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Use the 6 tips below to achieve the best possible pain relief using oral medications. This online medical advice is useful for treating a wide range of acute and chronic painful conditions seen in the pain clinic, such as low back pain, neck pain, sciatica and brachialgia, arthritis and joint pain, nerve problems and muscle pain.

This advice should contribute to your overall pain control and management, but please remember that it is usually impossible to achieve 100% relief in this way and that for chronic conditions 50% relief is more realistic.

Think about trying the Pain Gone Pen - a simple low-cost non-drug self-help pain device for home use.

Match the type of medication to the type of pain

• Try to discover which type of pain you have (see Pain Types), and then select the correct medication type:-
• Musculo-skeletal pain is more responsive to a wide range of common pain killers including paracetamol, codeine and anti-inflammatory medications.
• Sufferers with nerve pain (sciatica, neuralgia) may find that traditional pain killers are ineffective, and therefore may need to consider specific nerve pain medications, or may need to consider injections or surgery.
• Visceral pain is usually fairly morphine sensitive.
• Sympathetic pain may partially respond to nerve pain medications.

• Normal Release (NR) medications are absorbed from the gut into the blood stream within about one hour, and are effective for usually between 4 - 6 hours.
• Slow Release (SR) medications have a built-in modified release system, which allows the drug to be absorbed slowly over 12 - 24 hours giving a much longer duration of action.
• If the pain pattern is continuous, consider a slow release medication, which produces fewer peaks and troughs in blood levels and pain relief.
• If the pain pattern is intermittent, consider a normal release medication avoiding over-medication at times when there is no pain.
• If the pain pattern is continuous with intermittent peaks, consider a combination of a SR medication plus an intermittent NR medication for break-through pain.

• The strength of the medication should match the severity of the pain if reasonable pain relief is to be achieved. Look at the suggestions in the Analgesic Flow Chart for more information.

• Medication is often prescribed as PRN or as required. If the pattern of the pain is continuous, then the result of taking medications as PRN is often Pain Relief Nil i.e. the relief is poor.
• It is far better to take the medication regularly throughout a 24 hour period, so that medication levels in the blood stream are kept above the level required to produce relief.
• Intermittent use of medication allows blood levels to fall below the level required to produce relief.
• If the prescribed dose of your medication fails to give the desired effect, then it may mean that a higher dose is required. This may mean a dose increase of between 50% - 100% more.
• Increases of less than 50% are unlikely to produce any noticeable affect.
• Please discuss all dose increases with your doctor before making any changes to your medication !!

• Modern methods of pain relief suggest that using combinations of drugs which act at different pain receptors, have a greater chance of producing acceptable relief than using single drugs alone.
• Synergy is an apparent increase in drug pain relieving effect using combinations, which is greater than the sum of the individual effects of the drugs used.
• Using a combination allows lower doses of each drug to be taken, and therefore the lowers the risk of developing a drug side effect also.

• If you are not able to take pain medications by mouth because of nausea and vomiting or some other reason, then there are a number of other routes to consider e.g. under the tongue (sublingual), as a suppository (per rectum), by injection (subcutaneous, intramuscular, or intravenous) in hospital or by GP's and district nurses only, or as a skin patch (transcutaneous).
• Please discuss these options with your doctor for more information. If nausea and vomiting is a problem, then treating it effectively first will then allow you to continue to take the medication by mouth.