Types of Pain
| Type | Mechanism | Description | Examples |
|---|---|---|---|
| Nociceptive | Tissue damage activates pain receptors | Aching, throbbing, sharp | Post-surgical, fracture, arthritis |
| Neuropathic | Nerve damage or dysfunction | Burning, shooting, electric shock, allodynia | Sciatica, diabetic neuropathy, shingles PHN |
| Nociplastic | Central sensitisation — amplified pain signals | Widespread, disproportionate, fatigue, cognitive changes | Fibromyalgia, IBS, chronic widespread pain |
| Mixed | Combination | Features of multiple types | Many chronic pain conditions |
WHO Analgesic Ladder (Adapted)
| Step | Drug Class | Examples |
|---|---|---|
| Step 1 (mild) | Non-opioid | Paracetamol, ibuprofen, naproxen, topical diclofenac |
| Step 2 (moderate) | Weak opioid | Codeine, tramadol (+ Step 1) |
| Step 3 (severe) | Strong opioid | Morphine, oxycodone, fentanyl, buprenorphine |
| Neuropathic adjuvants | Non-opioid specific | Duloxetine, gabapentin, pregabalin, amitriptyline, topical capsaicin |
Paracetamol — Still the Best First StepParacetamol 1g four times daily is as effective as stronger analgesics for many types of musculoskeletal pain, with a far better safety profile. Take regularly rather than 'as needed' for chronic pain — steady levels are more effective.
Opioid Long-Term Risks
Tolerance (needing higher doses), dependence (withdrawal on stopping), opioid-induced hyperalgesia (opioids paradoxically worsen pain sensitivity), constipation, cognitive impairment, and endocrine effects (low testosterone, amenorrhoea). Long-term opioids for chronic non-cancer pain are now actively reviewed and tapered where possible.
Does ibuprofen or paracetamol work better for pain?
For musculoskeletal pain, anti-inflammatory analgesics (ibuprofen, naproxen) are generally more effective than paracetamol — especially when inflammation is the driver. Paracetamol is preferred for headache and post-operative pain. Combining both is safe and additive.
What is the best treatment for nerve pain?
First-line: duloxetine (best evidence for diabetic neuropathy), gabapentin or pregabalin (best for PHN and fibromyalgia), amitriptyline (low-dose, good for various neuropathies). Topical high-dose capsaicin 8% patch for localised neuropathic pain.
Can physiotherapy help chronic pain?
Yes — exercise and active rehabilitation are core treatments for chronic musculoskeletal pain. They reduce central sensitisation, improve function, and can reduce medication requirements. Pain psychology (CBT, ACT) addresses the cognitive and emotional dimensions of chronic pain.
Are opioids appropriate for back pain?
Strong opioids are generally not appropriate for chronic non-specific back pain. Evidence shows they are no more effective than NSAIDs but carry significant risks. Short-term use (days) for acute severe pain is sometimes justified; long-term use is actively avoided.
Medical Disclaimer: This page is for general education only and does not replace professional medical advice. Always consult a qualified healthcare provider.