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Managing Your Pain Effectively Using “Over the Counter” Medicines

We all know what pain is. Sometimes we hardly notice it and other times it is so severe that we ask a doctor or pharmacist for help. Sometimes we take a painkiller (analgesic) to lessen the pain until it goes away.


Short-term (acute) pain relief

Most of us have had occasional headaches, muscle or joint pain, or period pain. Short-term pain does not last long and tells the body that something is wrong. Short-term pain can be treated by painkillers that can be bought “over the counter” (OTC) either from a pharmacy or other shop such as a supermarket.


Long-term pain relief

Long-term pain, sometimes called chronic or persistent pain, is present everyday or comes and goes. Some people with long-term illnesses need to take painkillers everyday to manage this. You may find it helpful to read ‘Understanding and Managing Pain’ published by the British Pain Society which can be downloaded from, or see our pages on persistent pain and the ‘pain toolkit’.


Safe use of painkillers

  • When taken at the right dose OTC painkillers are safe and effective medicines
  • When you have short-term pain it may be best to take the painkiller as recommended on the pack to stop the pain from building up and becoming intolerable
  • If you need to take painkillers for longer than three days you should see your doctor or pharmacist for advice
  • If you feel the dose of a prescription medicine isn’t enough don’t ‘top up’ with painkillers bought over the counter – talk to your doctor or pharmacist
  • Speak to your doctor or pharmacist for further advice


Manage your pain effectively and safely with OTC medicines

  •     Paracetamol
  •     Aspirin
  •     Ibuprofen
  • Naproxen
  • Dihydrocodeine in combination with paracetamol
  • Codeine  (only available as a combination with paracetamol, aspirin, or ibuprofen)


Beware-medicines have more than one name!

A brand name is the name chosen by a manufacturer (e.g. Panadol®, Nurofen®, Feminax®). Each drug may have several different brand names. The active ingredient describes the drug  (e.g. paracetamol, ibuprofen and naproxen).

  • Always read the instructions and information in the leaflet and on the pack
  • Do not take two products containing the same active ingredient
  • Codeine or dihydrocodeine containing painkillers should only be used for short-term treatment of acute, moderate pain which is not relieved by paracetamol, ibuprofen, naproxen, or aspirin alone.
  • Some OTC painkillers can only be used to treat specific conditions
  • If you have conditions like asthma, any stomach problems or if you are taking certain medicines, then some painkillers may not be suitable for you and you should speak to your pharmacist or doctor about which painkiller would suit you best
  • Some people may have side-effects when taking medicines. You can help to make sure that medicines remain as safe as possible by reporting any unwanted side-effects via the internet at or through your pharmacy


 Understanding what you are taking

  • Keeping a pain and medicine diary can ensure that you are using your painkillers most effectively
  • Never take painkillers more frequently than it says on the instructions on pack or in the leaflet
  • Never take a product sooner than you should


Remember you do not always need painkillers to relieve pain

  • Applying heat to the skin can help some types of pain. Use compresses or products such as sprays, creams, ointments, gels and patches to help swelling and inflammation
  • Support from bandages or compression hosiery can help with sprains and strains
  • Acupuncture or transcutaneous electrical nerve (TENS) are alternatives to medication for pain control. Ask a healthcare professional about these treatments
  • Rest if your body tells you to
  • Exercise gently as soon as you are able to
  • Ask yourself what is causing the pain. If you do not know, if the pain persists for more than three days, or if you are unwell, always seek medical advice.


What kinds of pain can be helped by OTC medicines?

  • Headache, migraine
  • Toothache
  • Period pain
  • Minor injuries, strains and sprains
  • Backache, muscle aches, joint pains


How do different painkillers work?

  • Aspirin, ibuprofen and naproxen come from a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs work by changing the body’s response to pain and swelling. They are particularly helpful for acute strains and sprains, muscle and joint pains.
  • Codeine and dihydrocodeine are similar to, but weaker than morphine and work by blocking pain messages in the brain and spinal cord.
  • Paracetamol works in a different way to NSAIDs and codeine. It is particularly helpful in reducing fever and relieving pain.
  • Because each type of painkiller works in a different way to relieve pain, there are some products available that contain more than one type of painkiller. For example aspirin, paracetamol or ibuprofen can be combined with codeine and/or caffeine.


What do the other ingredients do?

  • Some painkillers contain caffeine as it may improve pain relief. Caffeine, also in coffee and tea, is a stimulant. It increases blood pressure and speeds up the heart. There is about 75mg caffeine  in a small cup of coffee and about 50mg in a small cup of tea, similar amounts to some OTC painkillers. Increasing caffeine intake may increase the risk of nervousness and dizziness.
  • Doxylamine, a sedating antihistamine, has muscle relaxing properties thought to be beneficial in headache.


Does your pain affect your life?

Ask yourself:

  • Do you need to take this medicine continuously for more than three days?
  • Do you have low moods?
  • Do you suffer from a lack of sleep?
  • Are you tired and irritable often?
  • Do you find it difficult to concentrate?
  • Does the pain make it difficult for you to exercise?

If you answer “yes” to any of these questions then you need help in managing your symptoms and it is important that you talk to your doctor or pharmacist. Although it may not always be possible to get rid of pain completely there is a range of different treatments available.


What side effects do painkillers have and what are the risks of taking painkillers in the long-term?

All medicines can cause unwanted  side effects. Used in the short-term these are not generally troublesome but if painkillers are used long-term, then the extent and severity of side effects can increase.

  • Paracetamol is a safe drug, except in overdose when the liver can become damaged, sometimes permanently.
  • High doses or long-term use of NSAIDs may lead to indigestion, bleeding from the gut, kidney problems, high blood pressure, fluid retention and slight increased risk of heart attack and stroke. They may also affect blood clotting and worsen asthma in about 10% of asthma sufferers. Aspirin must not be given to children under 16 years because of a very rare illness called Reye’s syndrome which can be fatal.
  • Prolonged use of painkillers containing codeine or dihydrocodeine can lead to constipation, “chronic daily headache” and addiction.


Chronic daily headache

If you are taking painkillers for 15 days or more a month you run the risk of getting daily or near-daily headaches that last, on average, for more than four hours. These headaches are often linked to overuse of painkillers. Unless the overused painkillers are completely discontinued the chronic daily headache is likely to continue. If you suffer from this then you need to see your doctor who can help you.



Although addiction to codeine and dihydrocodeine is rare, if it does occur it is a serious problem. Never take painkillers containing codeine or dihydrocodeine for longer than three days without medical advice. You may find it helpful to read Pain and substance misuse: improving the patient experience’ published by the British Pain Society which can be downloaded from


How do I know if I am addicted?

Ask yourself:

  • Do you feel that you need to take the codeine/dihydrocodeine products for longer periods of time than instructed on the pack?
  • Do you find yourself buying more and more pills?
  • Do you feel the need to take more than the recommended dose?
  • Do you feel very unwell when you stop taking the medicine but you feel better if you start taking the medicine again?

If you answer “yes” to any of these questions then you need help in managing your symptoms and it is important that you talk to your doctor. If you take the medicine according to the instructions on the pack, it is unlikely that you will become addicted to the medicine.


Reference: British Pain Society “Managing your Pain Effectively using Over-The-Counter (OTC) Medicines “2010”