Joint pain relief

Paracetamol is usually a safe and sensible place to start when reaching for pain relief, with relatively few risks or side effects if taken as instructed. It’s well-tolerated and may be sufficient for occasional mild pain that occurs for just a brief time. For a drug that’s been around for more than 100 years, it’s not well understood how paracetamol works or which area of the brain it works on, but it likely stops chemical neurotransmitters from transmitting a pain message.

It’s most effective if taken regularly, and for a short period of time, up to a few days. It’s preferred over ibuprofen as it’s considered safer, but they offer a similar level of pain relief.

You should be careful to take no more than the recommended maximum, and beware of other products that might contain paracetamol such as cold and flu treatments, so you don’t double-dose. It’s cleared by the liver, so if you have any liver problems, you should check with a doctor first. It causes liver toxicity if taken above the recommended dose.

Rarely people may experience stomach upset, a rash or blood disorders. You don’t need a prescription for paracetamol, it’s available to buy from any pharmacy. But you should consult your doctor if you’re taking it for more than a couple of weeks, or needing to turn to it very often.

Non-steroidal anti-inflammatory drugs (NSAIDs are a class of medications that work on pain and dampen down inflammation. Ibuprofen has a similar effect on pain as paracetamol, but can be particularly effective in cases such as joint pain and arthritis, where a muscle or joint is inflamed, causing much of the pain.

Ibuprofen is available to buy from any pharmacy, but stronger tablet NSAIDs such as naproxen, diclofenac or indometacin need a prescription. There are also topical NSAIDs which can be purchased over the counter such as Voltarol (containing diclofenac).

NSAIDs can cause increased acid production in the stomach, causing some discomfort, so you should always take them with food. Because of this, they carry the risk of gastrointestinal bleeding, which means those with a history of bleeding or a stomach ulcer, or the elderly, should avoid them. If taking for several weeks or more, your doctor may prescribe a proton pump inhibitor, to reduce the risk of a stomach ulcer forming. NSAIDs can also trigger certain types of asthma and can exacerbate existing kidney disease, so should be avoided in these cases.

Opioids include a wide-ranging scope of pain relief, from codeine at the mildest end, to tramadol as a medium strength, and different forms of morphine at the strongest end. Side effects become more pronounced with stronger doses – commonly constipation, drowsiness and feeling dizzy, sick or slightly out of it. Certain people seem more susceptible to this “wooziness” than others.

You can buy products containing low doses of codeine phosphate or dihydrocodeine (they are very similar drugs) in the pharmacy, that are often combined with paracetamol (co-codamol, or Ibuprofen (e.g. Nurofen Plus but higher doses are only available on prescription.

If you are needing stronger painkillers than co-codamol, you should probably be seeing your doctor about your joint pain. It may need to be assessed for whether there is another underlying cause.

Before reaching for the tablets and creams, we’d recommend starting with some good old fashioned home treatment. For the majority of mild joint aches and pains, this will be all that is needed. Start small by resting the painful joints. Try ice on the area to help reduce swelling and inflammation in the first few days (days 1 - 3) after an injury. Then after a day or so of rest, you can start gentle stretching exercises and starting to get the joints and muscles moving again, and introducing heat with a hot water bottle, or heat pads to get the joints back to full working order after day 3.