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Diclofenac (Voltarol™)An NSAID. In single doses it is used for mild to moderate pain but it is also used regularly as an anti-inflammatory medication which is often particularly effective in PGP. Usually starts to work after about an hour, with the duration of action depending on the preparation used. Available as tablets, slow-release tablets and suppositories (which may sound unpleasant but are acceptable and very effective). Not usually used in the last trimester months of pregnancy owing to effects on the foetus. Small amounts are passed into breast milk but adverse effects are unlikely. Commonly used on maternity wards after delivery. Naproxen and ketoprofen are possible alternatives as they are both in the same class of drugs.
Indicated for moderate to severe pain, but its use in pregnancy and breast-feeding is not advised.
Opiate patches are starting to be more commonly used, particularly through pain clinics, for example, buprenorphine (Transtec™).
NefopamA non-opioid analgesic. The way that it works is not fully understood but it can be used to treat moderate pain. It is not recommended in pregnancy or when breast-feeding.
Nerve blockAn injection may be used to temporarily block the nerve carrying the pain message. Can also be used to help to diagnose causes of chronic pain.