Medicine for body pain
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medicines for body pain analgesics NSAIDs paracetamol overview 2025
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Here is a well-organized overview of medicines used for body pain, drawing from medical textbooks (Miller's Anesthesia, Barash's Clinical Anesthesia, Swanson's Family Medicine, Lippincott Pharmacology) and current clinical sources:
Medicines for Body Pain
The WHO Analgesic Ladder
The World Health Organization developed a 3-step framework for pain management. It guides treatment from least to most potent:
| Step | Pain Level | Drug Class |
|---|---|---|
| Step 1 | Mild pain | Paracetamol (acetaminophen) + NSAIDs |
| Step 2 | Mild-to-moderate | Weak opioids (codeine, tramadol) ± Step 1 drugs |
| Step 3 | Moderate-to-severe | Strong opioids (morphine, fentanyl, oxycodone) |
Adjuvant drugs (antidepressants, anticonvulsants) can be added at any step for specific pain types.
1. Paracetamol (Acetaminophen)
- Brands: Tylenol, Panadol, Calpol
- Best for: Mild to moderate body pain, fever, headache, muscle ache
- How it works: COX inhibitor in the CNS; reduces pain perception and fever but does NOT reduce inflammation
- Dose (adults): 500-1000 mg every 4-6 hours (max 4 g/day)
- Caution: Hepatotoxic in overdose; avoid excess alcohol use; limit in liver disease
- Note: First-line for most mild pain; 20-25% of patients with cancer pain can be fully controlled with this alone
2. NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
These work by inhibiting COX-1 and/or COX-2 enzymes, reducing prostaglandins that cause pain, inflammation, and fever.
| Drug | Route | Notes |
|---|---|---|
| Ibuprofen | Oral | 200-400 mg every 6-8 hrs; most widely used OTC |
| Naproxen | Oral | 250-500 mg twice daily; longer acting |
| Diclofenac | Oral / topical / injection | Good for musculoskeletal pain; available as gel |
| Aspirin | Oral | Also antiplatelet; older option |
| Ketorolac | Oral / IV / IM | Potent NSAID for acute pain; short-term use only |
| Celecoxib | Oral | COX-2 selective; safer for GI tract; useful in arthritis |
| Mefenamic acid | Oral | Common for period pain and mild body ache |
Cautions: Avoid or use with care in:
-
Peptic ulcer disease (risk of GI bleed)
-
Cardiovascular disease (diclofenac and ibuprofen increase vascular risk; naproxen is safer)
-
Chronic kidney or liver disease
-
Bleeding disorders
-
Use with a proton pump inhibitor (PPI) if long-term NSAID use is needed
-
Miller's Anesthesia, 10e
3. Weak Opioids (Step 2)
Used when paracetamol/NSAIDs are insufficient.
| Drug | Notes |
|---|---|
| Tramadol | Synthetic opioid; also blocks norepinephrine + serotonin reuptake; 50-100 mg every 4-6 hrs; risk of serotonin syndrome with antidepressants |
| Codeine | Often combined with paracetamol (co-codamol); converted to morphine by CYP2D6 (poor metabolizers get no effect; ultra-rapid metabolizers can get toxicity) |
| Hydrocodone | Used mainly in the US; usually combined with acetaminophen |
- Barash's Clinical Anesthesia, 9e
4. Strong Opioids (Step 3)
For severe pain when other options fail.
| Drug | Route | Notes |
|---|---|---|
| Morphine | Oral / IV / SC | Gold standard for severe pain |
| Oxycodone | Oral | Common for moderate-severe pain |
| Fentanyl | IV / patch / buccal | Transdermal patch for chronic severe pain |
| Hydromorphone | IV / oral | 5x more potent than morphine |
| Methadone | Oral | Good for chronic and neuropathic pain |
Side effects of all opioids: Constipation, nausea, sedation, respiratory depression (overdose), dependence
5. Topical Agents
Useful for localized muscle and joint pain with fewer systemic side effects:
- Diclofenac gel (Voltaren) - NSAID absorbed through skin
- Lidocaine patches - local anaesthetic for neuropathic/localized pain
- Capsaicin cream - depletes substance P from nerve endings; burning sensation initially
- Glyceryl trinitrate (GTN) patches - used for some musculoskeletal conditions
6. Adjuvant Analgesics (for neuropathic/nerve pain)
When pain is described as burning, shooting, or electric:
-
Anticonvulsants: Gabapentin, pregabalin, carbamazepine (first choice for sharp/stabbing neuropathic pain)
-
Tricyclic antidepressants (TCAs): Amitriptyline, desipramine (first choice for dull aching neuropathic pain)
-
SNRIs: Duloxetine (good for diabetic neuropathy, fibromyalgia)
-
Swanson's Family Medicine Review
Quick Decision Guide
| Type of Pain | First Choice | Alternative |
|---|---|---|
| Mild muscle/body ache | Paracetamol | Ibuprofen |
| Inflammatory pain (joint, injury) | Ibuprofen / naproxen | Diclofenac gel |
| Fever + body ache | Paracetamol | Ibuprofen |
| Menstrual cramps | Ibuprofen / mefenamic acid | Naproxen |
| Neuropathic/nerve pain | Gabapentin / pregabalin | Amitriptyline |
| Severe acute pain | Short-course opioid (tramadol) | Ketorolac (short-term) |
| Chronic severe pain | Morphine / fentanyl patch | Oxycodone |
Important: Always take NSAIDs with food to protect the stomach. Do not exceed recommended doses of paracetamol. Opioids require a prescription and carry dependence risk. Consult a doctor before starting any new pain medicine, especially if you have kidney, liver, heart, or GI conditions.
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