Painkillers: Information for patients and carers

 This advice is sourced from Dr Ros Taylor a senior palliative physician

Q.   What are the best painkillers and what should I ask my doctor to prescribe?

A.  Good pain relief is crucial to make the most of life. It can help people to eat, drink and feel they have a reason to live.

There are many different medicines that can be used to treat pain. All of them have benefits and risks. Some work better for certain types of pain than others. Some work well in combination. Some should not be taken together.

This is why choosing the right type of pain relief depends on the cause of your pain, other health conditions and personal preferences. Do feedback to your clinician how your pain medicine works for you. Side effects can usually be treated effectively.

Please do consult your doctor or nurse if you have a new pain or a rapidly changing pain. 

This table is a simple overview of the main types of pain medications we use:

Type of pain relief

 

   Example 

          Use

    Side effects and issues to consider

 

Paracetamol

 

 

An effective pain killer which is used to treat pain and fever.

Paracetamol can amplify the effect of other painkillers.

Doses need reducing in people with liver disease.

Non steroidal anti inflammatory drugs

(NSAIDs)

Ibuprofen, Naproxen, Aspirin, Diclofenac, Celecoxib

These are used for pain, inflammation and fever.

Because they treat inflammation NSAIDs are very effective for certain types of pain such as bone pain or soft tissue pain caused by infection, wounds or cancer.

Can cause irritation or bleeding from the stomach or bowel and often are prescribed with medicines to protect the stomach lining.

NSAIDs can also affect kidney function. 

Weak Opioids

Codeine, Co-dydramol, Co-codamol, Tramadol

Depending on pain intensity the right strength opioid in the right dose will be prescribed by your doctor. Opioids can be effective for all types of pain.

Nausea and drowsiness often settle after the first few doses.

Constipation may well need regular laxatives.

Please see our information on opioid concerns.

Strong Opioids

Oxycodone, Morphine, Fentanyl

Depending on pain intensity the right strength opioid in the right dose will be prescribed by your doctor. Opioids can be effective for all types of pain.

Nausea and drowsiness often settle after the first few doses.

Constipation may well need regular laxatives.

Please see our information on opioid concerns

Can be given orally, via a patch on the skin or by injection.

Other medications which enhance pain relief

Certain medications which are not well known as 'pain killers' can be very effective for certain types of pain. For example certain antidepressants (e.g. amitriptylline, duloxetine) and some anticonvulsants (e.g. gabapentin, pregabalin) can be very effective for nerve pain. Anti-spasm medication (e.g. buscopan) can be used for crampy pain. Steroids can be very effective for pains caused by swelling. 

Mouthcare can be very effective for sore mouths

Important issues to consider

  • Liver and kidney function affects what doses you can safely take
  • Do not stop any of your analgesics suddenly in order to avoid withdrawal effects. Doses may need tapering down before stopping
  • Remember some medications already contain paracetamol (e.g. Co-codamol, Co-dydramol)

Marie Curie have comprehensive resources on Pain relief and common side effects

 

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