Medications for pain

Part of a good management plan

Along with self-management strategies such as exercise, distraction, healthy eating, managing stress, weight management, and getting a good night’s sleep, medication can help you keep your pain to a level where you can continue to do the things you want, and need, to do.

There are different types of medication that you and your doctor may use to help you at different times and in different ways. They should be tailored to your pain condition and other health concerns.

Over-the-counter medications

Medications that may help with mild to moderate pain include mild analgesic paracetamol, and anti-inflammatories ibuprofen and aspirin. These medications may be combined together – e.g. paracetamol and ibuprofen. They may also be combined with a low dose of codeine (a weak opioid) such as paracetamol and codeine.

All medications have potential side effects (or unwanted effects) and risks. The fact that you can buy these products over-the-counter doesn’t mean they’re without risk or completely safe. Talk with your pharmacist for more information.

*Note: from February 1 2018, you can no longer buy medications containing codeine over-the-counter. You will need to get a prescription from your doctor.

Prescription medications

Non-steroidal anti-inflammatories (NSAIDs) – there are some over-the-counter NSAIDs available in low dose, however, others need to be prescribed by your doctor. NSAIDs work to help provide temporary pain relief, specifically pain associated with inflammation, and to reduce fever.

Opioids – are used to treat severe pain associated with cancer or acute pain (e.g. following surgery). They may be helpful for some people with severe persistent non-cancer pain, however, their long term benefit is controversial. Opioids can have serious side effects (including constipation, breathing difficulties). They will also produce physical dependence over time and have the potential to produce addiction (although usually in those at risk). Long-term use of strong opioids are used cautiously; before prescribing an opioid you and your doctor will discuss the risks and benefits for you.

Anti-neuropathic pain medications – medications that act on the nervous system associated with pain may be used where nerve injury or dysfunction produces pain (neuropathic pain) or when the pain system is sensitised (in part due to severity or duration of pain). These include the older type anti-depressants, anti-epilepsy medications, and some blood pressure medications. These medications typically have significant side effects (e.g. reduced concentration, sleepiness, weight gain), however, sometimes they may be prescribed for these effects (e.g. to improve sleep).

Medication tips

• Before buying any over-the-counter medications talk with your doctor or pharmacist about the benefits and harms of these medications and how to use them most effectively as part of your pain management plan.
• Be aware of the active ingredients in all of your medications to prevent accidentally taking too much, e.g. be careful not to use other medications that contain paracetamol (such as some cold and flu remedies) while you’re taking paracetamol for pain relief. If you’re unsure of the active ingredients, talk with your doctor or pharmacist.
• Always take your medications as prescribed, and organise regular review appointments with your doctor.
• If you’re prescribed opioid medications make sure you store them safely. Be aware that your doctor will need to assess their ongoing use, suitability for your situation and may potentially need to obtain a government permit to continue to prescribe them.
• If you have difficulty remembering to take your medications, set up a reminder alert on your phone, use a pill dispenser or link your medications to a daily routine (e.g. cleaning your teeth).
• All medications have side effects. Discuss these with your doctor or pharmacist and read the consumer medicine information that comes with any new medication.
• Let your doctor know about any other medications or supplements you’re taking. This includes over-the-counter medications, supplements and products you’ve purchased from a supermarket or health food store, or products prescribed by a complementary therapist (e.g. naturopath, homeopath). They may interact with medications you’re taking for your pain or other health conditions.
• Keep track of your medications. Write down all of the medications, supplements etc that you take. Record them in your pain journal or download one of the many medication apps available.
• Don’t stop taking any medications without first discussing it with your doctor. Some medications need to be gradually reduced, rather than simply stopped, to avoid side effects.
• Consider a Home Medicines Review. They‘re particularly useful if you’re taking many medications, or if you have many health conditions. They help make sure you’re using your medicines effectively and will help you avoid any unwanted side effects. Your doctor or pharmacist can give you more information about a Home Medicines Review.

For information and advice over the phone contact:

• National Arthritis and Back Pain+ Help Line: 1800 263 265 or email helpline@msk.org.au – weekdays
• Medicines Line: 1300 633 424 (1300 MEDICINE) – weekdays
• Healthdirect Australia: 1800 022 222 – 24 hours
• Nurse-on-Call: 1300 60 60 24

Personal perspectives

Some of my medications need to be taken with food, but I often don’t feel like eating – which isn’t ideal. I’ve found that plain crackers and plenty of water works for me. So I make sure there’s always a box in the pantry. – Paul

More to explore

• Watch the recording of our webinar on medications 
• Consumer info – National Prescribing Service
• Medicines – Healthdirect
• Medication information – Australian Rheumatology Association

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