Painkillers 101: What A GP & Pharmacist Want You To Know

If your first response to a headache or sore back is to rummage through your medicine cabinet, you’re not alone. One in five adults in the UK takes painkillers at least once a week, while one in 11 of us takes some form of pain relief every day. But do you really know which ones you should take when and what their side effects can be? This is what a GP and pharmacist want you to know…

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What is it? The most used painkiller in the UK, paracetamol works by blocking an enzyme in the brain involved in the transmission of pain, Dr Deborah Lee from Dr Fox Online Pharmacy, tells SL. “Paracetamol dampens down pain perception by reducing pain signals to the brain and preventing the release of pain-causing chemicals,” she says. 

When should you take it? Use it to ease mild to moderate pain – think headaches, toothaches, muscle and joint pains, and hangovers. “It’s also commonly used as a post-operative painkiller,” says Deborah.

Are there any side effects? It’s unlikely to cause serious side effects when taken at the recommended dose. “Always make sure you aren’t doubling up on your paracetamol dose if you’re taking regular pills alongside a cold and flu remedy like Lemsip, Night Nurse or Anadin Extra,” Deborah adds.


What is it? Ibuprofen falls under the NSAID (non-steroidal anti-inflammatory drug) umbrella, Deborah tells us. “It works by reducing hormones in your body that cause pain and swelling.”

When should you take it? Use it to treat mild to moderate pain – think migraines and toothache. It is also effective at reducing inflammation and swelling caused by arthritis.

Are there any side effects? Experts agree that ibuprofen should always be taken with food and never on an empty stomach. “If you take it without food, it can cause an upset stomach,” says Abbas Kanani, superintendent pharmacist at Chemist Click. “If you are taking ibuprofen in the long term, you may also be prescribed a medication to protect the stomach lining, such as omeprazole.”


What is it? Like ibuprofen, aspirin is an anti-inflammatory that blocks pain at the source. Aspirin enters the bloodstream and travels through the body, but only works where it finds specific molecules, which are produced in response to an injury.

When should you take it? Aspirin provides effective pain relief and thins the blood, so may be prescribed to help you avoid heart attack or stroke, adds Abbas.

Are there any side effects? The NHS says aspirin is less effective than ibuprofen and is thought to be more likely to cause gastrointestinal side effects.

There is evidence to suggest paracetamol may provide BETTER PAIN RELIEF if given in CONJUNCTION with IBUPROFEN, and vice versa.

Here, the experts answer some of the most asked questions about painkillers…

If you need something stronger, what are your options?

“If the likes of paracetamol and ibuprofen aren’t enough to take your pain away, then combined painkillers such as co-codamol, which contains paracetamol and low-dose codeine, are available over the counter. There is evidence to suggest paracetamol may provide better pain relief if given in conjunction with ibuprofen, and vice versa. Paracetamol and codeine also appear to work synergistically. If you are prescribed a codeine-containing painkiller, take it exactly as prescribed – this generally should not be for more than 72 hours. This is very important as there is a large genetic variation in the rate we metabolise codeine. Some of us metabolise it very slowly and are more at risk of an overdose than others. Tramadol is another option – it’s a strong form of opiate used for severe pain, while amitriptyline increases serotonin in the brain, and hence reduces pain.” – Deborah 

What are the rules on mixing painkillers?

“You can mix most painkillers, just be careful with the dosage. Ibuprofen and paracetamol can be mixed as they provide different forms of pain relief, while it’s also safe to take ibuprofen and codeine with paracetamol. However, you cannot take naproxen with ibuprofen, as they both belong to the same class of drugs. Co-codamol and paracetamol shouldn’t be mixed as they both contain paracetamol.” – Abbas 

Is it ever okay to take more than the packet states?

“The maximum dose of ibuprofen is 400mg taken three times a day at six to eight hourly intervals. However, for severe pain, you can take 2,400mg per day, divided into three or four doses – but this is for short-term use only. If you have been taking ibuprofen for some time at the lower recommended dose and your pain increases, chat to your GP rather than just increasing the dose by yourself. This may be because the disease has flared, and other tests or treatments may be needed. You could also try adding in paracetamol if not already taking it.” – Deborah 

Does a branded painkiller mean it’s more effective?

“No, and you should avoid being hoodwinked into buying branded medicines. When a drug is first developed, it’s given a brand name – such as Nurofen – but the active ‘generic’ ingredient is ibuprofen. The drug has a licence, which means that until the licence expires, no one is allowed to copy it. Once the licence has expired, it’s perfectly legal for other drug companies to make a product with the same generic ingredient. There is no evidence to suggest these products work any less efficiently than the original brand, and they are often considerably cheaper. Buying the cheaper generic alternative is a sensible idea.” – Deborah 

Avoid being HOODWINKED into buying BRANDED MEDICINES. There is no evidence to suggest AFFORDABLE PRODUCTS work any LESS EFFICIENTLY than BRANDED VERSIONS.

Are there any other rules to know when it comes to taking painkillers?

“Take them exactly as prescribed. If you have been prescribed a painkiller, don’t miss a dose, and never take an extra dose. At the same time, don’t crush or break up tablets – always swallow them whole. Always check with your GP or pharmacist before taking any form of NSAID, as some drugs such as oral steroids, warfarin and heparin can increase the risk of gastric bleeding. NSAIDs can also exacerbate symptoms of Crohn’s disease, so care should be taken here too. Never take NSAIDs – whether it’s ibuprofen, aspirin or something else – with alcohol as this increases the risk of fatigue and drowsiness.” – Deborah 

What can you do to boost the efficacy of pain-relief drugs?

“It’s worth thinking about pain holistically. Chronic pain will get worse if you stay at home and don’t exercise – this is a sure-fire way to cause joint stiffness. Getting stress under control also helps, as stress is a major component of pain. There are many ways to do this, but regular exercise is a good starting point. Swimming is excellent as the water takes the weight off your joints and compresses swollen areas. When it comes to natural remedies and products, always check with your GP before starting, as many natural products can interact with drugs.” – Deborah 

The right painkiller for the job, according to Dr Deborah Lee…

Flu: “Both paracetamol and ibuprofen will provide relief from coughs, colds and flu. They can both help lower a fever and reduce aches and pains. There has been little research comparing their effectiveness, so take what works for you. If you’re unwell and taking ibuprofen, just make sure you’re always taking it with food or a small glass of milk.”

Headaches: “Paracetamol and NSAIDs, including aspirin, are all just as effective as each other when it comes to providing relief from tension headaches.”

Migraine: “Recent studies show the most effective, first-line treatment should be to take an NSAID – like ibuprofen – with a triptan (like Migraitan), or paracetamol with an antiemetic (a type of drug used to control nausea and vomiting).”

Arthritis: “Some NSAIDs seem to work more effectively than others, with ibuprofen and naproxen being the most effective. Aspirin has been shown to be less effective than ibuprofen. Studies also show ibuprofen can improve joint stiffness and mobility.”

Back pain: “NSAIDs like ibuprofen will be far more effective than paracetamol. The use of hot and cold pads applied to the painful area can also be helpful.”


For more information, visit DoctorFox.co.uk & ChemistClick.co.uk

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