Pain Killers
When we take a patient’s case history, we always ask about any medications they might be taking. People seem to be taking more and more prescription medication and there is often a long list to discuss. Due to the nature of the types of problems people come to see us with, we often end up discussing pain killers and anti-inflammatories. Here is a summary of some of the most commonly prescribed medications for pain, what they are prescribed for and how they work.
Paracetamol
Paracetamol belongs to a group of medicines known as analgesics, or painkillers. It is used to relieve mild/moderate pain. It is also used for lowering a fever.
Paracetamol is the most common painkiller and many brands of ‘over-the-counter’ combination painkillers contain paracetamol, as do many cold and flu remedies. It is important that you check the label on anything you buy to make sure that you are not taking more than one preparation containing paracetamol.
Despite it being the ‘go to’ medication for spinal problems, recent studies have suggested that Paracetamol may not be particularly effective in the management of lower back pain, and that other methods such as NSAID’s and exercise should be used instead. It also has potential side-effects. A GP was recently quoted in the Guardian “Paracetamol can cause kidney and liver problems, and causes as much gastrointestinal bleeding as NSAIDs”.
How does paracetamol work?
Paracetamol seems to work by blocking chemical messengers in the brain that tell us we have pain. It also reduces fever by affecting the chemical messengers in an area of the brain that regulates body temperature.
Key facts
- Paracetamol can take up to an hour to work.
- The usual dose of paracetamol is one or two 500mg tablets at a time.
- Don’t take paracetamol with other medicines containing paracetamol.
Non-steroidal anti-inflammatory drugs (NSAIDS)
Examples of NSAIDs include ibuprofen, diclofenac and naproxen. Aspirin is also an NSAID. However, it is mainly prescribed (in low doses) to help to keep the blood from clotting – for example, for people who have had a heart attack in the past.
How do NSAID’s work?
NSAID’s work by blocking the effect of natural chemicals called cyclo-oxygenase (also known as COX) enzymes. These enzymes help to make other chemicals in the body, called prostaglandins. Some prostaglandins are produced at sites of injury or damage, and cause pain and inflammation. By blocking the effect of COX enzymes, fewer prostaglandins are produced, which means pain and inflammation are eased.
Key facts
- NSAID’s take 20 to 30 minutes to work if you take them by mouth.
- NSAID’s such as ibuprofen may be taken for period pain or toothache. Some people find it more effective than paracetamol for back pain. Prescription NSAID’s such as Naproxen may be used to treat inflammation in joints and muscles, such as with rheumatoid arthritis, osteoarthritis, and gout
- Always take NSAID tablets and capsules with food or a drink of milk to reduce the chance of an upset tummy. NSAID’s have the potential to cause digestive irritation and even ulceration in severe cases if not taken correctly. People with cardiovascular or gastrointestinal risk factors should consult the doctor or pharmacist before taking an NSAID.
Opiates
Opiates are a group of analgesic (pain killing) medications. Codeine is the most commonly prescribed mild opiate, and is used to treat mild-to-moderate types of pain when painkillers such as paracetamol and ibuprofen have not been effective. However, it usually prescribed in combination with another painkiller (ie- Co-codamol = Codeine and Paracetamol). Stronger Opiates such as oxycodone, pethidine and tramadol are prescribed for severe pain.
How do Opiates it work?
Opiates work by binding to certain tiny areas, called opioid receptors, in your central nervous system (brain and spinal cord). This leads to a decrease in the way you feel pain and your reaction to pain. Codeine is available on a prescription from a doctor.
Key facts
- Co-codamol comes in many strengths. You can buy the lowest strength from pharmacies but higher strengths are only available on prescription.
- The most common side effects of co-codamol are constipation, feeling sick and sleepiness, taking too much co-codamol can be harmful.
- It’s possible to become addicted to the codeine in co-codamol, but this is rare if you’re taking it as a painkiller under medical supervision.
The take home message…
Should you be taking pain killers/anti-inflammatories? It’s worth remembering that pain and inflammation are normal, natural and necessary. Pain is an essential message that tells us when we are doing damage to our body and helps us to protect it. Inflammation is essential for healing and simply would not happen without it. If you rely too heavily on pain killers you can end up doing too much whilst unaware of the extra damage you’re doing because of the effect of the pain killers. If you rely too heavily on anti-inflammatories, some studies have suggested that healing time can be prolonged and less efficient. Cold compresses may be useful before resorting to anti-inflammatory medications, these can help manage and control swelling and pain rather than preventing inflammation altogether.
Listen to your body and take medication only when necessary and according to the advice of your GP and Pharmacist. At the Courtyard Clinic our team will diagnose the cause of your pain and, where appropriate, treat the problem allowing your body to heal and become pain-free as soon as possible.