When you need to buy painkillers

We all know what pain is. Everyone experiences pain at some point. Almost 10 million Britons suffer pain almost daily.

Sometimes we hardly notice pain, but on other occasions it is so severe that we take a painkiller (analgesic) to lessen the pain until it goes away.

Sometimes we need to get short-term relief from pain, and it makes sense to go to a reputable Pharmacy or Chemist and ask their advice.

Painkillers are safe and effective medicines if used appropriately and according to the instructions and information on the product package.

If you want to buy pain killers over the counter (OTC), always take either a prescription form or the packets of medicines you take to show the Pharmacist;  they can then check that something you are taking won’t react with another of your drugs.

The vast majority of people do use painkillers correctly when they have a problem that requires pain relief. The following e-feature bulletin brought to you by the over the counter medicine experts at the PAGB (Proprietary Association of Great Britain), looks at the safe management of pain with over the counter medicines and how various painkillers actually work.

What OTC painkillers are available and how do they work?

There are three main types of OTC painkillers:

Paracetamol relieves pain and fever. How it does this is still debated but it influences pain messages in the nervous system and reduces the production of some pain related chemicals.

Non-steroidal anti-inflammatory drugs (NSAIDs) eg aspirin, ibuprofen, diclofenac, naproxen are particularly helpful for pain associated with inflammation such as muscle and joint pains, acute strains and sprains. They work by influencing the production of inflammatory mediators and so change the body’s response to pain.

Codeine and dihydrocodeine are effective pain relievers belonging to the opioid group of medicines which block pain messages in the brain and spinal cord. They work by mimicking the naturally occurring pain reducing chemicals known as endorphins. Endorphins are the “feel good” chemicals of the brain.

Because painkillers work in different ways, some products contain more than one type of painkiller. For example, aspirin, paracetamol or ibuprofen can be combined with codeine. Combining codeine with other analgesics produces stronger pain relief which is particularly effective for ailments such as migraine, backache, dental pain and period pain.. Such a combination offers pain relief when a single ingredient is not effective.

Painkilling ingredients may also be combined with:

Caffeine. Caffeine may improve pain relief. Caffeine is found in coffee and tea and the amounts of caffeine contained in some OTC painkillers are similar to those found in a cup of tea or coffee.
Doxylamine. This substance acts as a muscle relaxant, a property thought to be beneficial in pain such as headache.

How to use painkillers effectively and safely

OTC painkillers can be used to manage various types of pain such as headache and migraine, toothache, period pain, minor injuries, strains and sprains, backache, muscle aches and joint pains.
Always read the information in the leaflet and pack. Know the names of the ingredients you are taking as it can be dangerous to take more than one painkiller with the same active ingredient.
Some painkillers can only be used to treat specific conditions.
Painkillers containing codeine or dihydrocodeine should only be used for short term treatment of acute, moderate pain which is not relieved by aspirin, paracetamol, ibuprofen, diclofenac or naproxen alone.
Painkillers should not be taken more frequently than stated in the instructions on the leaflet or pack.
Keeping a pain diary with the times of day that pain killers are taken can help ensure the most effective use of painkillers.
A doctor or pharmacist should be consulted if painkillers are needed continuously for longer than 3 days and/or the person suffers from lack of sleep, inability to concentrate, low mood or restricted movement due to the presence of pain.
An OTC painkiller should not be used to top up the effects of a prescription painkiller without asking the doctor or pharmacist.

Unwanted effects

All medicines can cause unwanted side effects if not used properly or according to the pack’s instructions. Used in the short-term OTC painkillers do not generally cause troublesome side effects but if painkillers are used long-term, then the extent and severity of side effects may increase.

Changes to OTC medicines containing codeine/dihydrocodeine

Products containing codeine are restricted to sale in pharmacies and cannot be sold without the supervision of a pharmacist or trained assistant.  The pack size for OTC medicines containing codeine / dihydrocodeine is now legally limited to 32 tablets. Pharmacists are not allowed to sell larger packs. This amount provides at least three days treatment which is more than enough for the short-term pain relief of occasional headaches, muscle or joint pain, toothache, period pain etc.

As part of its ongoing commitment to the safe use of OTC medicines containing codeine, the makers of OTC medicines are in the process of voluntarily adding prominent labelling onto packs to tell people that regular use of codeine can lead to dependence and that users should consult their doctor after 3 days of continuous use of a codeine product.

The advice relates only to OTC use.  Doctors can still prescribe analgesics containing codeine / dihydrocodeine for more than three days for patients suffering from ailments that require long-term pain relief, such as arthritis.


To help promote appropriate use of OTC analgesics, the Proprietary Association of Great Britain (PAGB) and the British Pain Society (BPS) have published a leaflet that explains how to manage pain effectively using OTC medicines.

The ‘Managing your pain effectively using “Over the Counter” (OTC) Medicines’ leaflet covers information areas such as:

  • The safe use of medicines in managing pain
  • How different OTC painkillers work
  • The importance of reading all pack instructions, labelling and the need to understand different OTC pain management ingredients
  • Guidance on recognising mismanagement of OTC medicines
  • Recognising issues such as chronic daily headache
  • Making the best use of all OTC analgesics

A downloadable version of the leaflet and further information on over the counter medicines can be found at www.pagb.co.uk, and also www.britishpainsociety.org .


Nicky Smith, Nexus Healthcare                                   0207 052 8850

Jenna Coles, Nexus Healthcare                                  0207 052 8854
Emma Sanderson, Nexus Healthcare                          0207 052 8853

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