Paul and Johnny have recently returned to university in order to be able to prescribe medication for pain relief. This is a recent advancement in our profession, enabling physiotherapists to prescribe medications in their area of practice (in our case musculoskeletal (MSK) medicine) so long as they are suitably trained and competent to do so. The primary driver for this advanced qualification was to be able to help our patients in a more timely manner – essentially becoming a one-stop shop for MSK pain and injury. We have now completed the course and can offer prescriptions as part of our consultations.
However, some common opinions we hear in clinic regarding pain relief include, “I don’t like taking pills”, “will masking the pain make the injury worse if I can’t feel it?” and “will I get addicted to the medication?”. Another factor that people are concerned about is that they feel they do not want to bother anyone with their pain or find it difficult to get an appointment with their GP.
Over the counter medication
Over the counter (OTC) pain relief, as the name suggests is available for general sale. This is the type of medication that you can buy in a supermarket – anything from Calpol (containing paracetamol) for a teething child to relief from a hangover (again paracetamol!). These are a group of drugs that are considered relatively safe and do not require a prescription or consultation with a medical professional. As the financial demand on the NHS has grown, many GPs are now directing their patients to over the counter pain relief as opposed to a prescription – perhaps you have experienced this. Do check out the NHS website to find out more about OTC medications and exemptions to this general rule.
Two of the most commonly used and readily available medications for the relief of pain are paracetamol and ibuprofen. As above, paracetamol is present in everything from remedies for teething children to colds and headache relief. Formulas continuing ibuprofen are used for conditions with an inflammatory component such as, sore throats, back ache and period pain.
As part of our non medical prescribing studies, we have looked into both of these drugs at length.
Paracetamol is one of the safest drugs available. The main governing body for health care and medication, NICE, have indicated the use of paracetamol in neck pain, back pain, sciatica, headaches, bursitis, shoulder conditions, tendinopathy and osteoarthritis.
Paracetamol acts in the central nervous system to dull pain signals and also to relieve fever. One of the best things about this medication if that as long as you have no issues with your liver or kidneys and take the medication as prescribed, paracetamol is a very safe drug and rarely causes any side effects. Hence paracetamol is considered ‘entry level’ pain relief. It is also very cheap – as little as £0.15 for a packet – thats less than a penny per tablet!
x2 (500mg), four times per day
Ibuprofen is termed a Non-steroidal anti-inflammatory drug (NSAID) and is considered the entry level drug of choice for painful and inflammatory conditions. Within the context of musculoskeletal medicine, ibuprofen is indicated for conditions such as acute blocked neck, nerve pain from the neck/in the arm, lower back pain, knee pain, osteoarthritis, plantar fasciitis, tennis elbow, bursitis and general sprains and strains. As well as tablet form, ibuprofen is also available as a cream or gel that you apply to the skin.
Ibuprofen exerts its action by effecting a particular group of enzymes in the body responsible for inflammation (cyclooxygenase). Where these COX enzymes are responsible for inflammation, they are also responsible for protecting the stomach and intestinal system. The use of ibuprofen (particularly if prolonged) can treat inflammation but can also have detrimental effects on the stomach/intestines such as indigestion or heartburn. Ibuprofen can also effect certain heart and respiratory conditions so do check out this website or ask your local pharmacy if ibuprofen is appropriate for you.
If it is safe to do so and make sure to read the packet instructions but ibuprofen is usually taken:
x2 (200mg), three times per day
Lots of people often choose to take these with their meals as it provides a level of protection for the stomach and follows a natural 3 times per day rhythm.
COVID-19 ADVICE: you may have read some information suggesting that Ibuprofen makes COVID-19 symptoms worse. This is a lab-based theoretical consideration only with little clinical evidence. The World Health Organisation does not advice against ibuprofen and the government have recommended ibuprofen to treat the symptoms of COVID-19.
Guidance suggests to start on paracetamol only for painful conditions but if this is ineffective to add ibuprofen also. With acute and painful MSK conditions often paracetamol only is not enough to relieve the pain. Also many MSK conditions such as osteoarthritis, shoulder pain, sciatica, etc have an inflammatory component so an NSAID is the therapeutic choice.
Paracetamol and ibuprofen can be taken together. Take ibuprofen at meal times and then intersperse the 4 doses of paracetamol throughout the day to gain the most benefit from the medication.
Both paracetamol and ibuprofen are entry level pain relief medication. They are as ‘cheap as chips’ (however I would like to get a check on the inflation rate of chips) – you can buy a packet of paracetamol and ibuprofen and still have change from 50p. Certainly paracetamol is a very safe medication and as long as you don’t have any health issues (heart problems, asthma, indigestion, etc) and take it for a short period of time, ibuprofen is safe also. If you are in any doubt about over the counter medications, simply have a chat with the pharmacist who will give you professional advice.
One of the main things we do as physiotherapsts is to restore movement and function. If pain is restricting your movement or ability to do a certain task, OTC pain relief can really help you on your way to restoration and recovery.
Musculoskeletal conditions respond very well to physiotherapy along side appropriate pain relief. To book an appointment with one of our experienced team give us a call (01142678181) or book online here.
Be sure to check out or upcoming blogs about alternatives to pain medication and common perceptions regarding pain relief. Should you have any questions feel free to get in touch: