Medicines and procedures

This module will supplement your discussions with your physician about your pain management. This information should not use alone as a treatment guide or medication.

Make an appointment to see your doctor about the following:

  • You may experience chills, fevers, sweaty episodes, and elevated temperatures. Other symptoms include weight loss or sudden weakness, muscle weakness, and changes in bowel and urine habits.
  • Suppose you are feeling down or anxious or have trouble sleeping. This module will provide information about some traditional medical methods for managing pain. Despite spending a lot of time and money trying to find the “perfect” pain reliever, there is still no such thing. Consider medical options for ‘helping some patients – sometimes’ rather than a miracle bullet or procedure which cures all pain.

Pain and function will improve if you use an active management strategy, which includes paced activities, everyday functional movements, and exercises. If you have significant pain that prevents you from returning to your normal activities, it is important to discuss possible medication or procedure options with your doctor.

Pain medications

Painkiller is a term that can be misleading. Most pain treatments, such as pain medications, pain modifiers, or analgesics, tend only to help one person in four improve their pain by 50% or more compared to placebos or dummy treatments. If a pain medication were give to four people, one would get at least 50% relief. Therefore, the name “pain moderator” is more realistic than the term “pain killer.” Keep your expectations low.

The placebo effect is present in all medications and procedures. It shows that our bodies are capable of controlling pain on their own. Placebos are positive because our bodies are “wire” to release natural pain reducers.

You should continue your activity despite pain if you feel a positive effect from the pain medication or procedure. It helps prevent the pain from returning.

Pain-modifying medications are designe to help you get active and improve your mood, sleep, physical function, and ability to manage pain.

Your doctor may recommend combining medications. It is because the drugs act in different parts of your body. Combining drugs may result in a lower dosage, reducing the risk of side effects while providing pain relief.

What are the most effective medications to treat musculoskeletal discomfort?

To explain the likelihood that a drug will “work,” we use the Number of patients Needed for Treat. The medication is compare with a placebo to see if it reduces pain by 50%—a sugar tablet (or ‘dummy”).

An NNT of 2 indicates that One patient out of two will experience a pain reduction (by at least 50%) when treated with a pain reliever, compared to a placebo. NNT = 4 means 1 in 4 patients will experience pain relief.

What are the dangers of medications?

The Number Needed Harm is use to describe how likely it is that a drug will cause side effects. An NNH value of 8 indicates that one in eight medication patients may experience side effects.

The medication that your doctor prescribes will depend on if you have other medical problems. You need to select the medication which:

  • The highest likelihood of helping (so a low NNT).
  • The lowest risk of side effects (that is, a high NNH).
  • The lowest risk of addiction

See our summary chart with NNT and NNH for pain-modifying medications.

Are the same pain medications effective for all types of pain?

No. Your doctor and pharmacist can help you choose the right medication for your condition. You can decide if the medication is worth it based on your information.

There are three broad types of pain:

  1. Nociceptive pain is a common symptom of acute pain, especially when tissue damage is present.
  2. Nociceptive inflammation pain is often worse in the mornings – like rheumatoid pain.
  3. “Neuropathic” pain is often a burning, shooting, or electric shock-like sensation and hypersensitivity to touch. People with shingles, trigeminal neuropathy, diabetic nerve damage, or sciatica often experience this type of pain.

The immune system can cause pain. There is more evidence to support the role played by the immune system. It is also call as ‘alloplastic pain’ or glial-mediat immune-responsive pain. Understanding how immune cells and glia in the nervous system can contribute to pain has made major advances. This understanding has led to several key messages, including reducing life stressors, such as physical, psychological, and environmental threats and anxiety.

Ask your pharmacist and doctor these helpful questions.

Ask your doctor or pharmacist about the evidence behind your prescribed medication. Here are some questions you can ask your doctor or pharmacist to learn more about available options.

  • What are the best options for treating my pain?
  • How long does it take for the medication to start working?
  • What are the benefits of a re-design?
  • What are the most likely side effects?
  • Is the drug addictive?
  • What are the different ways I can take my pain medication?
  • How will pain relievers interact with other medications?

There are many ways to take medication.

The medications are tablets, liquids, creams, patches (applied to the skin), capsules under the tongue, or suppositories in the rectum.

You can find more information in our fact sheet about the different types of medications and how to take them.

How often should I take my pain medication?

If you suffer from:

  • Every day, seven days a week, for 24 hours per day
  • Pain is feel most days of every Week.

If you are experiencing:

  • Pain on certain days of the Week
  • Pain on some days
  • Pain following specific events

Treatment is pace activity, mood management, and activity. The medications are use to assist you in doing these activities. The use of medications is not a form of treatment.

Pain medications are divide into four groups.

Your musculoskeletal condition 1, as well as any comorbid conditions that you may have, will determine what is best for you. To manage your pain, different types of medicine may recommend. Ask your doctor or pharmacist to explain the science behind each medicine’s benefits and risks.

Analgesics are traditional pain medication in Group 1.

Paracetamol is analgesic, as are Non-Steroidal Anti-inflammatory Drugs. (NSAIDs) such as Tramadol. (Tramal ™, Zydol ™, Tramahexal ™, and Durotram ™; and combinations like Panadeine. (Paracetamol 500mg with codeine 8mg), Panadeine Forte. (Paracetamol and codeine 500mg

Recent evidence shows that paracetamol is ineffective for treating acute low back pain two and has minimal benefits for osteoarthritis 3. Recent evidence shows that exercise (such as strength training) can significantly reduce lower limb pain 4. The ‘effect size,’ or the benefit gained from exercising for hip or knee osteoarthritis, is greater than the short-term use of paracetamol.

You can use these for acute pain that is not inflammatory or even neuropathic. Download our factsheet on Analgesics for more information on this group.

Group 2: anti-neuropathic drugs

You can try these medications for neuropathic or chronic pain 5 to “calm down” the nerve activity and reduce hypersensitivity of pain associated with conditions such as shingles, diabetes, sciatica, headaches, and fibromyalgia.

They are prescribe to people with burning or shooting (neuropathic or nerve injury) pain. They are effective for one out of three patients with neuropathic symptoms. Tramadol is the only one that helps with inflammatory and acute nociceptive (acute) pain. Download our summary of Anti-Neuropathic Medications for more information.

Other options in Group Three

  • Fish Oil: 12gm per day is an ‘anti-inflammatory dose’ and may be worth trying for 3-6 months (then halve this dose). For ‘good for the heart,’ take 2-3 capsules daily. There is some evidence that fish oil may beneficial for pain cause by rheumatoid arthritis. It includes joint swelling, pain, morning stiffness, and global pain assessments.
  • Glucosamine: Although not recommended consistently based on the current clinical guidelines, some clinicians might suggest this. The usual dose of glucosamine for osteoarthritis patients is 1500mg (1 gm) daily. Some evidence suggests that glucosamine can be beneficial for knee osteoarthritis 6, but the evidence for other conditions still needs to be provided.

Group four: Opioid pain modifiers

The term opioid refers to a medication that acts ‘like’ opium derived from the poppy plant. About 1 out of 5 sufferers can get effective pain relief from opioid pain medication without major side effects.

As the consumption of products containing codeine increases, so do related deaths. Codeine, commonly thought to be a weak opioid drug, has shown in recent research to cause more deaths than intentional overdoses (48.8%). In these deaths, comorbid mental disorders like depression or anxiety (53,6%), substance abuse (36.1%), and chronic back pain (35,8%) were common. The research showed that one codeine-related mortality occurred for every two opioid-related fatalities in 2009. Most of these deaths (83.7%) were due to toxicity from combined drug use.

We discuss opioids separately because of the health risks associated with their long-term use. Download our factsheet on Opioid Medications for more information on this group.

There is an opioid converter app that can help you calculate morphine equivalents, as they differ from medicine to medicine. It will help to ensure that the medicine is use safely. Watch this video about opioids, ‘Understanding pain: Brainman stops taking his opioids.’

Stay safe with your medication by following these six rules.

Rule number one: Go slow and start low

  • Please start with the lowest dose and gradually increase it every third day until you reach the recommended dose. It reduces side effects.
  • Some medications start working the moment you take them, while others may take up to 4 weeks. You can ask your pharmacist or doctor for information about each medication that you have prescribe.
  • Check if the tablet helps reduce your pain.

Rule two: Test each new medication for at least four weeks

  • Ask your doctor for the time it takes to see the maximum positive effects of this medication.
  • Ask your doctor about the time before the medication has a side effect or negative impact.
  • You should continue taking the medication if there are more positives and fewer negatives within the first four weeks.
  • If there aren’t any positives, you can discuss the possibility of gradually reducing or stopping the medication with your physician.

Rule three: When to take medications

  • If you are prone to feeling sleepy after taking tablets, you should take them towards the end of your day. Either at 6-7 pm, if it takes a few hours for them to kick in, or before bedtime, if you start to feel sleepy soon after.
  • Take tablets that will increase alertness in the morning, not at night.
  • Ask your doctor about the ‘alertness effect’ of any prescribed medication.

Rule four: Determine if your medication will help you achieve your goals

  • It is important to have a routine in place before starting any medication. The other modules cover pain management techniques, such as pace and goal setting, moving with pain, and approaching pain.
  • It would help if you determined whether the medication has improved your function and activity over four weeks and reduced your pain while performing activities.
  • If your body becomes accustomed to a drug, the positive effects may only last a short time. It is call as ‘tolerance,’ and it occurs with medications relate to morphine. If recommended, their use should only be for a short time.

Rule five: Combining medicines

  • Only start (or stop taking) one tablet per time. Assess the effects over four weeks.
  • Doctors may combine pain medication from various groups.
  • Ask your doctor about possible interactions between medications you take.

The sixth rule: No tablets

  • Stopping tablets taken for a long period (e.g., Rule 1 is reverse when taking tablets for a longer period (e.g., Reduce them gradually over a couple of days or weeks if your body is use to them.
  • Ask your doctor prescribing medications if the medication is habit-forming. It can lead to tolerance and addiction.
  • Ask your doctor prescribing medications if there are any side effects if you suddenly stop taking the medication.

You can use the medications to progress your skills from our other modules on pain management.

Medical procedures

It is important to discuss the following details with the doctor who will be performing the procedure. Before discussing the options, this doctor will perform a clinical exam.

You can discuss with your doctor the benefits and risks of each procedure (CT scan, Ultrasound, or X-ray with Image Intensifier).


  1. The doctor performing the procedure will examine you.
  2. The procedure will perform in a low-risk (safe and sterile) facility.
  3. It is important to arrange a follow-up with the doctor that performed the procedure. You can then discuss the procedure’s results and how they relate to your overall management plan.

Diagnostic procedures: This procedure determines if the pain is coming from a specific area of the body or if numbing liquid or Local Anaesthetic fluid (LA) is blocking the nerves that carry pain messages.

Get Helpful Insights

  • The Local Anaesthetic should start working within 30 minutes and last for a few hours
  • If your pain is “almost” go during this LA phase (30 mins to 4-6 hrs), it may indicate that the source of your pain could in that area of the body or carry by the block nerve.
  • A medium-to-long-term steroid is often use for a few days to a couple of months. It takes 24 to 48 hours for this to start working, and it only has its full effect in two to four weeks.
  • Common side effects include red flushing of the face and higher blood sugars in people with diabetes; mood changes and blood pressure are less common.

Tips for a better understanding

  • Just before the procedure, note the exact location and level of pain (we use a 10-cm line marked from 0-10 to indicate pain – “0” means no pain, and “10” is the worst possible pain).
  • Record the pain score (and location of pain) immediately before, after 4 hours, and then 1, 7, and 14 days.
  • Continue to do your normal activities (in a pace-based manner) to know the amount of pain you are experiencing compared to what you normally experience.

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