Pain Relief in the UK: Which Painkiller, Where to Get It and How to Use It Safely
A practical guide to UK painkillers: what you can buy in a supermarket, what needs a pharmacist or a prescription, matching the medicine to the pain, combining them safely, and when pain needs more than a tablet.
Part of the Complete Pain Guide.
Key fact: For most everyday pain, the most effective approach is not a stronger painkiller but the right one, at the right dose, for long enough. Paracetamol and ibuprofen can safely be taken together, an anti-inflammatory gel is often better than a tablet for a painful joint, and codeine adds less than most people expect while bringing constipation and the risk of dependence.
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Almost all everyday pain relief in the UK comes from three groups of medicine. Each works in a different way, which is why they suit different kinds of pain and why some can be combined.
| Group | Examples | How it works | Best for |
|---|---|---|---|
| Paracetamol | Paracetamol tablets, capsules and liquids | Acts mainly in the brain and spinal cord to reduce pain signals and fever | Headache, fever, mild to moderate pain; the safest starting point for most people |
| Anti-inflammatories (NSAIDs) | Ibuprofen, naproxen, diclofenac, aspirin, and NSAID gels | Block the production of prostaglandins, which drive pain, swelling and inflammation | Sprains, back pain, period pain, dental pain, gout and arthritis flares |
| Opioids | Codeine, dihydrocodeine, tramadol, morphine | Act on opioid receptors in the brain, spinal cord and gut | Short-term moderate to severe acute pain, when the other two are not enough |
Alongside these sit medicines for specific types of pain that ordinary painkillers do not treat well, such as triptans for migraine and nerve pain medicines such as amitriptyline. How pain is classified into types is explained in the complete pain guide; this guide is about choosing and using the medicines.
What you can buy, and what needs a prescription
UK medicines fall into three legal categories, and which one a painkiller is in decides where you can get it and how much you can buy at once.
| Category | Where | Pain relief examples |
|---|---|---|
| General sale (GSL) | Supermarkets, petrol stations and shops, as well as pharmacies | Small packs of paracetamol, ibuprofen 200mg and 400mg, aspirin, and some NSAID gels |
| Pharmacy medicine (P) | From a pharmacy, with a pharmacist’s oversight | Larger packs of paracetamol and ibuprofen, low-strength co-codamol (8/500) and other codeine combinations, and naproxen for period pain |
| Prescription-only (POM) | With a prescription from a doctor, dentist or other prescriber | Ibuprofen 600mg, naproxen 250mg and 500mg tablets, diclofenac tablets, stronger co-codamol (15/500 and 30/500), tramadol, and nerve pain medicines |
Pack sizes are deliberately limited. Paracetamol and aspirin are sold in packs of up to 16 tablets outside pharmacies and up to 32 in a pharmacy, a rule introduced to reduce overdoses. Over-the-counter codeine products come in packs of no more than 32, and must carry a warning that they can cause addiction and should be used for no more than three days.
16
Maximum paracetamol pack outside a pharmacy
4g
Maximum paracetamol in 24 hours for most adults
3 days
Limit for over-the-counter codeine without advice
Matching the painkiller to the pain
The single most useful question is whether the pain involves inflammation — swelling, heat, a recent injury, a period, a tooth or a flare of arthritis. If it does, an anti-inflammatory usually works better than paracetamol. If it does not, or if anti-inflammatories are unsuitable for you, paracetamol is the usual first choice.
| Type of pain | Usually tried first | Worth knowing |
|---|---|---|
| Tension headache | Paracetamol or ibuprofen | Using painkillers on many days a month can itself cause headaches (see below) |
| Migraine | Ibuprofen, aspirin or paracetamol early in the attack; a triptan if these are not enough | Triptans are compared in triptans for migraine |
| Sprains, strains and bruising | An NSAID gel or ibuprofen tablets, plus paracetamol if needed | Rest, ice and gentle movement still matter |
| Short-term back pain | An NSAID such as ibuprofen | NICE does not recommend paracetamol alone for low back pain; keeping active helps recovery |
| Period pain | Ibuprofen or naproxen, started at the first sign of pain | Anti-inflammatories reduce the prostaglandins that cause cramping |
| Toothache | Ibuprofen, with paracetamol if needed | Pain relief buys time; it does not treat the cause, so see a dentist |
| Knee or hand osteoarthritis | An NSAID gel | NICE recommends a topical NSAID first for knee osteoarthritis |
| Gout attack | A full-dose NSAID such as naproxen, if suitable | Start as early as possible in the attack |
| Nerve pain: burning, shooting, electric-shock or pins-and-needles pain | Usually prescription nerve pain medicines | Ordinary painkillers often do little for nerve pain |
The anti-inflammatories differ mainly in how long they last and in their side effects. They are compared side by side in NSAIDs compared.
Taking painkillers together safely
Because paracetamol and anti-inflammatories work in different ways, adults can take them together, or alternate them, for better pain relief than either alone. What you must not do is double up on the same type.
| Combination | Safe? | Why |
|---|---|---|
| Paracetamol with ibuprofen | Yes, for most adults | Different mechanisms; each at its own normal dose |
| Paracetamol with co-codamol | No | Co-codamol already contains paracetamol, so this risks an overdose |
| Ibuprofen with naproxen, diclofenac or aspirin | No | Two NSAIDs add side effects, especially stomach bleeding, without adding much benefit |
| Oral ibuprofen with an NSAID gel | Usually avoided | Some of the gel is absorbed; ask a pharmacist if you want both |
| Codeine with alcohol or sleeping tablets | No | Increased drowsiness and slowed breathing |
Watch for hidden paracetamol. Paracetamol is also in co-codamol, many cold and flu remedies, hot lemon drinks, night-time cold medicines and some migraine tablets. Taking two of these together, or one alongside ordinary paracetamol, is one of the commonest ways people accidentally exceed the daily limit. Check the active ingredients of everything you take.
Usual adult doses of over-the-counter painkillers
| Medicine | Usual adult dose | Maximum in 24 hours |
|---|---|---|
| Paracetamol | 500mg to 1g every 4 to 6 hours | 4g (eight 500mg tablets); lower if you weigh under 50kg, drink heavily or have liver disease |
| Ibuprofen (over the counter) | 200mg to 400mg up to three times a day, with food | 1,200mg without medical advice |
| Aspirin | 300mg to 900mg every 4 to 6 hours | 4g; not for anyone under 16 |
Always follow the leaflet for the specific product, as strengths differ. Higher prescription doses of ibuprofen, such as ibuprofen 600mg, are only used after a clinical assessment. More detail on paracetamol, including what to do if you have taken too much, is in the paracetamol guide.
If you have taken more paracetamol than the maximum, go to A&E straight away, even if you feel well. Paracetamol overdose damages the liver over the following days, often with no symptoms at first, and treatment works best when it is started early.
Who should be careful with anti-inflammatories
NSAIDs such as ibuprofen and naproxen are effective and safe for most people in short courses, but they can irritate the stomach, affect the kidneys, raise blood pressure and, at higher doses over longer periods, slightly increase the risk of heart attack and stroke. Speak to a pharmacist or prescriber before taking one if any of these apply:
| Situation | Why it matters |
|---|---|
| A past stomach ulcer or bleed, or indigestion | Higher risk of bleeding; a stomach-protecting medicine may be needed |
| Aged over 65 | Stomach, kidney and heart side effects are more likely |
| Kidney disease or heart failure | NSAIDs can worsen both |
| Heart disease, a past stroke, or high blood pressure | Higher cardiovascular risk, particularly with longer use |
| Asthma that has worsened with aspirin or ibuprofen before | Some people with asthma are sensitive to all NSAIDs |
| Taking blood thinners, steroids or SSRI antidepressants | Increased risk of bleeding |
| Taking blood pressure tablets such as ACE inhibitors with a diuretic | The combination with an NSAID can harm the kidneys, especially when dehydrated |
| Pregnancy | Not usually recommended, particularly in later pregnancy |
Take oral NSAIDs with or after food, use the lowest dose that works for the shortest time, and stop and seek advice if you get black stools, vomit blood, or develop severe indigestion.
Gels and creams: often the first choice for joints
For pain in a single joint or muscle near the surface — a knee, hand, ankle or elbow — an NSAID gel can work about as well as a tablet, with far less of the medicine reaching the rest of the body. That makes gels a good option for older adults and for people who should avoid oral NSAIDs, and NICE recommends a topical NSAID as the first medicine for knee osteoarthritis.
| Product | What it is | Worth knowing |
|---|---|---|
| Voltarol Emugel | Diclofenac gel | Applied three or four times a day |
| Voltarol 12 Hour Emugel | Higher-strength diclofenac gel | Applied twice a day, morning and evening |
| Ketoprofen gel | Ketoprofen anti-inflammatory gel | Can cause a skin reaction in sunlight; keep the treated area covered from the sun during use and for two weeks after |
| Lidocaine 5% ointment | A local anaesthetic | Numbs a small area of painful skin or mucous membrane rather than reducing inflammation |
Wash your hands after applying a gel, do not apply it to broken skin, and do not cover it with a tight bandage. How to get the most from diclofenac gel is covered in the diclofenac gel guide.
Codeine and stronger painkillers
Codeine is converted in the liver into morphine. Low-strength combinations such as co-codamol 8/500 are available from pharmacies, and stronger versions need a prescription. They have a place in short-term moderate pain, but they are often less helpful than people expect, and the trade-offs are significant.
Dependence
Codeine can be addictive, even at over-the-counter doses. That is why it is limited to three days without advice.
Constipation
Almost universal, and it does not wear off. See opioid-induced constipation.
Drowsiness and driving
Codeine can impair driving. Do not drive if you feel drowsy, and do not combine it with alcohol.
Variable effect
Some people convert codeine poorly and get little benefit; a few convert it very quickly, which is risky.
Codeine must not be given to children under 12, should not be used when breastfeeding, and is not recommended after tonsil or adenoid removal in under-18s. Tramadol and stronger opioids are prescription-only and are usually reserved for short-term severe pain.
Medication-overuse headache. Taking simple painkillers on 15 or more days a month, or codeine, combination painkillers or triptans on 10 or more days a month, for three months or more can cause daily headaches. The cure is a planned withdrawal of the painkillers, ideally with a GP’s support. If you are reaching for painkillers most days, it is worth reviewing the headache rather than the painkiller.
Pregnancy, breastfeeding, children and older adults
| Group | Usually suitable | Usually avoided |
|---|---|---|
| Pregnancy | Paracetamol, at the lowest effective dose for the shortest time | Ibuprofen, naproxen and other NSAIDs, especially in later pregnancy, unless a doctor advises; codeine unless prescribed |
| Breastfeeding | Paracetamol and ibuprofen | Codeine and aspirin |
| Children | Children’s paracetamol from 2 months and ibuprofen from 3 months, dosed by age or weight | Aspirin under 16; codeine under 12 |
| Older adults | Paracetamol, and NSAID gels for joint pain | Regular oral NSAIDs without review; sedating painkillers that raise the risk of falls |
For children, alternating paracetamol and ibuprofen is only recommended if one alone has not helped. Always use the measuring device that comes with children’s medicines.
When pain lasts: what NICE now recommends
Pain that lasts more than three months is called chronic pain, and the evidence on painkillers for it has changed. For chronic primary pain — long-term pain that is not explained by another condition, such as fibromyalgia or some chronic back pain — NICE now advises against starting paracetamol, NSAIDs or opioids, because they do little and their harms add up over time. Instead, it recommends exercise programmes, psychological therapies such as CBT or acceptance and commitment therapy, acupuncture in some cases, and certain antidepressants, which can help with pain even when mood is not the problem.
For nerve pain, such as sciatica that persists, diabetic nerve pain or pain after shingles, the first-line medicines are amitriptyline, duloxetine, gabapentin or pregabalin, chosen and adjusted by a prescriber. Gabapentin and pregabalin are controlled drugs because of their potential for misuse. Pain that comes from a clear cause, such as osteoarthritis or inflammatory arthritis, is still treated according to that cause.
The options for long-term pain are covered in more depth in chronic pain treatment, and the common causes of joint and muscle pain in musculoskeletal pain.
When to get medical help
Call 999 for sudden severe chest pain or chest pain spreading to the arm, jaw or back; a sudden, severe headache that peaks within a minute; pain with weakness, numbness or difficulty speaking; or severe abdominal pain with vomiting blood or collapse. For back pain with numbness around the bottom or genitals, new difficulty passing urine or controlling your bowels, or weakness in both legs, go to A&E immediately.
See a GP or pharmacist if:
- pain has not improved after a few days of over-the-counter painkillers, or keeps coming back
- you are taking painkillers on most days
- pain comes with a fever, unexplained weight loss, or night sweats
- a joint is hot, red and swollen
- pain is stopping you working, sleeping or doing everyday activities
- you are not sure which painkillers are safe with your other medicines or health conditions
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See pain relief treatments →Frequently Asked Questions
Can I take paracetamol and ibuprofen together?
Yes, most adults can take paracetamol and ibuprofen at the same time, or alternate them, because they work in different ways. Take each at its normal dose and do not exceed the daily maximum of either. Do not combine ibuprofen with another anti-inflammatory such as naproxen or aspirin, and check that nothing else you are taking also contains paracetamol.
What is the strongest painkiller you can buy over the counter in the UK?
Pharmacies can sell low-strength codeine combinations such as co-codamol 8/500, but they are limited to three days of use because codeine can cause addiction, and they often add less than expected. For many types of pain, paracetamol and ibuprofen taken together at full over-the-counter doses work as well or better. Stronger painkillers need a prescription.
Is ibuprofen or paracetamol better?
It depends on the pain. Ibuprofen is usually better for pain involving inflammation, such as sprains, back pain, period pain and toothache. Paracetamol is usually the first choice for headaches and fever, and for people who should avoid anti-inflammatories, such as those with stomach ulcers, kidney problems or in pregnancy.
How much paracetamol can I take in a day?
Most adults can take 500mg to 1g every 4 to 6 hours, up to a maximum of 4g, which is eight 500mg tablets, in 24 hours. The maximum is lower if you weigh under 50kg, drink alcohol heavily or have liver disease. Remember that co-codamol and many cold and flu remedies also contain paracetamol.
Do painkiller gels really work?
Yes, for pain in joints and muscles close to the skin, such as the knee, hand or ankle. Anti-inflammatory gels such as diclofenac can work about as well as tablets for these areas, with much less of the medicine reaching the rest of the body. NICE recommends a topical anti-inflammatory as the first medicine for knee osteoarthritis.
Which painkiller is safe in pregnancy?
Paracetamol is the usual first choice in pregnancy, at the lowest effective dose for the shortest time. Ibuprofen and other anti-inflammatories are not usually recommended in pregnancy, particularly in later pregnancy, unless a doctor advises them, and codeine should only be used if prescribed. Speak to a pharmacist, midwife or GP before taking any painkiller while pregnant.
Why can painkillers cause headaches?
Taking painkillers on many days each month can lead to medication-overuse headache. It is linked to simple painkillers on 15 or more days a month, or codeine, combination painkillers or triptans on 10 or more days a month, for three months or more. The treatment is a planned withdrawal from the painkillers, ideally with a GP's support.
References
- National Institute for Health and Care Excellence. Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain (NG193). nice.org.uk
- National Institute for Health and Care Excellence. Neuropathic pain in adults: pharmacological management in non-specialist settings (CG173). nice.org.uk
- National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management (NG226). nice.org.uk
- National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management (NG59). nice.org.uk
- National Institute for Health and Care Excellence. Clinical Knowledge Summaries: Analgesia — mild to moderate pain; NSAIDs — prescribing issues; Headache — medication overuse. cks.nice.org.uk
- Medicines and Healthcare products Regulatory Agency. Codeine: restricted use in children and over-the-counter codeine warnings. Drug Safety Update. gov.uk
- Joint Formulary Committee. British National Formulary: paracetamol, ibuprofen, naproxen, codeine. bnf.nice.org.uk
- NHS. Painkillers, paracetamol and ibuprofen. nhs.uk
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Painkillers are not suitable for everyone and can interact with other medicines. Always read the patient information leaflet, do not exceed the stated dose, and speak to a pharmacist or doctor if pain persists or you are unsure what is safe for you. In a medical emergency, call 999.