Pain management
Pain is treated with a plan, not just a tablet.
Painkillers are one part of pain management. This page explains how UK clinicians approach pain, where strong opioids fit, what else works, and the warning signs that need urgent attention.
Start here
Acute pain and long-term pain are different problems.
Acute pain is a warning signal — it usually settles as tissue heals. Long-term pain (lasting more than three months) often persists after the original injury has healed, and is driven by changes in the nervous system rather than ongoing damage.
That difference matters. Opioids work well for short, severe episodes. Used long-term for chronic pain they often help less than expected, while side effects and dependence continue to build.
A good plan names the type of pain, sets a realistic goal — sleeping better, walking further, returning to work — and reviews whether the treatment is meeting it.
The analgesic ladder
How painkillers are stepped up — and back down.
The three-step ladder is a teaching model, not a strict escalator. Clinicians now step treatment up only when it is needed, and step it down whenever possible.
Step 1
Simple painkillers
Paracetamol, ibuprofen, naproxen, topical NSAID gels
For mild pain. Paracetamol and anti-inflammatories remain the backbone of most pain plans and are often used alongside stronger medicines rather than replaced by them.
Step 2
Weak opioids
Codeine, dihydrocodeine, tramadol
For moderate pain when step 1 is not enough. Usually prescribed for short periods, because tolerance and dependence develop with regular use.
Step 3
Strong opioids
Morphine, oxycodone, hydromorphone, fentanyl, buprenorphine
For severe pain, usually under specialist supervision. Started at a low dose, reviewed frequently, and reduced or stopped when it is no longer helping.
Beyond medicine
What works alongside painkillers.
These are not alternatives you try once medicine has failed. They are the treatments with the strongest evidence base for long-term pain, and they work best started early.
Movement & physiotherapy
Graded activity and strength work are among the most effective treatments for long-term musculoskeletal pain.
Psychological support
CBT and acceptance-based approaches change how pain is processed and reduce distress and disability.
Sleep & routine
Poor sleep amplifies pain. Consistent sleep and waking times often reduce pain intensity measurably.
Pacing
Breaking activity into manageable blocks prevents the boom-and-bust cycle that flares pain.
Weight & load
Where relevant, reducing joint load can ease pain in knees, hips and the lower back.
Heat, cold & TENS
Simple physical measures help some people manage flare-ups without additional medicine.
Using opioids safely
Six rules that prevent most opioid harm.
- 01Take it exactly as prescribed — never top up with extra doses or a friend's supply.
- 02Never mix with alcohol, sleeping tablets, benzodiazepines or gabapentinoids.
- 03Take a laxative if one is prescribed; constipation is expected, not optional.
- 04Store it locked away and return leftovers to a pharmacy.
- 05Do not stop suddenly after long-term use — reduce gradually with your prescriber.
- 06Ask for a review if the pain has changed, or if the medicine is no longer helping.
Seek help urgently
- New weakness, numbness or loss of bladder or bowel control with back pain.
- Chest pain, breathlessness, or pain after a significant injury.
- Sudden severe headache, or pain with a high temperature.
- Pinpoint pupils, extreme drowsiness or slow breathing after an opioid.
- Signs of serotonin syndrome on tramadol: agitation, tremor, fast heartbeat, high temperature.