OVER THE COUNTER PAINKILLERS (OTC)

Paracetamol
Paracetamol and aspirin are generally effective at relieving pain, but paracetamol is less irrtating to the stomach. For this reason, it is often used preferentially in the elderly and in other susceptible groups of people like pregnant women, those with asthma and gastric ulcers.

Overdosing on paracetamol is extremely dangerous because it may cause permanent and irreversible damage to your liver. Always take paracetamol as directed on the packaging (two 500mg tablets every 4 hours up to a maximum of eight tablet in 24 hours). Consult your doctor if your pain persists. You should also be aware that paracetamol can be 'hidden' in some branded products and take extra care not to overdose inadvertently.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs like aspirin and ibuprofen are amongst the most widely used types of pain relief. Aspirin is also widely used to prevent the formation of blood clots in people who are at risk of developing cardiovascular disease. Because, like paracetamol, they start to work quickly, NSAIDs are often used to relieve acute pain. The major problem associated with NSAIDs is the irritation they cause to hte stomach and digestive system. Taking these drugs after eating can help to prevent this. NSAIDs are not suitable for:

• people over 65 years of age
• people with a history of gastric ulcers
• people using blood-thinning drugs like warfarin
• people with some other diseases like heart disease, diabetes and asthma

Compound Analgesics
Compound analgesics are tablets that contain both a simple analgesic (such as aspirin or paracetamol) and a low dose of an opioid analgesic (such as codeine). Solpadeine, solpaflex and co-codamol are all examples of compound analgesics. Depending on how strong they are, these drugs can be obtained either over-the-counter or as prescription only medicines that you must be given by your doctor.

Co-proxamol, a compound analgesic containing paracetamol and dextropropoxyphene, was until recently used by many people suffering from the chronic pain associated with arthritis. However, from 2005 co-proxamol is being withdrawn from general use because of concern that it is too dangerous if taken in large quantities.

Muscle Relaxants
Although not strictly analgesic drugs, muscle relaxants like diazepam (Rimapam, Tensium) and baclofen (Baclospas, Lioresal) can relieve back pain by relaxing muscle spasm and thereby allowing you to be more active.

Although diazepam is the most widely used drug for this purpose, there is a slight risk of becoming physically dependent (addicted) if you use it for longer than 2 weeks. Diazepam can also cause drowsiness. For this reason, this type of drug is usually given to people with back pain who suffer from severe episodes of muscle spasm.

Antiepileptic Drugs
Also known as anticonvulsants, antiepileptic drugs like carbamazepine (Tegretol), gabapentin (Neurontin) and pregabalin (Lyrica) can sometimes be used to treat certain types of neuropathic pain. The exact way in which these drugs relieve pain is not fully understood.

Opioid Analgesics
Opioids medications derived from the opium poppy have been used in pain management for hundred of years. Most of these are taken as tablets, but opioids can be injected or delivered via a patch applied to the skin. Opioids can be divided into 'weak' and 'strong' categories. This classification may be slightly misleading, because in fact no opioid is a 'weak' drug, and all should be taken with extreme care.

If your back pain is particularly severe or persistent than your doctor may prescribe you a short course of strong opioids (eg. fentanyl, morphine), although these drugs are often used as a last resort because they are associated with a number of unpleasant side-effects. You should not drink alcohol when you are taking opioids, and whilst your dose of opioid is being adjusted it is not advisable that you drive a car.

If opioids are not taken accordingly to the directions of your doctor, they can sometimes cause severe breathing difficulties. Addiction to opioids is extremely rare in people who are taking opioids to treat pain and is instead more likely to affect those people who abuse these drugs recreationally.

The Side-effects Of Drug Treatment
No drug treatment is without its side-effects. People may respond in slightly different ways to the same medicine. If you experience symptoms which you think may be due to the medication you are taking, you should talk to your doctor, pharmacist or nurse. You should always ask your doctor if you are concerned about any aspect of your pain management.