Pain relief for back pain

How painkillers work and why not all painkillers are the same!

I see a lot of patients who are reluctant to take pain medication, often because they don’t want to “mask the pain” in case they do something that makes their back pain worse.

There are different types of pain killers which work in different ways, meaning that some are more appropriate to use than others depending on the circumstances. Some drugs can be used together and can be more effective if used in that way, others shouldn’t because they are too closely related in action. Side effects from pain killers tend to increase the stronger the medication and some should only be taken after a meal.

The science behind painkillers:

Painkillers (analgesics) can be grouped into opioids (with similar properties to drugs derived from opium, such as morphine) and non-opioids.

Non-opioids include all of the other analgesics, including paracetamol and non-steroidal anti-inflammatory drugs (NSAID’s) such as aspirin and ibuprofen. Local anaesthetics can also be used for pain relief.

Opioid drugs and paracetamol act directly on the brain and spinal cord to alter the perception of pain signals. Opioids act like endorphins, hormones naturally produced in the brain to stop cell-to-cell transmission of pain signals. NSAID’s however act at the site of pain, blocking the formation of pain-modulating substances at nerve endings.

GP’s will frequently recommend taking either paracetamol or ibuprofen to try and relieve symptoms, if that is unsuccessful they’ll recommend them both together. Which makes sense because paracetamol effects the brain and ibuprofen effects the site of pain (as described above). A mild opioid (e.g. codeine) may also be used. If these less powerful drugs aren’t effective, a strong opioid such as morphine might be used.


  • Used for everyday aches and pains such as headaches, toothache, and joint pains
  • This acts by reducing the production of prostaglandins in the brain so it doesn’t reduce inflammation, although it can reduce fever.
  • One of the safest types of pain medication as it doesn’t usually irritate the stomach and allergic reactions are rare

NSAID’s (non-steroidal anti-inflammatory drugs) e.g. Aspirin

  • Used for headaches, toothache, chronic rheumatoid arthritis (if used regularly), sore throat and discomfort caused by feverish illnesses
  • This reduces pain and fever but also reduces inflammation by blocking the production of prostaglandins in the affected tissue
  • Aspirin is also found in combination with other drugs and used to treat some blood disorders due to it’s anti-clotting properties
  • Soluable aspirin dissolved in water is more quickly absorbed into the bloodstream, therefore relieves pain faster


  • An NSAID (see above) most commonly used to treat muscle and joint pain

Combination analgesics (e.g. cocodamol)

  • Mild opioids such as codeine are often found in preparation with other non-opioids (such as paracetamol)
  • Although both opioids and paracetamol act centrally the mixtures have the advantage of combining different mechanisms of action. Another advantage is that smaller quantities of each are used, reducing the potential side effects of the medication.

Opioids (Codeine, Tramadol, Morphine, Diamorphine, Pethidine)

  • Used for pain post-surgery, serious injury and cancer & terminal illnesses
  • Work direction on several sites in the nervous system to block the transmission of pain signals. Because they work directly on the brain where pain is perceived, they’re the strongest pain killers you can get
  • In addition to relieving pain they can create a state of euphoria, relieving the stress that accompanies severe pain, which means they can be highly addictive if used incorrectly
  • Side effects include confusion, nausea, vomiting, constipation, drowsiness, and depressed breathing and overdose can result in a coma


Whilst people often worry that they are “masking the pain” by taking pain killers, reducing your pain level can help to allow you to move without as much pain which can ease tension and encourage a reduction in inflammation in symptomatic areas. It is important to know what is causing pain in order to know that you’re not risking making it worse and seeing an osteopath can help you to understand more about what is causing your symptoms.

If you’re unsure about which pain medication is best for you, always speak to your GP and always follow instructions on the label. Not all painkillers are suitable for everyone.

If you’d like to know more about how osteopathy can help your pain, please contact me on or 07534933516


Reference New Guide to Medicines & Drugs by British Medical Association