Managing medicines

With Dr Lars Williams

Lars is Consultant Anaesthetist and Pain Specialist at NHS Greater Glasgow and Clyde and at the Scottish National Pain Management Service.

This information was last updated in June 2025. It is due for a review in June 2028.

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Most people would prefer not to take medication that doesn’t help, or that causes unwanted side effects. But when you have been taking pain medication for years, it can be hard to be sure of what helps and what doesn’t.

Painkillers can be effective for short-lived (acute) pain, but they are rarely as helpful when it comes to chronic pain. Even if they do help, they can cause unpleasant side effects that outweigh any benefit, and these side effects can build up over time. Some (like the opioids) cause physical dependence, which means you get a withdrawal reaction if you stop them too quickly. This can make it even harder to be sure how much the drug is actually helping. 

Let’s look at how you can evaluate the medication you take for pain, and how to go about changing it if you feel it is no longer worth taking. 

The good news 

The good news when it comes to pain medication is that you have the freedom to choose what to take, or not to take. 

What do we mean by freedom to choose? Well, say you had another long-term condition, like diabetes for example. You may hate having to take the medication that lowers your blood sugar, but if you didn’t take it then you could end up dangerously ill. When it comes to pain, the medication you take doesn’t have any effect on the underlying condition causing your pain. You don’t have to take a painkiller. All painkillers can do is relieve the symptom of pain. So if they are not even doing that, then there is no reason to continue taking them. 

How do I know if they are helping? 

This can be a difficult question to answer. If you are taking ten different types of medication for your pain, but your pain is still there every day at moderate-to-high levels, what does that mean? 

Are any of the drugs helping? All of them? And what about side effects? Which ones are making you sleepy? Or is it your underlying pain condition that is making you tired all the time? 

Helps versus harms: part 1 

The first thing to do is to take a mental step back and try to get an overall sense of how much your pain medication helps and how much it harms. For some drugs this is easy. Traditional painkillers work within a few hours of your taking them, and wear off a few hours later. By traditional painkillers, we mean drugs that belong in one of these three groups: 

• Paracetamol. Often taken as a combination with an opioid. For example, co-codamol is a mixture of paracetamol and codeine.

• Anti-inflammatory drugs. For example, ibuprofen, naproxen and diclofenac.

• Opioids. The morphine family drugs. For example, codeine, tramadol, morphine, oxycodone and fentanyl.

Because these drugs act soon after you take them, you should have a good sense of what a tramadol, say, or naproxen tablet does to your pain levels. So, ask yourself, on a scale of 0–10, how helpful is my cocodamol, tramadol, etc.? ‘Helpful’ in this sense can include the obvious (‘it reduces my pain’), but it might also include things like ‘it helps my sleep ‘, or ‘it allows me to go for a walk’. 

Now do the same thing, but this time thinking about how much the drug harms you, on a scale of 0–10. ‘Harm’ in this sense might be an obvious side effect that you experience when you take the medication – perhaps constipation or drowsiness. But harm might also be something subtle. Maybe your family notice you have become more withdrawn, maybe the medication makes you feel unsafe to drive, or maybe you no longer meet friends in the pub because the medication stops you taking alcohol. 

Helps versus harms: part 2

This reflection process is harder when it comes to the more specialised drugs that you may be taking for your pain. Broadly, these are the antidepressant drugs (like amitriptyline or duloxetine) and the antiepileptic drugs (like gabapentin or pregabalin). 

These drugs don’t work straight away. In fact, they can take weeks to have any noticeable effect. You may still have a good sense of the effect they have on you, perhaps because you remember the effect when you first started taking them, or if you have recently increased the dose. But because you can’t rely so much on your immediate experience, it is helpful to have a good understanding of what they can be expected to do, and what sort of side effects they are known to cause. 

For example, gabapentin is sometimes helpful for nerve pain, like diabetic neuropathy or sciatica, but it wouldn’t usually be helpful for back pain. Amitriptyline makes most people sleepy, which can be helpful overnight, but not so helpful if the sleepiness lingers into the following day.

Once you have a better picture of how much your medication helps you, set against how much it harms you, you will be in a better position to decide if you need to change anything. 

What now?

Once you have completed this reflection process you will be ready for the next step: making a change. This is the point at which you need to involve your GP or pharmacist. Let them know what you want to do with your medication, and they can support you to make any change slowly and safely.

Tips for reducing medication

There are a few golden rules that will help you reduce your pain medication:

1. Choose your time. Don’t start any change until you are ready. If you are about to start a new job, wait till you’re settled in. If your pain is always worse in the winter, wait till summer. 

2. Start with the low-hanging fruit. Make it easy on yourself! Start with the medication that you think is least helpful. If you have back pain and are taking gabapentin, it’s almost certain you can stop gabapentin with no impact on your pain. 

3. Change one thing at a time. If you want to change more than one drug then do this in sequence, starting with the easy ones (see tip #2).

4. Go slow. Reduce by the smallest possible dose, leaving at least two weeks between decreases. Your GP or pharmacist will suggest a reduction plan, but remember there is no need to rush. If you are planning to completely stop a drug, expect to take at least 2–3 months to do so. With morphine drugs, a good rule of thumb is to decrease by no more than 5% of the total dose per week. 

5. Keep a pain diary. Before you start, and while you are reducing, it can be helpful to keep notes on your pain levels, any side effects and the current dose of your medication. It is impossible to remember exactly how much pain you were in 3 months ago, so it can be helpful to have this information on hand when looking back and reflecting on the effect of your medication change. 

6. Be flexible! Enter into the process with curiosity, and be prepared to stop reducing or even go back to your former dose if necessary. Treat the reduction process as an experiment, and trust what your body tells you as you go. Deciding to reduce your medication doesn’t commit you to anything – if it turns out the medication was better than you gave it credit for, there is no shame in going back. 

Knowledge is power. The more you know about your medication, the better placed you will be to make changes with confidence.

Good luck!