# Painkillers and anti-inflammatory medicines > Painkillers such as paracetamol ease pain, and anti-inflammatory medicines (NSAIDs) such as ibuprofen also calm swelling. They relieve symptoms rather than cure the cause. A gel or cream is often tried first for sprains and knee arthritis, while tablets suit some people but carry more risks. Guide in [Treatments](https://footanklelowerlimb.com.au/learn/topics/treatments), from Foot Ankle Lower Limb: https://footanklelowerlimb.com.au/learn/analgesics-and-anti-inflammatory-medicines Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod (Podiatrist) on 27 October 2026. Next review by 27 October 2027. - **They ease pain, and NSAIDs also calm swelling.** NSAIDs (non-steroidal anti-inflammatory drugs) treat the symptoms, not the cause. - **For a sprain or strain, a gel or cream is often tried first.** Tablets or paracetamol are the alternatives. - **Relief is usually modest.** Not everyone gets good relief, and paracetamol alone helps little with some problems. - **Use the least you need, for as short a time as you can.** NSAIDs carry stomach, kidney and heart risks. - **Check with a pharmacist or GP first** if you're older, pregnant, take other medicines or have other health conditions. ## What are painkillers and anti-inflammatory medicines, and how do they work? Analgesics (painkillers) are medicines that ease pain. NSAIDs, such as aspirin, ibuprofen and diclofenac, also reduce inflammation (redness and swelling) and lower fever [1]. They work by stopping injured cells from making prostaglandins, the chemicals that cause inflammation and swelling [1]. That eases pain, but it isn't a cure [2]. Paracetamol is often the first medicine suggested for short-term pain [3]. The right choice depends on the pain. Paracetamol and anti-inflammatories are most effective for pain caused by inflammation, such as an injury or arthritis, while pain from sensitive or damaged nerves usually needs a different type of medicine [4]. ## What are they used for, and how well do they work? For sprains, strains and whiplash in adults, topical NSAIDs (gels or creams rubbed on the skin) gave the best balance of benefit and harm, followed by NSAID tablets or paracetamol [5]. For knee osteoarthritis (wear-related joint pain), topical NSAIDs are strongly recommended [6]. For hip or widespread osteoarthritis, NSAID tablets are favoured, because a gel isn't expected to reach a deep joint [6]. Expect modest relief. Some NSAID tablets give clearly meaningful pain relief in knee and hip osteoarthritis, but paracetamol gives only a small benefit [7], and it didn't speed recovery from sudden low back pain [8]. After surgery, many people don't get good relief [9], and most medicines for long-term pain help only a minority of people [10]. Tablets can take up to an hour to start working, and a gel or cream up to 2 days for its full effect [2]. ## Are they right for me? Most adults can take NSAIDs [11], but you shouldn't if you're allergic to them, pregnant or planning a pregnancy, or have a kidney or liver condition or a gut ulcer or bleeding [1]. They're not usually recommended while breastfeeding [11]. Avoid them, or take particular care, if you have asthma, Crohn's disease, ulcerative colitis, heart problems or a bleeding disorder [4]. Being over 65, dehydrated or already taking another NSAID raises the chance of side effects, and older people shouldn't use NSAIDs regularly [1]. Older adults and people with high blood pressure or heart disease need a careful weighing of benefit and risk [5]. For knee osteoarthritis, a gel or cream is favoured if you're frail or have stomach or heart conditions, because less reaches the rest of your body [7]. > [!see] If you have other health conditions > Check with a pharmacist or your GP before starting an NSAID, especially if you take other medicines, including blood thinners. The evidence here is in adults. Get advice from a doctor or pharmacist before giving any of these medicines to a child. ## What should I expect when I use them? Over-the-counter medicines are usually suitable for mild-to-moderate pain [3]. Read the label, follow the amount your pharmacist or doctor advises, and don't go over it [4]. Use the lowest amount that controls your pain, for as short a time as you can, ideally only when you need it rather than every day [7]. Taking NSAID tablets with food lowers the chance of stomach upset [1]. If your pain improves, ask your pharmacist or GP whether you can reduce or stop the medicine, which helps cut side effects [2]. Don't take someone else's medicine. ## What are the risks and side effects? NSAIDs can cause stomach ulcers or bleeding, kidney problems and serious allergic reactions [11]. They're also linked with high blood pressure and heart disease [12]. The chance of side effects goes up if you're over 65, take more than the recommended amount, take them for a long time, or take more than one NSAID [1]. Gels and creams cause more skin reactions than a dummy treatment, but fewer stomach problems [13]. Regular large doses of paracetamol can damage the liver [14]. Opioids (strong prescription painkillers) can be addictive and cause life-threatening breathing problems, even when taken as prescribed [3]. If you stop suddenly or cut back too fast you can get withdrawal, so any reduction should be gradual and supervised by a healthcare professional [10]. Alcohol and other sedating medicines add to the breathing and drowsiness risk [15], and opioids may not be safe with obstructive sleep apnoea [10]. ## How do they compare with other options? Guidelines put non-opioid options ahead of opioids for common pain. Opioids aren't recommended first for low back pain, sprains and strains, because NSAIDs work as well or better and opioids carry risks of long-term use [5]. For osteoarthritis, the benefit of opioids doesn't outweigh the harm [7]. Medicines also aren't the only choice. Exercise is strongly recommended for osteoarthritis, alongside gels for the knee [6]. For sudden low back pain, non-drug options such as a heat pack or massage come first, with NSAIDs or muscle relaxants if you want a medicine [16]. If paracetamol alone isn't helping, ask your pharmacist or GP about other options. ## When to see a podiatrist See a podiatrist if your foot or ankle pain isn't settling with self-care. Talk to a pharmacist or your GP if a medicine isn't helping, you have frequent or worrying side effects, or you're thinking of using an NSAID for a long time. Stop taking the NSAID. Call 000 and ask for an ambulance if you have chest pain, signs of a stroke (such as sudden weakness or difficulty speaking), vomiting of blood or coffee-ground-like material, or a swollen throat or tongue or difficulty breathing [11]. Call 000 and ask for an ambulance if someone who has taken an opioid medicine has collapsed, isn't breathing or can't be woken [15]. See your GP the same day if you think you or a child may have taken too much paracetamol, because it can damage the liver [14]. See your GP or a podiatrist the same day if you have black or bloody stools or severe stomach pain while taking an NSAID [11]. For urgent advice when it isn't an emergency, call healthdirect on 1800 022 222 (24 hours a day), or go to a Medicare Urgent Care Clinic. ## Common questions ### Is paracetamol or ibuprofen better for pain? It depends on the pain. Paracetamol is often the first medicine suggested for short-term pain. Ibuprofen is an NSAID, so it also reduces swelling and works well for inflammatory pain such as an injury or arthritis, but NSAIDs carry stomach, kidney and heart risks. A pharmacist can tell you which suits you. ### How long can I safely take anti-inflammatory tablets? As briefly as you can. Using them only occasionally, for a limited time and at the lowest amount that controls your pain lowers the chance of side effects. Long-term use is best avoided unless a doctor advises it. If you need one for a long-term condition, talk with your GP or pharmacist first and have it reviewed regularly. ### Are opioids a good option for long-term pain? Usually not. There's no clear evidence that opioids help long-term pain that isn't from cancer, and they can be addictive and cause serious side effects. If a doctor prescribes one, it should be a considered choice after other treatments haven't worked, with the risks and realistic benefits discussed first. ## Further reading - [Painkillers and anti-inflammatory medicines on Clindice](https://clindice.com/analgesics-and-anti-inflammatory-medicines) - [Ibuprofen for adults: painkiller that also treats inflammation](https://www.nhs.uk/medicines/ibuprofen-for-adults/), NHS - [Options for chronic pain management](https://www.healthdirect.gov.au/options-for-managing-chronic-pain), healthdirect - [Over-the-counter medicines: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/002208.htm), MedlinePlus - [Getting the best out of medication for persistent (chronic and long term) pain](https://www.gloshospitals.nhs.uk/your-visit/patient-information-leaflets/getting-the-best-out-of-medication-for-persistent-chronic-and-long-term-pain/), NHS ## Sources 1. Anti-inflammatory medicines (NSAIDs) · Healthdirect Australia. https://www.healthdirect.gov.au/medicines/anti-inflammatory-medicines 2. Non-Steroidal Anti Inflammatory Drugs (NSAIDs) for the Treatment of Pain · Faculty of Pain Medicine. https://fpm.ac.uk/sites/fpm/files/documents/2025-04/NSAID%20PIL%202023%20update.pdf 3. Pain-relief medicines · Healthdirect Australia · 2016. https://www.healthdirect.gov.au/pain-relief-medicines 4. Use of pain relief A&E Leaflet - University Hospitals Sussex NHS Foundation Trust · NHS · 2023. https://www.uhsussex.nhs.uk/resources/use-of-pain-relief-2/ 5. CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022 · Dowell D, Ragan KR, Jones CM et al. · MMWR · 2022. https://doi.org/10.15585/mmwr.rr7103a1 6. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee · Kolasinski SL, Neogi T, Hochberg MC et al. · Arthritis & Rheumatology (Hoboken, N.J.) · 2020. https://doi.org/10.1002/art.41142 7. Effectiveness and safety of non-steroidal anti-inflammatory drugs and opioid treatment for knee and hip osteoarthritis: network meta-analysis · da Costa BR, Pereira TV, Saadat P et al. · BMJ (Clinical Research Ed.) · 2021. https://doi.org/10.1136/bmj.n2321 8. Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial · Williams CM, Maher CG, Latimer J et al. · Lancet (London, England) · 2014. https://doi.org/10.1016/s0140-6736(14)60805-9 9. Single dose oral analgesics for acute postoperative pain in adults - an overview of Cochrane reviews · Moore RA, Derry S, Aldington D et al. · The Cochrane Database of Systematic Reviews · 2015. https://doi.org/10.1002/14651858.cd008659.pub3 10. Information for patients · Faculty of Pain Medicine. https://fpm.ac.uk/opioids-aware/information-patients 11. NSAIDs · NHS. https://www.nhs.uk/medicines/nsaids/ 12. Non-steroidal anti-inflammatory drug (NSAID) therapy in patients with hypertension, cardiovascular, renal or gastrointestinal comorbidities: joint APAGE/APLAR/APSDE/APSH/APSN/PoA recommendations · Szeto CC, Sugano K, Wang JG et al. · Gut · 2020. https://doi.org/10.1136/gutjnl-2019-319300 13. Topical nonsteroidal anti-inflammatory drugs in the treatment of knee osteoarthritis: a systematic review and meta-analysis · Wolff DG, Christophersen C, Brown SM et al. · The Physician and Sportsmedicine · 2021. https://doi.org/10.1080/00913847.2021.1886573 14. Randomized open-label non-inferiority trial of paracetamol or celecoxib for patients with chronic low back pain · Hayashi K, Miki K, Ueno H et al. · Scientific Reports · 2025. https://doi.org/10.1038/s41598-025-31094-y 15. Accidental overdose of medicine · Healthdirect Australia. https://www.healthdirect.gov.au/medicines/accidental-overdose-of-medicines 16. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians · Qaseem A, Wilt TJ, McLean RM et al. · Annals of Internal Medicine · 2017. https://doi.org/10.7326/M16-2367 --- This page is general information, not a diagnosis or a treatment plan for you. For advice about your own feet or legs, see a podiatrist or your doctor. In an emergency, call 000.