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A Guide to Pain Medications

Many patients who undergo osteopathic or physiotherapy treatment also take medication to help relieve some symptoms such as pain. It can be useful for patients to understand how these drugs work and the effects they may have.

Introduction

There are a number of drugs, which can be helpful in alleviating pain. Different drugs act on different pain mechanisms within the body. Many prescription drugs have two names:

  • The brand name given by the drug company which develops the preparation
  • The generic or scientific name, which is the name of the active ingredient in the drug, which is decided upon by an expert committee.
GP's will normally prescribe the generic version of the drug wherever possible because this avoids confusion and is often cheaper for the NHS. For example, as an anti-inflammatory, Ibuprofen is the generic name, where as the brand name use Brufen or Nurofen.

Non-Steroidal anti-inflammatories (NSAIDs)

There drugs have anti-inflammatory properties and are widely prescribed and bought over the counter.
  • Aspirin is classed as a NSAID and has an analgesic effect lasting for about 4 hours
  • Paracetamol although classed as a NSAID by some, has weak anti-inflammatory effects
but is widely used as an analgesic when pain has no inflammatory component. Adverse events are common with these drugs because they are often taken at high doses over long periods. They can cause gastro-intestinal problems such as ulceration and kidney dysfunction.
  • Anti-inflammatory gels. These work locally by being absorbed through the skin and the use of this type of product is appealing to many patients because of the reduced association with serious adverse reactions.
Type Generic Name Brand Name
NSAIDs ibruprofen Brufen or Nurofen
diclofenec Voltarol
piroxicam Brixidel or Feldene
paracetamol Panadol

Type Generic Name Brand Name
Topical NSAIDs ibruprofen Ibugel or Fenbid gel
diclofenec Voltarol


Some reviews have found that topical NSAIDs provide good pain relief in sudden onset and chronic muscular skeletal pain with fewer side effects. They are often useful in peripheral joints where the absorption through the skin is close to the joint and where often used purely for pain in hand, knee and elbow problems.

Opioid analgesics

The term opioid is used to describe a substance which produces a morphine like reaction, they are normally prescribed for moderate to severe pain, although they can be effective for most types of acute and chronic pain, they are not as effective for nerve pain such as sciatica or nerve pain in the upper extremity. Side effects are that they often cause nausea and vomiting and they often produce a sense of euphoria.

Type Generic Name Brand Name
Opioids morphine Oramorph or Zomorph
diamorphine
pethadine
buprenophine Temgesic
Weak opioids codeine dihydrocodeine
meptazinol


Skeletal Muscle relaxants

These are used in cases of severe muscle spasm and can be helpful in the treatment of spinal pain when used in conjunction with a codeine based drug and an NSAID.

Type Generic Name Brand Name
Skeletal Muscle relaxants baclofen
diazepam Stesolid or diazemuls


Anticonvulsant drugs Anticonvulsants such as gabapentin are generally used for the relief of nerve pain such as sciatica and brachial nerve pain from neck problems.

Type Generic Name Brand Name
Anticonvulsants gabapentin Neurontin
pregabalin Lyroca


Cyclic anti-depressants

These used at a low dose have been found to have an effect on pain perception, tricyclic antidepressant drugs are effectively reducing nerve pain by acting on the central nervous system, although the exact mechanism is not well understood.

Compound preparations Such as co codamol for pain relief are believed to be helpful because the suppress more than one type of pain mechanism at the same time.

Type Generic Name Brand Name
Compound preparations paracetamol & codeine phosphate Co codamol
aspirin & codeine phosphate Co-codaprin
paracetamol & buclizine Migraleve

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