiries when providing medical advice or treatment. Where permitted by law, NPS disclaims all liability (including for negligence) for any loss, damage or injury resulting from reliance on or use of this information. Read our full disclaimer.

References to brands should not be taken as an endorsement by NPS.