Painkillers: which, when and for what?

The active ingredient  diclofenac also  belongs to the group of NSAIDs.

That is why, like ibuprofen, it is used for gynecological pain or joint inflammation. Diclofenac is also used in other diseases of the musculoskeletal system, such as tendonitis or back pain, and in the treatment of pain after surgery. 

What is to be considered?

Like the areas of application, the risks are similar to those of ibuprofen. People who are also taking medication containing cortisone, for example as part of the treatment of chronic inflammatory bowel diseases, are particularly at risk of developing gastric ulcers, which can occur when taking NSAIDs.

Some dosage forms of Diclofenac, for example in the form of gel, painkillers or suppositories, are available in pharmacies without a prescription. 

Acetylsalicylic acid  (ASA), better known as Aspirin®, also belongs to the group of NSAIDs. It has analgesic, fever-reducing and anti-inflammatory effects. In addition, acetylsalicylic acid inhibits blood clotting, which can lead to increased and prolonged bleeding. 

Aspirin® is also used for mild to moderate pain and fever. In addition, the blood-thinning effect is used in high-risk patients to protect against (further) heart attacks or vascular occlusions ( thrombosis ). 

What is to be considered?

Children should only take acetylsalicylic acid in exceptional cases, if directed by a doctor, since taking it can cause damage to the liver and brain, known as Reye’s syndrome.

There is also an increased risk of bleeding due to the blood-thinning effect, which is why people who are at risk of falling should avoid taking it. 

Acetylsalicylic acid is also available from pharmacies without a prescription; higher doses require a prescription. 

Paracetamol also has an analgesic and fever-reducing effect, but is not one of the anti-inflammatory painkillers. It is also used for mild to moderate pain, including menstrual cramps in women, back pain and  fever . It can also be taken during pregnancy and breastfeeding and also by children.

What is to be considered?

Excessive doses of paracetamol can damage the liver. For this reason, no more than the amount listed in the leaflet should be taken. If the liver is already severely damaged, for example as part of an  alcohol addiction , another painkiller should be chosen. 

Paracetamol is also available in pharmacies without a prescription. Larger amounts require a prescription due to the possible damage to the liver, i.e. only available with a prescription. 

Metamizol , also known as Novaminsulfon, is the active ingredient in the pain medication Novalgin®. It has an antipyretic, analgesic and antispasmodic effect.

Compared to the painkillers mentioned above, metamizol can be used for stronger pain and high fever. It can help with colic, i.e. severe, labor-like pain caused, for example, by gallstones or kidney stones. 

What is to be considered?

If Novaminsulfon is taken for a long time, regular blood count checks by the doctor are recommended, since the active ingredient can lead to dangerous blood count changes in rare cases.

Metamizole is only available with a prescription from the pharmacy. 

Etoricoxib is used for joint pain, osteoarthritis or an acute attack of gout and also for toothache after surgery.

What is to be considered?

The cardiovascular risk, i.e. the probability of developing an arterial occlusion, a  heart attack  or a stroke, is increased when taking it. However, this risk is also increased with the NSAIDs mentioned, with the exception of acetylsalicylic acid. In addition, like NSAIDs, etoricoxib can damage the kidneys and lead to stomach ulcers. 

Etoricoxib is also only available in pharmacies with a doctor’s prescription. 

A strong painkiller is  Tilidin , which belongs to the group of opioids. Opioids are not available in pharmacies without a prescription and are particularly effective against pain. You need a so-called “narcotic prescription”, which only doctors can issue, in order to obtain opioids from the pharmacy. Compared to other opioids, tilidine is relatively weak: for example, morphine is five times stronger.

The active ingredient is used for severe to very severe pain and is well suited to combating chronic pain, i.e. pain that lasts over a longer period of time.

What is to be considered?

Opioids are only available in pharmacies with a prescription for narcotics, as they can lead to dependency and reduce the natural drive to breathe. The reduction in respiratory drive leads to slower breathing and can cause symptoms such as shortness of breath, shortness of breath or symptoms of suffocation. Ingestion can also lead to  constipation  .

The opioid morphine is administered for moderate to severe pain when the classic drugs, such as paracetamol or  ibuprofen , in combination with weaker-acting opioids, such as tilidine, are not effective enough against the pain. Like tilidine, morphine is used to treat chronic pain and to relieve pain associated with cancer.

What is to be considered?

Like any opioid, morphine is subject to the Narcotics Act. The prescription can only be issued by a specific prescription from the doctor to prevent abuse of the drug and addiction to the substance.

Fentanyl also   belongs to the opioids and is significantly more effective than morphine. This painkiller is used for severe pain associated with cancer, severe life-threatening injuries to the body, for example in the context of a traffic accident or severe burns.

What is to be considered?

As with the other opioids, a specific prescription must be issued for the prescription of fentanyl, since it should only be used in the case of severe pain and dependence can threaten.

NSAIDs, such as ibuprofen or diclofenac, have an anti-inflammatory effect, which is why they can be used to treat swelling and pain from injuries or after surgery. They are also used for menstrual pain in women,  back pain ,  headaches  or migraines and can be purchased in pharmacies without a prescription. Compared to the other painkillers in this category, the NSAID Aspirin® leads to a greater tendency to bleed, which must be taken into account.

Children and pregnant women can take paracetamol or ibuprofen, although pregnant women should only take ibuprofen in the first and second trimester of pregnancy.

Opioids, such as tilidine or morphine, are reserved for very severe, chronic pain because they can lead to addiction. 

However, not only the opioids, but also all other pain medications can cause undesirable side effects. That is why it is recommended not to take painkillers for more than three to four days without consulting a doctor.