How to Choose Best Pain killer Tablet for Body Pain in India

Posted On March 2, 2021December 3, 2022

Introduction 

Wondering about the best pain killer tablet for body pain?

Well! It’s always hard to choose a good painkiller for body pain. The reason is that no single medicine can treat every type of pain.

You must have felt pain in your daily routine, like a sports injury, muscle pain, headache, tooth pain, back pain, neck pain and joint diseases. 

Most people get confused about selecting the ideal painkiller. 

But you don’t need to worry. 

In this post, we will discover the best pain killer tablet for body pain.

Here, I have made a list of body pain killer tablet names that might be prescription or OTC painkillers. 

Apart from this, we will also see the best pain relief medicines for various pain conditions such as toothache, headache, body pain, joint pain, muscle pain, acute pain etc. 

So, without further delay, let’s get started.

Anatomy & Physiology of Pain Pathway 

Have you ever thought about why we feel pain?

Usually, our body is well decorated by pain detectors. These pain detectors are just like the receptors, called Nociceptors.

Nociceptors are sensory receptors found at the nerve endings of the skin, joints, muscles, etc. 

These nociceptors are get activated when it gets stimulation like – 

• Extreme high temperature 
• Very low temperature 
• Stretch 
• Strain 
• Pinch 
• Injury 

When you get a tissue injury, burns, body aches, insect bite or even a tiny pinch by a needle. 

These pain receptors are get activated and send a signal to your brain. After that, your brain perceives it as pain and response. 

Meanwhile, your body cells (mainly affected area) release a chemical called arachidonic acid. 

Arachidonic acid is released from your cell membrane and then binds to two special enzymes called COX-1 or COX-2. 

COX-1 or COX-2 is a cyclooxygenase enzyme. 

COX-1 usually is present in our blood vessels, smooth muscle cells, platelets, stomach, intestine and kidney. 

Moreover, the COX-1 enzyme helps to maintain your body’s homeostasis and manage your physiological function by – 

• inhibit gastric acid secretion 
• increase flow to the kidney 
• help in blood clotting by platelet aggregation

Therefore, COX-1 is also known as the “housekeeping” enzyme. 

While COX-2 is mainly responsible for pain, inflammation, and fever. 

As soon as arachidonic acid binds to these two COX enzymes, arachidonic acid converts into prostaglandin. 

Here, this prostaglandin is a major culprit in inducing fever, pain, and inflammation by activating the COX-2 enzyme pathway. 

Prostaglandin is also responsible for releasing other inflammatory chemicals like thromboxane, nitric oxides etc. 

You must have experienced redness, swelling, heat, and pain in the affected area. 

These characteristics reflect the classical sign of inflammation. In Latin, it is also known as – 

• rubor (redness)
• tumour (swelling) 
• calor (heat) 
• dolor (pain) 
• functio laesa (loss of function) 

But somehow, prostaglandin is good for us. 

Because the COX-1 enzyme helps in protective physiological functions by releasing prostaglandin chemicals. 

Learn about Painkiller 

Do you know what a painkiller is? 

Painkillers are the most commonly used medicines that help reduce pain sensation and inflammatory response. These medicines are also known as analgesics or anti-inflammatory drugs.

Analgesic medicines also improve the quality of life in long-lasting pain and help to relieve different pain conditions like generalized body pain, headaches, joint pain, muscle pain, etc.

They are broadly classified into three groups – 

• Paracetamol (Antipyretic)
• NSAIDs (Non-Steroidal Anti-inflammatory Drugs)
• Opioids (Narcotics)

Paracetamol has two important properties – antipyretic and analgesic. In other words, it can treat fever and mild to moderate body pain by inhibiting prostaglandin synthesis in the brain region.

However, it does not have anti-inflammatory properties. So, it would not work in swelling and severe pain. 

As far as concern of NSAIDs, these medicines have three important properties – antipyretic, analgesic, and anti-inflammatory.

NSAIDs generally decreases prostaglandin production by blocking cyclooxygenase enzymes (COX-1 and COX-2) or only COX-2.

If we talk about Opioids, it it has only one property – analgesic. It does not work in inflammation. It blocks the pain transmission by interfering in opioids receptors. 

List of best pain killer tablet names in India 

Now it’s time to know the best pain killer tablet for body pain. There are various classes of drugs used to control pain and inflammation. 

Although it is classified into three major groups – 

• Paracetamol (or acetaminophen) – Only for fever and pain
• Non-narcotic analgesic – NSAIDs for inflammatory pain 
• Narcotic analgesic – Opioids for visceral pain 

NSAIDs are usually preferred; if there is inflammation and pain. 

In contrast, opioids are the strongest pain killer. These medicines are usually preferred if there is only visceral pain (or pain in internal organs like the heart, kidney, intestine, etc.), after surgery, burn and cancer pain. 

Opioids do not have anti-inflammatory properties. 

Here, I have made a list of prescription and non-prescription painkillers with salient key features –  

Best OTC pain reliever for body aches/fever

We commonly suffer from nagging headaches, muscle spasms, general aches, and joint problems. We don’t want to go to a doctor for minor pain. 

Some OTC (Over-the-counter) pain relievers are available, which don’t require a prescription. 

There is a variety of brands, which each have different active ingredients. 

You must have heard the brand name of Dolo, Calpol, Paracip, etc. It contains paracetamol. 

Paracetamol should be the first medicine choice for mild pain or fever. 

Paracetamol is also called acetaminophen. It works in your brain by inhibiting prostaglandin production. 

It has an excellent anti-pyretic effect because it works on COX-3 (present in the brain). It is effective in migraine or headaches too. 

If Paracetamol is ineffective during pain conditions such as toothache, headache, body ache etc. In that case, you should always prefer NSAIDs. 

In NSAIDs, you may take OTC NSAIDs like Aspirin (Disprin 325 mg), Naproxen (Naprosyn) and Ibuprofen (Brufen, Ibugesic).

You must consult your doctor if you are not getting pain relief from OTC NSAIDs. They may prescribe strong painkillers like prescription NSAIDs or Opioids. 

Best pain killer for acute pain 

Acute pain is generally sudden short-lasting pain. It only remains for a short time.

Suppose you get an injury like a cut, bruise, burn, broken bone, or pulled muscle. In that case, you should choose a fast-relieving painkiller.

Although OTC painkillers (like Paracetamol, Ibuprofen and Naproxen) are always the first choice for acute pain. 

If an OTC painkiller does not work, your doctor may suggest a prescription painkiller like Nimesulide.

Nimesulide is a quite effective medicine in short-lasting painful inflammatory conditions such as sports injuries, fever, sinusitis, low backache, osteoarthritis, pain after surgery, painful female period, dental surgery, and ear-nose-throat disorders. 

It gives instant relief within 15 minutes because it has the fastest onset of action.

One major problem with Nimesulide is that you may have a high risk of liver toxicity. That’s why it is banned in most countries like Spain, Turkey, Switzerland, Spain, United states, etc. 

But Nimesulide medicine is available in India with a black box warning. 

It would be best to strictly avoid Nimesulide in children due to hepatoxicity.  

Popular brand names – Nicip, Nise, Nimutab 

Best painkiller syrup for children

Choosing the safest pain reliever for children is challenging for everyone. Your child may need a pain reliever to control pain sensations. 

Here, you have limited options in choosing painkillers for kids. These are – 

• Paracetamol Syrup (Paracip, Calpol suspension)
• Ibuprofen syrup (Ibugesic suspension)
• Combination of ibuprofen and paracetamol suspension (Ibugesic plus suspension)

You may give these medicines to your child in mild to a moderate pain condition. It would be better to ask your doctor before giving any painkillers to your child. 

Also read, 

• How to calculate paracetamol dose for children
• Albendazole dose for kids  

Best pain killer tablet for toothache in India 

Selecting an ideal tooth painkiller tablet can also be a real challenge. 

According to American Dental Association, 2022, NSAIDs and NSAIDs/paracetamol combinations are considered the safest and first-line treatment options for acute dental pain. 

Ibuprofen for toothache 

Among NSAIDs, Ibuprofen has shown a satisfactory effect in managing toothache, tooth extraction and dental surgery pain.

The analgesic efficacy of Ibuprofen is faster and better than other analgesic medications without compromising safety.

Ibuprofen is an OTC (Over-the-counter) medicine. You can take this medicine without a prescription for toothache or other body pain. 

Ibuprofen starts to provide pain relief within 30 mins, giving you an analgesic effect for 4 hours because its half-life is 2 hours. 

You can take the next Ibuprofen 200/400 dose every 4 to 6 hours. But you should not take more than 1200 mg per day.

Ibuprofen is also available in combination with Paracetamol. The combination of ibuprofen and paracetamol tablets is more effective than Ibuprofen alone. 

It is trendy in the brand names Combiflam, Flexon, and Ibugesic plus tablets. 

Ketoprofen for tooth pain

Ketoprofen is a prescription painkiller for tooth pain but is also available as an OTC in some countries. 

You may take the Ketoprofen in the following toothache conditions – 

• Severe tooth pain 
• Inflammatory gums
• Tooth extraction pain
• Post-operative dental pain

If you are not getting pain relief from Ibuprofen. In that case, you may take 25 to 75 mg of Ketoprofen thrice a day. 

Opioids analgesic for tooth pain

If NSAIDs are ineffective in tooth pain, you may take opioids (like tramadol) under proper medical supervision. 

Opioids are potent analgesics, but they have a lot of side effects. Therefore, opioids are reserved for a severe pain condition. 

Best pain killer tablet for stomach pain or painful period 

Some medicines are most widely used for treating stomach discomfort symptoms. It includes – 

Hyoscine butylbromide tablets

Hyoscine butylbromide is very popular in India with a brand name Buscopan tablet. 

It is an antispasmodic drug that belongs to a class of anticholinergic medications (block M3 muscarinic receptors)

Hyoscine is also known as Scopolamine, and it is widely used to treat various abdominal problems, such as – 

• Abdominal cramp
• Stomach pain
• Period pain (dysmenorrhea)
• Stomach discomfort
• Motion sickness

You may get this drug as a prescription in many countries and without a prescription (OTC).

Hyoscine also comes in a combination of Paracetamol and is available under the brand name Buscopan Plus. 

Dicyclomine hydrochloride tablets 

Dicyclomine is also an anticholinergic drug that has antispasmodic action such as – 

• Stomach pain
• Morning sickness
• Motion sickness
• Period pain
• Irritable bowel syndrome (IBS)
• Nausea and vomiting

Brand names – Colimex 20 mg, Diospas 10/20 mg, Cyclominol 20 mg

Drotaverine hydrochloride

Drotaverine is another antispasmodic medicine that belongs to the anticholinergic category (inhibiting Phosphodiesterase-4 enzyme)

The main benefit of this medicine is to treat painful abdominal problems without showing anticholinergic side effects.  

It is an effective medicine in the following conditions –

• Abdominal pain
• Irritable Bowel Syndrome (IBS)
• Intestinal colics (cramp-like pain in the small or large intestine)
• Renal colic (Kidney stone pain)
• Biliary colics (Stones in the cystic duct or common bile duct)
• Menstrual pain
• Uterine spasms (Cramp in the uterus or pelvic area)

Brand names – Drotin 40/80 mg, Doverin 40/80 mg, Dotarin 40/80 mg. 

Mefenamic acid 

Mefenamic acid is a quite effective medicine in painful periods (or dysmenorrhea).  

The combination of tranexamic acid and mefenamic acid tablets relieves menstrual pain and abnormally heavy menstrual bleeding.

Mefenamic acid is also used in post-operative pain (pain after operation or surgery) and postpartum pain (pain in the body after giving birth or after delivery).

It belongs to the NSAIDs category of anthranilic acid derivatives. 

Mefenamic acid has good analgesic and fever control properties but does not have anti-inflammatory activity. 

Therefore, you can use this drug if there is no inflammation, like soft tissue pain, osteoarthritis and some muscle pain. 

You may get this medicine in various brands like Medol 250/500 mg capsules and Meftal 250/500 mg tablets.  

It is also available in combination with other antispasmodic medicines, such as – 

• Mefenamic acid and dicyclomine hydrochloride tablets (Cyclopam-MF, Mefspas, Meftal spas)
• Drotaverine hydrochloride and mefenamic acid tablets (Drotin M, DVN plus)

Best pain killer tablet for headaches or migraine 

You may take simple analgesics for headaches or mild migraines like Paracetamol 500 to 1000 mg thrice a day and Aspirin at high doses 300 to 600 mg (Disprin Regular 325mg Effervescent Tablet) thrice a day.

If you are not getting relief from simple analgesics for migraine. Then you need to take a combination of NSAIDs and antiemetic drugs under proper medical supervision like – 

• Domperidone and naproxen sodium tablets (Naxdom 250/500)
• Other NSAIDs (like Ibuprofen 400 to 800 mg, Diclofenac 50 mg, Mefenamic acid 500 mg, Indomethacin 50 mg) with antiemetics (like Metoclopramide 10 mg, Domperidone 10-20 mg, Prochlorperazine 10-25 mg)

Even if you are not getting relief, you must consult your doctor. Your doctor may manage your medicine therapy as per the severity of your migraine pain. 

They may prescribe some medicines for moderate and severe migraine –

• Vasograin tablet (Caffeine+ Ergotamine+ Paracetamol + Prochlorperazine)
• Ergot alkaloids
• Sumatriptan 
• Propranolol 
• Amitriptyline
• Flunarizine 
• Valproate 

Best pain killer tablet for joint pain/muscle pain

As you age, joint pain becomes more prevalent. Your doctor may recommend prescription painkillers to help with joint or muscle pain. It includes –

Diclofenac sodium/potassium

Diclofenac has good tissue permeability, especially in the synovial fluid area.

It enters your bones and muscles with high concentration. That’s why Diclofenac is widely used in acute joint pain conditions such as 

• Bone pain (rheumatoid arthritis, gout, osteoarthritis, ankylosing spondylitis)
• Muscular pain, and 
• Fracture pain. 

So, Diclofenac is the best pain killer tablet for knee and joint pain disorders.  

Moreover, Diclofenac causes less gastric disturbance because it slightly interferes with the COX-1 enzyme. So, it is also a good gastric-friendly painkiller. 

You may also get a combination of diclofenac sodium and paracetamol tablets, tolperisone hydrochloride and diclofenac sodium tablets, etc. 

Popular brand names – Voveran, Diclonac, Movonac, Tolpidol D

Aceclofenac tablet

Now, aceclofenac is surpassing the benefits of Diclofenac.

According to published review literature in Indian Journal of Pain, 2016 – aceclofenac is superior and more effective in various acute joint pain with fewer side effects than Diclofenac. 

Aceclofenac is a more gastric-friendly and longer-acting drug. So, aceclofenac is also the best pain killer tablet for joint pain.

You can also get a combination of aceclofenac and paracetamol tablets. 

Popular brand names – Zerodol, Dolokind, Aceclo

Piroxicam tablet

Piroxicam is a strong anti-inflammatory NSAID. 

It is a prescription NSAID. Your doctor may prescribe Piroxicam 20 mg if you exacerbate joint pain. 

Piroxicam is quite effective in various joint disorders such as rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, acute gout, and musculoskeletal injuries. 

It is the longest-acting drug that gives you a long-lasting anti-inflammatory effect and short-term analgesic effect. 

The longest acting (half-life 2 days) of piroxicam because of enterohepatic recycling. 

It can also be used in tooth pain and painful period. 

Popular brand name – Dolonex DT 20 mg tablet and Pirox DT tablet

Side effects – Gastric disturbances like nausea, vomiting, gastric mucosal damage and gastric ulcer

Indomethacin tablet

Indomethacin is also a prescription painkiller; you cannot take this medicine without a prescription. 

Indomethacin is also a potent anti-inflammatory drug. It is rarely used as a reserve pain killer because of its severe side effects. 

It can be used if other NSAIDs are ineffective. 

The main use of indomethacin in ankylosing spondylitis, arthritic pain and acute gout. 

It is a drug of choice in Barter Syndrome (excess prostaglandin production in the kidney) and closure of PDA (Patent Ductus arteriosus). 

Popular brand names – Indocap SR capsule

Best pain reliever for osteoarthritis 

Osteoarthritis is a non-inflammatory condition; you don’t need anti-inflammatory painkillers (NSAIDs). 

In this condition, Paracetamol is the most effective medicine for osteoarthritis. 

It is recommended as the first choice of analgesic for osteoarthritis. It is also considered the safest analgesic than NSAIDs or opioids. 

Your doctor may start paracetamol medicine in the early stage of osteoarthritis.  

Best pain reliever for stomach ulcer patients 

Generally, every NSAID causes gastric disturbance except COX-2 inhibitors. Suppose you are suffering from body aches with pre-existing stomach ulcer problem. 

In that case, you should choose COX-2 selective inhibitor NSAIDs. This class of drugs does not cause a gastric disturbance. 

Most of this class’s drugs (like Celecoxib, Rofecoxib, Valdecoxib) are banned due to their cardiovascular risk. 

Now, only one COX-2 inhibitor (i.e., Etoricoxib) is available in the market. 

But you should strictly avoid selective COX-2 inhibitors if you are a patient of ischemic heart disease, high blood pressure, and other heart diseases because it can add additional risk. 

Etoricoxib is a highly effective drug with better tolerability than non-selective cox inhibitors. 

It has a long half-life, around 24 hours. So, you don’t need to take the frequent dose; once a day is sufficient for your treatment. 

Etoricoxib tablet uses mostly in osteoarthritis, rheumatoid arthritis, gout, ankylosing spondylitis, acute dental surgery pain, etc. 

Best pain relief for asthmatics

Asthmatic people are more sensitive to aspirin or other non-selective NSAIDs.

These medicines are generally induced bronchospasm. So, they are contraindicated in asthma conditions. 

Certain medicines are recommended for asthmatics. These are – 

• Paracetamol high dose 
• Nimesulide 
• Etoricoxib

Best painkiller for pregnant women

Pregnancy is a delicate condition, and there is always a high risk for a premature baby or mother. You don’t want to take any risk in this condition. 

All NSAIDs and opioids are contraindicated in pregnancy. These drugs may cause congenital disabilities and increase the risk of foetal life. 

Paracetamol is the only choice for pregnancy. It is the safest medicine to use for fever/pain during pregnancy.  

Aspirin can be a second option for pregnant women under proper medical supervision. 

Therefore, you should always consult your doctor before taking any painkiller during pregnancy. 

Also read, 

• Safe drugs in pregnancy 
• 12 Shocking Risk Factors of High Risk Pregnancy
• Development of the embryo from fertilization to birth

Best strongest pain killer tablet in India 

If your pain is more severe and unbearable. In this case, you will require opioids. This is also prescription medicine but rarely used.

Opioids are narcotic analgesics that originate from the poppy plant. Generally, opioids are classified into – 

• Natural – Morphine, codeine
• Semi-synthetic – Heroin, Ethylmorphine
• Synthetic – Pethidine, Fentanyl, Methadone, Tramadol

They are a more powerful pain reliever than NSAIDs. It is generally safe when prescribed for a short time. 

Although, it has only one property – analgesic. It does not have the property to treat fever and inflammation. 

Opioid medicine only helps to reduce your pain sensation by blocking the transmission of severe pain. It works on various opioid receptors – mu (μ), delta (ẟ), and kappa (κ).

Among opioids, fentanyl is considered a highly potent medicine. It is 80-100 times more potent (powerful) than morphine. While heroin is 3 times more potent than morphine.

These medicines are only used in emergencies because they have life-threatening side effects. 

These opioids are highly likely to develop an addiction because they produce euphoria (which provides intense pleasure).

You should avoid opioids if you have respiratory problems like emphysema, pulmonary fibrosis, bronchial asthma, etc. Moreover, they may also cause constipation problems. 

Currently, tramadol is mainly prescribed and available under the brand name Tramazac. It comes in tablet and injection form. 

Tramadol works best with Paracetamol. It is available under the brand name Ultracet semi, Tralam semi, Tromanil extra, Calpol T, etc. 

It has fewer side effects than other opioids. It causes less constipation, respiration problem, urinary retention, sedation, etc. 

But you should not take this medicine if you are already taking antidepressant drugs, especially SSRI (Selective Serotonin Reuptake Inhibitors), because of the risk of ‘serotonin syndrome.’

Side effects of Opioids – Similar to the anticholinergic effects like respiratory depression, decrease cough, sedation, constipation, urinary retention, anorexia, meiosis (pinpoint), convulsion

Contraindication – Head injury, asthma, and biliary colic 

Conclusion

This post has discussed the best pain killer tablet names for various conditions. 

Here, I have reviewed the best pain killer medicine for fever, acute pain, toothache, stomach pain, joint pain, muscle pain, and other body pain.

Moreover, I have explored the safest pain killer in children, pregnancy, asthma conditions, peptic ulcers and heart disease conditions. 

This is only an informative article. 

You don’t need to choose any painkiller yourself except OTC painkillers. It is always better to consult your good doctor or pharmacist before taking any painkiller medicine.  

If you found this post (best pain killer tablet for body pain) informative, please share it on social media.

FAQ

Q 1. Which is the best pain killer tablet without side effects?

Each medicine has pros (desirable effect) or cons (undesirable effect). Among all painkillers, Paracetamol is considered the safest painkiller with minimum or without side effects. 

Q 2. Is Crocin/Dolo a painkiller?

Yes. Crocin and Dolo are painkillers. Both (Crocin and Dolo) contain paracetamol medicine. It has two important properties – antipyretic and analgesic activity. Therefore, you may take Crocin or Dolo for various pain conditions like headache, migraine, dental pain, period pain, muscle pain etc. 

Q 3. Is Combiflam a painkiller?

Yes. Combiflam is a good painkiller. It contains two medicines – Paracetamol and Ibuprofen. They help to reduce pain, fever and inflammation. 

Q 4. Which is the best pain killer tablet for knee and joint pain disorders?  

Diclofenac, Aceclofenac, and Etoricoxib medicines are the most frequently used painkillers in joint disease. 

Q 5 Which is strongest over the counter (OTC) painkiller?

Paracetamol and Ibuprofen are the only options for OTC painkiller medicine.

References

1. K.D. Tripathi. Essentials of Medical Pharmacology, 7^th edition. Jaypee Brothers Medical Publishers (P) Ltd; 2013. Chapter-14, Nonsteroidal Anti-inflammatory Drugs and Antipyretic-Analgesics, Page-192.

2. Cardiovascular effects and safety of (non-aspirin) NSAIDs

3. NSAID induced gastrointestinal damage and designing GI-sparing NSAIDs

4. Gastrointestinal safety of NSAIDs and over-the-counter analgesics

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