In the early stages of their pain people were sometimes prescribed paracetamol. They thought that paracetamol by itself wasn’t effective for chronic pain, but several commented that it helps when combined with other types of medication.

Many people we talked to were taking a combination of codeine and paracetamol. Codeine is a mild opioid with an analgesic effect. Many got good pain relief from these medicines although often they had tried different preparations to find the most effective.

Most people found that they could take a stable dose although a few told us that they had sometimes increased their dose because they had become more active. One woman who had just started work had changed to a different codeine medication and was concerned that she might be becoming tolerant. Some didn’t get enough pain relief from codeine medicine and were prescribed stronger opioids (see also ‘Medication’ strong opioids‘).

People taking drugs containing codeine described problems with constipation, nausea and sweating. Such drugs (drugs with the prefix ‘co’) often also contain paracetamol. Often people worried about the effects that the paracetamol might have on their liver and kidneys. There is no evidence that, at moderate dosages, paracetamol damages previously healthy liver or kidneys when used for long periods.

It is important to talk to the GP about medication regularly, to ensure that paracetamol intake is safe. Some recent research* into the long-term use of paracetamol has shown that high doses can have potential effects upon the cardiovascular system, kidney and gastrointestinal system, but it is agreed that further research is needed and individuals should consult their doctor if concerned.

A few people were using anti-inflammatory drugs (nonsteroidal anti-inflammatory drugs (NSAIDS)) such as asprin, ibuprofen, diclofenac and naproxen and a couple had been prescribed a new type of anti-inflammatory drug, a cox-2 inhibitor (celecoxib), which produces less side effects in the stomach and gut (see also ‘Introduction: medication and side effects‘).

People taking anti-inflammatory drugs often experienced mild stomach or gut problems and said it was important to take their tablets with food. Sometimes people had to take additional medicine together with it to protect the gut lining. However some people found that they could not take or had to change their medication.

One man had a history of ulcers and could not take anti-inflammatory drugs. A woman who had developed irritable bowel syndrome (IBS) changed to a cox-2 inhibitor, which does not affect the gut lining.

A few people had bought creams or ointments containing an anti-inflammatory. Some people with arthritis found these helpful: a woman got relief from massaging an anti-inflammatory cream into her hip and knees. Others felt they were ineffective and not worth the money.

One woman with work-related bilateral wrist pain had tried capsaicin cream (contains extract of chilli) and menthol cream. She had some relief from the cooling effect of the menthol cream while also taking an antidepressant for pain.

Qutenza patches are now available through the NHS. They contain a high dose of capsaicin which over stimulates the pain receptors in the skin and desensitises them. The patch needs to be applied in the outpatients’ department of a hospital as specialist training is required. The patch is applied to the painful area and left for 30 to 60 minutes and removed. It can take 1–14 days for the full pain relief to take effect. It can provide relief for some people, for up to 3 months. Some may not get any benefit from the treatment. The treatment can be repeated every 90 days. No one we interviewed had tried this treatment.

Occasionally, people had been prescribed a benzodiazepine, prescribed mainly as a muscle relaxant, but these drugs also have a sedative effect. People who take a benzodiazepine for a long time can become dependent on them and need to be weaned off them.

One woman said she used to reserve this type of medication for severe muscle spasm as her doctor had warned not to use it regularly. Another woman who had moved GP practices had mistakenly taken a benzodiazepine for a long period and had to be weaned off it very gradually.

*Roberts E, Nunes VD, Buckner S, et al. Paracetamol: not as safe as we thought? A systematic literature review of observational studies. Annals of the Rheumatic Diseases. Published online March 2 2015.

For an overview of the research see NHS Choices: Is long-term paracetamol use not as safe as we thought?