Painkillers for treating pain: How do they work and should I take them?
Chiropractors see many people in pain. As a chiropractor myself the majority of patients who come to see me come because they are in pain. Back and neck pain is the problem for a significant proportion of these patients. That said, I see lots of patients with shoulder, knee or ankle pain and many that suffer from headaches. One of the most frequently asked questions is should I take painkillers for my pain? Often followed by, will painkillers actually help with my pain? And how do painkillers actually work? The short answer is yes painkillers can help to varying degrees with back pain and other muscle and joint problems.
Should I take painkillers?
Giving a balanced accurate answer to these questions can be tricky, it’s important that people receive all the help possible with their pain but painkillers must not be taken like an unattended child next to a smarty jar! I Have had some pretty painful experiences myself so I know this can sometimes be the temptation. My response to these questions is usually as follows: Yes, if your doctor of a pharmacist have said that you can. To the other two questions I would say yes over the counter medications can help, but there are other medications that can be prescribed by a doctor. These prescription medications are stronger and can only be used in certain circumstances because they have more significant side effects.
How do painkillers work?
This is the can of worms question, you can open it but sometimes you wish you hadn’t; it’s not a straightforward answer if you are going to give clear and accurate information without too many simplifications or untruths in it. So I’ll do my best to answer this below.
“Why are there no painkillers left in the Zoo- because the parrots eat e mol”. Possibly the worst joke I know, but there aren’t many pharmacology based jokes! How does paracetamol useful as a painkiller for people in pain? Well despite what you might think it does actually act as a weak anti-inflammatory. However its main pain suppressing effect is thought to be due the activation of a neurotransmitter in the brain called serotonin. It can actually be a surprisingly effective painkiller especially if taken at the correct dose for a few days. As most people know this is often the best medication to take for muscle and joint pains or for headaches. Paracetamol can even be given via an I.V. drip in hospital. According to some studies I.V paracetamol can be as effective as morphine for certain kinds of pain.
Anti Inflammatory Drugs
Ibuprofen, Diclofenac (voltarol) and Naproxen: These are some of the common forms of painkiller. Aspirin was one of the first to be used and in its unrefined form is actually found in the bark of the willow tree. These painkillers are collectively called NSAIDs- Non Steroidal Anti-Inflammatory Drugs. Wow that’s a mouthful! These are painkillers that reduce swelling (but aren’t corticosteroids). How do anti inflammatories painkillers work for the treatment of pain? Inflammation is basically the body’s response to injury or damage. It involves making blood vessels more leaky so that immune cells and other compounds important for tissue repair can reach a site of injury. Why would you want to suppress that? Well the problem is if the inflammatory response is too great the tissues swell up, become stiff and the nerve endings can be made very sensitive creating more pain.
In treating back pain and sports injuries for example there is great debate as to how much we should suppress the level of inflammation. We want these painkillers to help reduce pain and swelling for the acute injury, but we don’t want to suppress inflammation too much as research shows under certain circumstances this can slow the rate of healing.
When you think of the opium poppy we generally think of films about illegal drugs and bad people (or perhaps that’s just me). Codeine, morphine, tramadol, diamorphine, Fentanyl, Oxycodone; these are all opiates. These are extremely effective at reducing pain; the problem is they can have some nasty side effects. They work on receptors in the brain and affect how the brain processes messages that the brain would otherwise interpret as pain. As a pharmacology professor once said when I was at University- your leg might be hanging off but if you’ve been given morphine you say “ahh what the heck I’ve got another one”! This is somewhat of a stretch of the scientific truth, but you get the idea!
Heroin or (diamorphine) has traditionally been a commonly abused drug. Opiate abuse and addiction claims the lives of over half a million people a year and in countries like the United States. This has rightly been described the as a crisis of medication abuse. The sad thing is that sometimes people can become addicted even when they are following their doctor’s advice and taking these medications as they’ve been told. Clearly this does not cause overdose but can create an addiction, which sometimes means people start to abuse these drugs at a later stage. This problem has sparked a review about the rate that these drugs are prescribed, so they are only given if necessary and for as short a time period as possible. That’s why when you buy cocodamol over the counter it only contains only very small amounts of codeine in each pill and it’s recommended you only take them for 3 days.
Lastly let’s talk about steroid injections. Sometimes people ask: I’ve had a steroid injection for shoulder pain (or tennis elbow) will that make my muscles big like a body builder? Great question but sadly no it won’t. Steroids that make your muscles bigger are called anabolic steroids. Steroids used in injections of this kind are corticosteroids and they do different things. Corticosteroids can be very helpful in reducing inflammation and therefore pain. However, we are back to that old conundrum; if we suppress inflammation too much we might slow down tissue healing.
So what does this all mean in reality? Well if you’ve had a recent onset of muscle or joint pain you could get some advice about painkillers. They really can help you feel better and get back to doing normal activities…IF they are used appropriately. They should not be used as a crutch or masking agent for the long-term problems if at all possible. This means making sure people you get the right treatment and advice. Often this means doing appropriate rehabilitation to allow as far as possible full tissue healing, normal range of movement and strength as well as correcting faulty movement patterns. If you do that you may well find you don’t visit the cabinet for painkillers all that often.
The Context of Pain
Have you ever cut your leg playing football, rugby or when you were occupied, adrenaline fueled and happy? Most people have and they know that even something quite serious didn’t hurt at the time. Now think of a time when you were bored, anxious, stressed or depressed. Generally the same level of message from the body is interpreted completely differently in these two scenarios. Pain is a complex context based, personal experience and needs to be treated as such.
For those with chronic (long term pain) the complex relationship between the brain and the body must be considered. In these situations the brain can get used to nerve signals and “the volume of the signal” can be turned up such that the brain then interprets the message as persistent pain. This is through no fault of the individual in pain. By explaining this process of persistent pain and reducing anxiety and stress we can help people to sleep better and start to recover. For these people normal daily tasks can be very painful and so they become fearful of them. This can be reversed. By giving people genuine support and understanding these complex pain situations can be improved.
Finally if people are provided good treatment and advice they are less likely to be faced with these tough challenges. So with our health systems across the globe being stretched to the limits by the Corona virus pandemic. If you know people who are in pain, please be kind, helpful, sympathetic and understanding you may well help them recover and prevent them falling into a painful pit that they may struggle to get out of.
For more information look up the pain revolution with Professor Lorimer Moseley: \https://www.painrevolution.org/vision
or watch his fascinating TED TALK: https://www.youtube.com/watch?v=gwd-wLdIHjs
If you are in pain and would like to talk about how you can receive help please get in touch: