Painkillers and NSAIDs (non-steroidal anti-inflammatory drugs) are analgesics used for pain treatment. Painkillers work by interrupting pain signals to the brain, while NSAIDs reduce pain and fever mainly by minimising inflammation. However, they may not resolve the underlying cause of long-term pain or inflammation. Available over-the-counter, common options include paracetamol, ibuprofen, aspirin, diclofenac gel and compound painkillers like co-codamol. They’re typically recommended for short-term, mild to moderate pain management but can also be used under medical guidance for long-term conditions.

Most people can use these drugs safely but certain groups should seek advice before taking them, including those underweight, under 16 or over 65, pregnant or breastfeeding with certain health conditions like asthma, liver or kidney issues or those taking other medications. Codeine-containing painkillers should not be used for more than three days without medical advice. Using over-the-counter drugs for more than ten days without professional guidance can increase the risk of side effects, including stomach, heart, liver or kidney problems.

If over-the-counter options don’t alleviate pain, a doctor may prescribe stronger medication or alternative treatments.

Types of Painkillers

Painkillers, despite their variety, fall into three main categories based on their functioning mechanisms. First are Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, diclofenac, naproxen and aspirin, the latter often used in low doses to prevent blood clotting. Second is paracetamol, known for its broad use in pain relief. The third category includes opioids, classified as weak (e.g., codeine, dihydrocodeine) and strong (e.g., morphine, buprenorphine, oxycodone, pethidine, tramadol). While weak opioids are effective, they can lead to addiction and adverse effects and strong opioids are often used in hospital settings. Combination painkillers, such as paracetamol plus codeine (co-codamol), are also common.

Additionally, certain antidepressants and antiepileptic medications can treat neuropathic pain, which isn’t covered in detail here. Alternative pain relief methods like transcutaneous electrical nerve stimulation are also available.

Opioid Based Painkillers

Opioid painkillers, such as oxycodone, hydrocodone and codeine, are derived from the opium poppy plant. They are highly effective in treating moderate to severe pain but also carry a significant risk of addiction. Opioids can produce a sense of euphoria making them attractive to some individuals. However, using them beyond prescribed limits or without a medical need can lead to dependence and addiction.

Non-opioid painkillers, also known as nonsteroidal anti-inflammatory drugs (NSAIDs), include medications like ibuprofen, aspirin and naproxen. These drugs work by reducing inflammation and relieving pain. Unlike opioids, they are not addictive but their long-term use can have side effects on the stomach, kidneys and cardiovascular system.

Addiction to painkillers can have serious consequences, including physical and psychological dependence. Tolerance can develop over time, requiring higher doses to achieve the same level of pain relief, which can further increase the risk of addiction. Suddenly stopping the use of opioids can lead to withdrawal symptoms such as muscle aches, anxiety, insomnia and nausea.

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