Walk into any pharmacy and you’ll be confronted with dozens of pain relief products. Most contain just a handful of active ingredients, often in different combinations and with different prices. Here’s how to cut through the noise and choose wisely.

The Two Main OTC Analgesics

Paracetamol (acetaminophen in the US) has been used for over 60 years and remains one of the safest analgesics available when taken correctly. It works centrally — raising the pain threshold and resetting the hypothalamic temperature set-point for fever. It has no anti-inflammatory effect at the doses available. Maximum dose: 4g per 24 hours for a healthy adult (8 x 500mg tablets, no closer than every 4 hours). Smaller doses (3g maximum) are recommended for elderly patients and those under 50kg body weight. The window between therapeutic and toxic dose is narrower than most people realise — paracetamol overdose is the leading cause of acute liver failure in the UK.

Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID). Unlike paracetamol, it reduces inflammation at the source — making it more effective for pain with an inflammatory component. It also lowers fever. Maximum OTC dose: 1200mg per 24 hours (three 400mg tablets). Must be taken with food to reduce gastric irritation. The most common adverse effects are gastrointestinal: stomach pain, heartburn, and (with prolonged use) peptic ulcers. People on ibuprofen long-term should consider taking a PPI (omeprazole) to protect the stomach lining. Cardiovascular and renal adverse effects increase with dose and duration.

Aspirin

Aspirin (acetylsalicylic acid) is an NSAID with additional antiplatelet properties. At the OTC analgesic dose (300–900mg), it’s effective for headache, mild-to-moderate pain and fever. At low dose (75mg daily), it’s used for secondary cardiovascular prevention. Not recommended for children under 16 (risk of Reye’s syndrome). Its main use in acute pain has been largely superseded by ibuprofen, which is better tolerated.

Caffeine Combinations

Many branded pain products add caffeine (typically 50–65mg per tablet) to analgesics. Caffeine acts as an analgesic adjuvant — it increases the bioavailability of paracetamol and has mild vasoconstrictive properties that specifically help tension headaches and migraines. Studies show caffeine combinations provide around 40% better analgesia than the analgesic alone. Examples: Anadin Extra (aspirin + paracetamol + caffeine), Panadol Extra (paracetamol + caffeine).

Codeine-Containing Combinations

Codeine (8mg) combined with paracetamol (500mg) — co-codamol 8/500 (Solpadeine, Nurofen Plus contains ibuprofen + codeine) — provides modestly stronger pain relief than analgesic alone. Available from pharmacy for short-term use only (maximum 3 days). Codeine is a prodrug converted to morphine in the liver — there is wide variation in conversion rates, meaning it works well for some people and not at all for “ultra-slow metabolisers.” Risk of dependence with longer use. Constipation is a predictable side effect. Not suitable for children under 12 or breastfeeding women.

Browse Pain Relief products at Huncoat Pharmacy. Related: Sports Injuries & Muscle Pain, Heart Health Guide.

At Huncoat Pharmacy: Pharmacy First, Browse pain relief products.