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Thank goodness for modern painkillers

                                        July 2010  


Thank goodness for modern painkillers

PainkillersWomen especially seem to carry a large range of painkillers around with them. A recent survey indicated that two out of every three women have at least one packet of painkilling tablets in their bag and more often than not, two or three different types.

The survey included cold relief tablets and other less specific medication in their study, so it is not a totally clear indication, but nevertheless it seems a huge number of us regularly buy painkilling products over the counter at our local pharmacy.

It is of course excellent that there is a range of effective medication easily available, but it is important to know the difference between the main types of commercial painkillers available; different medication works better for different types of pain. Painkillers also can cause a variety of side effects, so it really is important to carefully read the notes and understand what you are taking. Something that works well for one person may not necessarily offer the best relief for someone else.

Pain is actually easier to understand than most people realize. There are three distinct mechanisms that work together to produce pain; pain relievers work by interfering with these mechanisms. At the point of the problem, injured tissues release chemicals that stimulate nearby nerve endings. These nerves carry the painful impulse up the spinal cord and finally into the higher centres of the brain where the sensation is registered as unpleasant.

The popular painkillers such as paracetamol, aspirin and ibuprofen reduce the production of the chemicals that are released to stimulate the nearby nerve endings. Morphine-style drugs which include codeine work in the brain itself to dull the perception of pain.

Interestingly, the nerves that carry the pain impulse into the brain are also responsible for transmitting touch and temperature sensations, so sometimes is it possible to override their pain-carrying messages by rubbing the injured area, or applying heat or ice.

The NHS ( has a wealth of information on pain and the best ways of pain relief and gives considerable advice on various painkillers. The main ones used today include:


Paracetamol is used to treat headaches and most non-nerve pains. Two tablets of paracetamol up to four times a day is a safe dose for adults.
Side effects are not common and this dose can be taken regularly for long periods. Overdosing on paracetamol can cause serious side effects. If the pain is severe, do not increase the dose. If the pain lasts for more than three days, see your GP.


Ibuprofen, diclofenac and naproxen seem to work better when there is clear evidence of an inflammatory cause, for example arthritis or an injury.
They should not be used for a long period unless you have inflammation. When taken for long periods there's an increased risk of stomach upset, including bleeding, and kidney and heart problems. Don't take more than the recommended dose as this will increase the risk of serious side effects.


Aspirin produces the same type of side effects as other anti-inflammatories, but is not as effective as a painkiller, which means it is not usually prescribed for pain. It is dangerous for children under 12.

Codeine and other medium-strength painkillers

Codeine doesn’t work very well on its own. It works better when combined with paracetamol in a single pill. You can buy co-codamol (paracetamol and low-dose codeine) over the counter. Higher dose codeine in on prescription only.
Other medium-strength prescribed painkillers include tramadol (Zydol) and dihydrocodeine.
All these painkillers can cause dependency, which means that when you stop taking them you may feel unwell for a short period. If you need more and more of these drugs, contact your GP or other healthcare professional for advice.

Amitriptyline and gabapentin

Amitriptyline is a drug for depression and gabapentin is a drug for epilepsy. Each of these tablets can also be used to treat pain caused by nerve sensitivity or nerve damage, such as shingles, diabetes nerve pain and sciatica. You don’t have to have depression or epilepsy for these tablets to help nerve pain.
Amitriptyline and gabapentin both have to be prescribed by a GP. Side effects include drowsiness and dizziness.


Morphine and morphine-like drugs (for example, oxycodone, fentanyl and buprenorphine) are the strongest painkillers there are. Some come as a patch, but they all work in similar ways and should only be used for severe pain.
They will only be prescribed after consultation with your GP or a pain specialist. The dose and your response will be closely monitored. These drugs should only be used as part of a long-term plan to manage your pain.
Pain is a dreadful problem and anything that can be done to alleviate it can only be welcomed. However, pain doesn’t occur without reason; so it is always best to consult your doctor before turning to over-the-counter painkillers on a regular basis.


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