These are first generation drugs such as ibuprofen (Nurofen®) or diclofenac (Voltarol®). They can be very effective at relieving musculoskeletal pain and are generally well tolerated although some patients can get side effects, particularly gastrointestinal bleeding and fluid retention. They can also cause an exacerbation of symptoms in asthmatics.
These are second-generation anti-inflammatory agents, which have been available for the last few years. There are many drugs available in this class, for example celecoxib (Celebrex®) or valdecoxib (Bextra®). They are generally better tolerated than NSAIDs and are associated with less risk of gastrointestinal bleeding.
This group of drugs includes, in roughly increasing strength, codeine, dihydrocodeine, and tramadol (which also has non-opioid analgesic properties). Codeine and dihydrocodeine preparations are often given in combination with paracetamol. Common such combinations include co-proxamol (paracetamol + dextropropoxyphene), co-codamol (paracetamol + codeine), and co-dydramol (paracetamol + dihydrocodeine).
This class of drugs is normally used in combination with NSAIDs and COX-2 inhibitors. While NSAIDs and COX-2 inhibitors can be particularly helpful with musculoskeletal pain, mild opioid preparations are often more helpful with stronger, more visceral pain.
This group of drugs includes buprenorphine, morphine, and fentanyl. These drugs are used for pain that has not been adequately controlled by weaker drugs. If you need one of these drugs it is likely you will initially be started on oral morphine liquid. Once your dose has been stabilised you will probably be changed to once or twice daily morphine tablets. Some patients may be suitable for buprenorphine or fentanyl patches, which are changed every few days. If you need one of these drugs you will have to be closely monitored and may need other drugs to help avoid side effects.
Neuropathic pain (nerve pain) is very common in many pain problems from spinal pain through to cancer pain. Its incidence is often underestimated and it is important that you realise that it does not respond well to treatment by normal painkillers. You will likely need special drugs, such as amitriptyline, carbemazepine, gabapentin, or pregabalin. You may be suitable for some topical preparations such as lidocaine patches, or capsaicin cream, if you have a localised area of neuropathic pain.