Few of us consider exactly what painkiller we are popping when we feel under the weather. But many types of over-the-counter painkillers are available, each group effective for specific ailments.
Here Dr Mike Serpell, consultant in pain medicine at the University of Glasgow, and Dr Richard Marks, an anaesthetist at the Spire Bushey Hospital in North London, explain which drugs we should be using according to the type of pain we experience.
Pain is the sensation we experience when we have either injured ourselves or are about to injure ourselves.
It is the body’s way of warning us to limit a body part’s use or to move it away from something dangerous. This arises because chemicals called prostaglandins are released by damaged cells which then trigger pain, inflammation and sometimes a high temperature.
Non-steroidal anti-inflammatory drugs (NSAIDs) are a group that stop the production of prostaglandins.
There is little difference between cheaper ‘generic’ drugs and their branded equivalent as their basic chemical composition is the same.
NSAIDS such as ibuprofen and naxoprofen are good for treating period pain, toothache and joint pain because they all involve inflammation.
Ibuprofen lysine is a faster-acting NSAID ideal for tackling migraines or when pain needs to be dealt with quickly. It is absorbed faster than traditional ibuprofen because lysine speeds up the pill’s breakdown in the stomach.
NSAID pain relief usually lasts eight hours.
Diclofenac is more potent and is mildly anaesthetic. It is available in low doses over the counter and is good for acute back and severe menstrual pain.
Dr Serpell says: ‘Ibuprofen is a global leader on tackling tissue-damage pain.’
Long-term use of NSAIDS can cause nausea, constipation and heartburn because prostaglandins not only trigger pain but also protect the stomach lining from its own acids.
Aspirin is also an NSAID but works by switching off the body’s pain response for longer – days rather than hours – so it cannot react to tissue damage. Aspirin thins the blood so is effective against migraines, when blood vessels in the head and neck are constricted. Long-term use can cause stomach upset.
Paracetamol possesses no anti-inflammatory effect and instead works by blocking pain signals from being sent to the brain. It also reduces body temperature, which makes it an ideal option for fevers or hot joints.
Dr Serpell suggests combining paracetamol with ibuprofen for persistent pain: ‘Chronic pain needs multiple drugs, although if you experience any inexplicable pain for more than a few days it is important to visit your GP.’
Paracetamol can increase the blood-thinning effects of anti-coagulant drugs such as Warfarin, but it is one of the few painkillers you can take while pregnant.
Over the counter, this drug is available only in a low dose, combined with paracetamol, ibuprofen or aspirin to boost its pain-busting properties.
Derived from morphine, codeine mimics the impact of the body’s pain-reducing ‘happy’ chemicals called endorphins.
Dr Serpell says: ‘As well as dulling all types of pain, this is more specifically effective in providing relief from nerve pain or severe headaches.’
Codeine should not be used for more than ten days as it is highly addictive.
Pain-relieving Gels, Lotions, Lozenges and Sprays
Topical remedies contain anti-inflammatory painkillers. Dr Marks says: ‘These are absorbed into the skin at the site of pain so are more targeted than tablets and have fewer side effects.’
Ibuprofen gel targets arthritic and sports-related injuries quickly. Choline salicylate, a form of aspirin, is the active ingredient in gum gels such as Bonjela because it helps stop pain at the source for longer.
Benzydamine hydrochloride is the active ingredient in throat sprays and gargles such as Difflam as it reduces swelling but is mildly anaesthetic too.
Methyl salicylate, extracted from peppermint, is a counter-irritant and found in products like Deep Heat. The compound triggers blood vessels to dilate, flooding the affected area with blood and heating it, which helps counter pain, especially if it’s muscular. Menthol is also a mild natural anaesthetic.
Even in topical form, it is possible to overdose on ibuprofen, methyl salicylate and Difflam if higher than recommended doses are used.