Use of pain relief A&E Leaflet

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What is this information about?

This information provides an overview of the main pain medicines available. 

The type of medicine you need for pain depends on the kind of pain you are experiencing. 

• For pain caused by inflammation, like back pain or headaches, paracetamol and anti-inflammatory painkillers are most effective. 
• If your pain is caused by sensitive or damaged nerves (like shingles or sciatica), tablets that affect the central nervous system are typically used.

The goal of pain medication is to improve your quality of life. All painkillers can have side effects, so it is important to weigh the benefits and risks. 

Paracetamol

• Paracetamol is commonly used for headaches and most non-nerve-related pains. Side effects are rare, and it can be taken regularly for long periods. However, if the pain lasts more than three days, consult your GP.
• A safe dose for most adults is two 500mg tablets up to four times a day. Discuss with your doctor if you have liver or kidney issues, are on medication for epilepsy or TB, weigh less than 50kg, or drink more than 14 units of alcohol per week.
• Be careful with other pain medicines that contain paracetamol. Taking too much can cause serious side effects, so do not increase the dose if the pain is severe.

Soluble painkillers

• Effervescent painkillers (ones that dissolve in water) are high in salt, up to 1g per tablet. Too much salt can raise your blood pressure, increasing the risk of heart disease and stroke. 
• Consider switching to a non-effervescent painkiller if you have been advised to reduce your salt intake.

Ibuprofen

• Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, diclofenac, and naproxen work well for pain with an inflammatory cause, such as arthritis or injury. 
• Avoid long-term use unless advised by your doctor, as it can lead to stomach issues, gastric bleeding, and kidney or heart problems. 
• Do not exceed the recommended dose, as it increases the risk of serious side effects.
• Avoid NSAIDs if you have asthma, Crohn’s disease, ulcerative colitis, liver, heart, or kidney problems, or bleeding disorders. 

Aspirin

• Aspirin is another NSAID with similar side effects, but it is less effective as a painkiller and not commonly used for pain relief. 
• It should not be given to children under 16. 

Amitriptyline & gabapentin

• Amitriptyline (used for depression) and gabapentin (used for epilepsy) can also treat nerve-related pain, such as pain from shingles, diabetes, and sciatica. They need to be prescribed by your GP. 
• Side effects include drowsiness and dizziness. 

Codeine

• Codeine does not 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 must be prescribed. 
• Codeine and other medium-strength painkillers can lead to dependency. This means you may feel unwell if you stop taking them. 
• If you find you need more of these medications, contact your GP for advice. 

Morphine

• Morphine and similar drugs (like oxycodone, fentanyl, buprenorphine) are the strongest painkillers. Some come in patch form, but all work in similar ways and are used for severe pain only. 
• These drugs are prescribed only after consultation with your GP or a pain specialist, and the dosage and response will be closely monitored. 
• They should only be used as part of a long-term pain management plan. 

Further support

For general medical advice please use the NHS website, the NHS 111 service, walk-in-centres, or your GP. 

The NHS website provides online health information and guidance. 

There are walk-in and urgent treatment services at Brighton Station, Crawley Urgent Treatment Centre, Lewes Victoria Hospital, Horsham Minor Injuries Unit and Bognor Regis War Memorial Hospital.