Pain Relief and Anti-Inflammatory Medicines
Pain relief medicines are widely used in primary care for short-term injuries, inflammatory conditions, menstrual pain, abdominal colic, headaches, and chronic musculoskeletal problems.
However, pain is not a single condition. The safest and most effective treatment depends on:
- The type of pain
- Duration
- Underlying cause
- Other medical conditions
- Age
- Pregnancy status
- Current medications
- Cardiovascular and gastrointestinal risk
Medication choice should always balance benefit with potential harm.is usually considered only after assessment of underlying causes and sleep habits.
These articles are intended as educational sources, not diagnostic nor taking place of a proper medical assessment. If you need help, please book an appointment with one of our GP’s.
Understanding Different Types of Pain
Different medicines work better for different pain mechanisms.
Acute Pain
Often follows injury, infection, or surgery. Usually short-term.
Inflammatory Pain
Associated with swelling, warmth, and stiffness. Often responds to anti-inflammatory medicines.
Mechanical Pain
Common in back pain or joint strain. Often related to movement or posture.
Neuropathic Pain
Burning, tingling, or electric-type pain caused by nerve irritation.
Visceral or Colicky Pain
Cramping, wave-like pain often arising from bowel, urinary, or gynaecological causes.
Identifying the pain type is essential before treatment.
Chronic Pain
Chronic pain is pain that persists beyond the usual healing time, often lasting more than several months.
Unlike acute pain, chronic pain is not always driven by ongoing tissue damage. Over time, changes in the nervous system can make pain signals more sensitive, meaning pain continues even after the original trigger has resolved.
Chronic pain is influenced by multiple factors, including:
- Physical health
- Sleep
- Stress
- Mood
- Activity levels
- Past injury
- Work and lifestyle factors
Modern pain management recognises the biopsychosocial model, which explains how biological, psychological, and social factors interact to influence pain experience.
Medication may play a role in chronic pain management, but it is rarely the only solution. Exercise rehabilitation, pacing, psychological approaches, and sleep optimisation are often equally important.
Identifying the pain type and its broader context is essential before treatment decisions are made.
Understanding the analgesic ladder
The analgesic ladder is a traditional framework used to guide the stepwise treatment of pain. It suggests starting with simpler, lower-risk medicines and escalating only if pain remains uncontrolled.
- Step 1: Simple analgesics such as paracetamol, with or without an NSAID.
- Step 2: Weak opioids in selected cases for short-term use.
- Step 3: Stronger opioids for severe pain, typically under specialist supervision.
In modern practice, this ladder is used as a general guide rather than a strict rule. Medication choice depends on the type of pain, underlying cause, and individual risk factors.
Paracetamol
Paracetamol is commonly used for mild to moderate pain and fever.
Key Points
- Generally well tolerated at correct doses
- Does not reduce inflammation
- Suitable for many individuals when NSAIDs are not appropriate
Safety Considerations
- Do not exceed recommended daily dose
- Risk of liver injury in overdose
- Use cautiously in liver disease
Paracetamol may be used alone or alongside other medicines where appropriate.n.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs reduce inflammation and pain.
Common examples include:
- ibuprofen
- naproxen
- diclofenac
They are frequently used for:
- joint and muscle pain
- inflammatory arthritis
- sprains
- menstrual pain
Benefits
- Reduce inflammation
- Provide effective short-term relief
Risks
NSAIDs may increase the risk of:
- stomach irritation and ulcers
- gastrointestinal bleeding
- kidney injury
- raised blood pressure
- cardiovascular events
Risk increases with:
- Age over 65
- History of ulcers
- Concurrent blood thinners
- Heart disease
- Chronic kidney disease
Gastroprotection may be considered in higher-risk individuals.
NSAIDs are generally avoided in pregnancy.
Topical Anti-Inflammatory Medicines
Topical NSAID gels may be helpful for:
- Localised joint pain
- Tendon injuries
- Mild musculoskeletal strain
They provide lower systemic exposure and reduced gastrointestinal risk compared with oral NSAIDs.
Opioid Medicines
Opioids include medicines such as:
- codeine
- tramadol
- morphine
They may be used for short-term severe pain but carry significant risks:
- dependence
- tolerance
- constipation
- sedation
- respiratory depression
Long-term opioid therapy for chronic non-cancer pain is rarely recommended in primary care.
AccessGP does not prescribe controlled drugs.
Steroids for Pain
Short courses of oral steroids may be used in certain inflammatory conditions.
However, risks include:
- elevated blood sugar
- mood changes
- infection risk
- bone thinning with repeated use
Steroids should only be used when clearly indicated.
Learn more: Steroids Explained
Neuropathic Pain Medicines
Neuropathic pain may respond to medicines such as:
- amitriptyline
- duloxetine
- gabapentinoids
These are not traditional painkillers and require careful titration and monitoring.
Some are controlled drugs.
Learn more: Neuropathic Pain Medicines
Abdominal, Colic and Bowel-Related Pain
Colicky abdominal pain is often described as cramping or wave-like discomfort.
Possible causes include:
- Irritable bowel syndrome
- Constipation
- Gastroenteritis
- Gallstones
- Kidney stones
- Urinary infection
- Menstrual-related pain
Because abdominal pain can represent a wide range of conditions, suppressing symptoms without assessment may delay diagnosis.
Medicines Sometimes Used
Antispasmodics
Such as hyoscine butylbromide or mebeverine, may relieve bowel cramping.
Simple analgesia
Paracetamol may be used for mild discomfort.
NSAIDs may help menstrual-related pain but are usually avoided in gastrointestinal conditions.
Strong painkillers should not be used to mask unexplained abdominal pain.
Menstrual Pain (Dysmenorrhoea)
Menstrual pain is common and often caused by uterine contractions triggered by prostaglandins.
NSAIDs are often first-line because they:
- Reduce prostaglandin production
- Decrease cramping pain
- Improve associated symptoms such as back pain
They are usually most effective when started at the onset of bleeding or just before.
If menstrual pain is:
- Severe
- Worsening
- Associated with heavy bleeding
- Associated with pain outside menstruation
Further assessment may be required to exclude conditions such as endometriosis or fibroids.
Hormonal contraception may also play a role in symptom management depending on individual circumstances.
Learn more: Painful or Heavy Periods
Chronic Pain and Holistic Management
Chronic pain is influenced by:
- sleep
- mood
- stress
- physical conditioning
- underlying health conditions
Medication alone is rarely sufficient.
Management may include:
- physiotherapy
- exercise rehabilitation
- pacing strategies
- psychological approaches
- weight management
- sleep optimisation
Treatment should be individualised.
Physiotherapy for Chronic Pain
Physiotherapy is a cornerstone of chronic pain management. Our specialist physiotherapists work with patients to build strength, improve movement patterns, and develop pacing strategies that reduce pain over time.
Learn about physiotherapy services →Red flags requiring urgent assessment
Seek urgent medical attention if pain is associated with:
- Chest pain
- Sudden severe headache
- New neurological weakness or numbness
- Bowel or bladder changes
- Unexplained weight loss
- Persistent vomiting
- Blood in stool or urine
- Severe abdominal pain with fever
Frequently Asked Questions
1. What is the difference between a painkiller and an anti-inflammatory?
Painkillers such as paracetamol help reduce the perception of pain. Anti-inflammatory medicines such as ibuprofen reduce inflammation as well as pain. The most suitable option depends on the type of pain being treated.
2. Why shouldn’t I ignore ongoing pain?
Persistent or recurring pain may signal an underlying condition rather than a simple strain. If pain continues despite over-the-counter treatment, assessment can help identify the cause and guide appropriate management.
3. When should I see a GP about pain?
You should seek medical advice if pain is severe, worsening, recurring, or affecting daily life. Pain associated with other symptoms such as fever, weight loss, neurological changes, or abdominal tenderness should be assessed promptly.
When to contact a GP
You should consider contacting a GP if:
- pain persists beyond a few weeks
- over-the-counter medicines are ineffective
- menstrual pain is severe or worsening
- abdominal pain is recurrent
- you require frequent NSAIDs
- side effects occur
- you have underlying heart, kidney, or stomach conditions
Persistent or unexplained pain should be reviewed.
Further Reading and Hub Links
Visit our Medication and Prescribing hub or browse more health topics in the AccessGP Knowledge Base.
If pain is affecting your mobility, sleep, work, or quality of life, a GP can help guide you on the safest and most effective next step.
Last reviewed by Dr Zamiel Hussain, GMC registered GP
Updated: 14 February 2026