Pain, Inflammation & Musculoskeletal M Guides

What Pain, Inflammation & Musculoskeletal Medicines covers

This section covers medicines given for pain, swelling and problems affecting muscles, joints and bones. It includes simple painkillers, anti-inflammatories, corticosteroids, muscle relaxants and the combination products South African pharmacies dispense for moderate pain.

It is the most searched medicines section on the site, and the reason is straightforward: pain is the most common reason people take medicine at all, and the products come in a confusing number of brand names and combinations.

The guides here divide roughly into four groups. Simple analgesics such as paracetamol relieve pain without much effect on inflammation. Anti-inflammatories — the NSAIDs, including diclofenac and ibuprofen — reduce swelling as well as pain, and carry stomach, kidney and cardiovascular cautions that simple analgesics do not. Corticosteroids such as prednisone suppress inflammation far more powerfully and are prescribed courses, never something to take casually. Combination products pair a painkiller with codeine or a muscle relaxant, which introduces drowsiness and dependence considerations.

Knowing which group your medicine belongs to explains most of what matters about it. Each guide says so near the top.

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Most searched questions in this topic

Prednisone is by a wide margin the most searched medicine on this site. That reflects how widely corticosteroids are prescribed and how little explanation usually comes with them — a short course for an unexpected reason, with instructions to finish it, and no obvious answer to what it actually does.

How the guides in this section differ

Four distinctions decide which guide you need.

Anti-inflammatory or not. Paracetamol and an NSAID are not interchangeable. If swelling is the problem, that difference matters; if you have a stomach, kidney or heart condition, it matters more.

Does it contain codeine? Several widely dispensed South African combination products do, including Synaleve. Codeine causes drowsiness, is unsuitable before driving, and can cause dependence and rebound headache with prolonged use. Products containing it are treated differently at the pharmacy counter for exactly this reason.

Oral, topical or injected. The same active ingredient behaves differently depending on route. A diclofenac gel applied to a knee and a diclofenac tablet are not equivalent, and the tablet carries systemic risks the gel largely avoids.

Short course or ongoing. Corticosteroid courses are designed to be completed and, past a certain length, tapered rather than stopped abruptly. This is one of the few places where stopping a medicine early is itself a risk.

Safety, accuracy and next-step checks

These are informational guides. They do not diagnose, set doses or clear a medicine as safe for you.

The cautions that matter most in this section:

Do not double up on paracetamol. It is present in a great many combination cold, flu and pain products. Adding a separate paracetamol tablet on top is the most common serious accidental overdose, and liver damage can occur without early warning symptoms.
NSAIDs and the stomach. Anti-inflammatories can cause bleeding and ulcers, particularly with prolonged use, in older adults, or alongside blood thinners or steroids. Take them with food and mention any stomach pain.
NSAIDs and the kidneys. They are riskier if you are dehydrated, have kidney disease, or take blood-pressure medicines including ACE inhibitors and diuretics.
Do not stop a steroid course abruptly unless told to. Longer courses need tapering.
Codeine and driving. Combination painkillers containing it cause drowsiness. Do not drive or operate machinery until you know how it affects you.
Persistent pain needs a diagnosis. Painkillers manage a symptom. Pain lasting beyond a few days, or waking you at night, should be assessed rather than medicated indefinitely.

Speak to a pharmacist or doctor before taking anything here if you are pregnant — NSAIDs in particular are avoided in later pregnancy — breastfeeding, buying for a child, taking blood thinners, or living with a stomach, kidney, liver or heart condition.

Frequently asked questions

What is the difference between paracetamol and an anti-inflammatory? Paracetamol relieves pain and reduces fever but does little for inflammation. NSAIDs reduce inflammation as well, and carry stomach, kidney and cardiovascular cautions that paracetamol does not.

Can I take an anti-inflammatory and paracetamol together? They are different medicines and are sometimes used together on professional advice. The risk is not the combination itself but accidentally taking paracetamol twice through a combination product. Check the ingredients and ask your pharmacist.

Why was I given a steroid for a short course? Corticosteroids suppress inflammation quickly across many conditions. A short defined course is the usual way to use them because of the effects of longer use. Your prescriber can explain the reason in your case.

Is it safe to take painkillers every day? Not without advice. Regular use raises the risk of stomach and kidney problems with NSAIDs, and of rebound headache with codeine products. Daily need is a reason to see a doctor.

How do I know if mine contains codeine? It will be listed in the active ingredients on the pack. If you are unsure, your pharmacist can tell you immediately.

Pain, Inflammation & Musculoskeletal Medicines Used-For Guides