Pain Killers: A Complete Guide for Indian Patients
Pain is one of the most common reasons people visit a pharmacy. While pain medicines (analgesics) provide important relief, they are also among the most misused medicines in India. Understanding how different pain medicines work and their risks helps you use them safely and effectively.
The Analgesic Ladder
The WHO analgesic ladder provides a framework for pain management:
- Step 1 (Mild pain): Paracetamol, NSAIDs (ibuprofen, diclofenac)
- Step 2 (Moderate pain): Weak opioids (tramadol, codeine) ± Step 1 medicines
- Step 3 (Severe pain): Strong opioids (morphine, oxycodone) ± other medicines
Paracetamol (Crocin, Dolo, Calpol)
The safest and most widely used pain medicine globally.
- Best for: Mild to moderate pain, fever, headache, body ache
- Safe for: Most people including elderly, children, pregnant women (when necessary)
- Dose: 500mg–1g every 4–6 hours; max 4g per day in healthy adults, 2g in liver disease
- Key risk: Liver damage at high doses or with alcohol use. The maximum daily dose limit is strictly important.
- Does NOT reduce inflammation
NSAIDs — Non-Steroidal Anti-Inflammatory Drugs
NSAIDs relieve pain AND inflammation, making them useful for arthritis, muscle injuries, and menstrual pain. However, they carry significant risks especially with long-term use.
Ibuprofen (Brufen, Combiflam’s component)
- Best for: Mild to moderate pain with inflammation, fever, dental pain, menstrual pain, headache
- Dose: 200–400mg every 6–8 hours with food; max 1200mg per day OTC / 2400mg with doctor’s advice
- Avoid in: Kidney disease, peptic ulcer, heart failure, asthma triggered by NSAIDs, late pregnancy
Diclofenac (Voveran, Voltaren, Dicloran)
- More potent anti-inflammatory than ibuprofen
- Available as tablets, topical gel, and injections
- Higher cardiovascular risk than ibuprofen in some studies
- Topical diclofenac gel is safer than oral for localised joint/muscle pain
Nimesulide
- Popular in India for pain and fever
- Banned in many countries due to hepatotoxicity concerns
- Should not be used in children under 12 or in liver disease
- Limited to short-term use only
Aceclofenac
- Widely used in India for musculoskeletal pain
- Similar risk profile to other NSAIDs — take with food, avoid in kidney/liver disease
NSAID Safety Precautions
- Always take with food or milk to protect the stomach
- Avoid combining two NSAIDs simultaneously
- Use the lowest effective dose for the shortest duration
- Never take NSAIDs with blood thinners without medical supervision
- Omeprazole (stomach protection) is often prescribed alongside regular NSAIDs to prevent ulcers
Combination Pain Medicines
Many popular Indian pain medicines combine multiple active ingredients:
- Combiflam: Paracetamol 325mg + Ibuprofen 400mg
- Dart: Paracetamol + Caffeine
- Saridon: Paracetamol + Propyphenazone + Caffeine
Be careful not to take additional paracetamol alongside these combination products to avoid exceeding the maximum daily dose.
Tramadol — Moderate to Severe Pain
Tramadol (Tramazac, Ultram) is a weak opioid painkiller for moderate to severe pain that doesn’t respond to paracetamol or NSAIDs. It:
- Requires a prescription in India
- Can cause nausea, dizziness, constipation, and drowsiness
- Has dependency and misuse potential (Schedule H1 in India)
- Should not be combined with SSRIs (serotonin syndrome risk)
- Avoid alcohol while taking tramadol
Topical Pain Medicines
For musculoskeletal pain, topical medicines often provide effective relief with fewer systemic side effects:
- Diclofenac gel (Voveran, Volini): Effective for joint and muscle pain
- Ketoprofen gel: Good for sports injuries
- Methylsalicylate + Menthol (Iodex, Moov): Counter-irritants providing warmth relief for muscle aches
- Lidocaine patch: For localised nerve pain
When Painkillers Are Not the Answer — See a Doctor
- Persistent pain lasting more than 2 weeks without improvement
- Severe pain that prevents normal activities
- Pain with fever, weight loss, or other systemic symptoms
- Chest pain or abdominal pain (requires diagnosis before treatment)
- Need for increasing doses to control pain
- Pain requiring more than occasional painkiller use
Pain Management at Dashvanth Healthcare
Our orthopaedic, neurology, and general medicine specialists can diagnose the cause of your pain and develop comprehensive pain management plans beyond just painkillers — including physiotherapy, injections, and surgical options when appropriate. Our pharmacy stocks the full range of pain medicines and can advise on appropriate OTC options.
