Pain & Painkillers
According to the International Association for the Study of Pain: "Pain is an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage or described in such terms."
The cause of this "unpleasant sensation" is usually obvious like a bruise, a paper-cut, or a broken bone, but sometimes it is not so easy to discover the exact source.
Despite this unpleasantness our ability to feel pain is necessary. It acts like an early warning signal to alert us that something is wrong with our bodies, and if left untreated it can seriously limit our capability to follow a daily routine and live a normal life.
Starting at the nerve endings nearest the injury or source of pain, these warning signals are passed through our bodies via the central nervous system as they travel up the spinal cord and into the brain.
However, we all experience pain in different ways which can sometimes make it difficult to describe. This can become particularly frustrating when more than one type of pain is being felt at the same time.
Understanding the different kinds of pain is an important step towards deciding which painkiller treatment to use. Although this can be a complex issue, health professionals believe that most pain can be placed into these four categories:
- Nociceptive pain - is the most common type of pain and is caused by tissue damage such as; sprained or pulled muscles, burns, insect stings/bites, and bone fractures. Inflammation is often seen around the damaged tissue as part of the body's natural healing process.
- Neuropathic pain - is usually described as a shooting or burning pain. It is sometimes not caused by an event or injury, but the body just sends pain signals to the brain for no apparent reason.
- Acute pain - is a medium term pain related to tissue damage. It can last between 3-6 months, but usually goes away once the initial injury has healed.
- Chronic pain - is a more persistent pain lasting longer than acute pain, and continues even after the original injury has healed.
Because there are these different types of pain, there are different kinds of painkilling treatments. There are three main types of painkiller: non-steroidal anti-inflammatory drugs (NSAIDS), paracetamol and opioids, and each type works in a different way.
The vast majority of people need to only take painkillers for no more than a few days or weeks, however some people need to take them for a longer period. While treatments like some NSAIDs, and paracetamol are available over the counter (OTC) from pharmacies, strong painkillers are usually only available with a prescription.
How do Painkillers Work
As previously stated, different pain treatments work in different ways. Most people treat pain by taking pills, but some pain relievers are also available as creams, ointments, sprays, or patches.
In order to explain how each type of pain treatment works, we have selected some of the most commonly used and well-known examples of each.
Paracetamol
Although paracetamol has been used to treat mild pain such as headaches since the 1800's, no-one really knows exactly how this analgesic medicine works. Scientists generally agree that it is processed through the liver and seems to work by blocking chemical messengers (prostaglandins)in the spinal cord and brain that tell us we have pain.
Paracetamol is also used to reduce fevers by affecting the chemical messengers in an area of the brain that regulates body temperature.
Ibuprofen
When we are injured or have an infection, our bodies make hormones called prostaglandins. These hormones cause swelling and sometimes fever and send pain signals to the brain. This is all part of our body's natural response to injury.
Ibuprofen is a type of medicine called a . It works in a very similar way to paracetamol by reducing the production of prostaglandin hormones that cause pain. Where NSAIDs are different to paracetamol is that they are processed through the kidneys and reduce pain and swelling by targeting the nerves at site of the pain.
Codeine
Codeine is probably the best known and most widely used opioid. Opioid medications are strong painkillers and work by attaching themselves to proteins called G protein-coupled receptors (GPCRs) that are opioid receptors on nerve cells in the brain, and spinal cord. When this happens, the opioids block pain messages sent from the body through the spinal cord to the brain.
Patients should always follow the directions about how to correctly take a painkilling drug. Mistakes may lead to health problems, addiction, dependency, or fatalities.
Care is needed to avoid mistakes such as:
- Taking the drug incorrectly, can result with too much of the drug in your system, or too little.
- Taking drugs with other drugs, can cause drug conflicts or contraindications.
- Taking the drug with food, or not can make the patient sick, depending on the directions.
- Taking the next dose before it is due, can mean you overdose, and doing this often can lead to dependence and/or addiction.
- Using a second pain reliever may lead to toxic levels and increase the risk of unwanted side effects.
- Waiting too long between doses may allow pain to breakthrough, or you may have withdrawal symptoms.
- Drinking alcohol or consuming grapefruit may interfere with pain medications, and can be highly dangerous when mixed with many pain relief medicine.
- Abruptly stopping an opiate drug can cause withdrawal symptoms like an increased heart rate, profuse sweating or anxiety.
Opioid Painkillers
Opioids, sometimes called narcotics, are medications prescribed by doctors to treat acute and chronic pain. They are used by people with chronic headaches (migraines), back pain, and by patients recovering from surgery or experiencing severe pain associated with cancer.
When used correctly, these strong painkillers are also effective for treating sport injuries or for those who have been seriously injured in falls, and traffic accidents.
Because opioids are such strong painkillers, there can be some side effects including:
- Constipation
- Nausea
- Vomiting
- Drowsiness
- It may be more become difficult to think clearly
- flushing, sweating, itching,
- difficulty passing urine
Not everyone will get these side-effects and often they will settle with time. Side-effects may be more noticeable at the start of treatment or when the dose is increased. If side effects persist or become a concern, we advise you contact your doctor as soon as possible.
Anti-Inflammatory Painkillers
Although ibuprofen is probably the most commonly use NSAID, there are many others including; high dose aspirin, naproxen, and diclofenac.
All of these pain relieving medicines are used to treat mild to severe pain symptoms like; muscle strain, headaches, joint pain, and reduce swelling. Many are available over the counter under different brand names, and a short course of an anti-inflammatory medicine is often recommended to ease brief bouts of painful conditions.
However, NSAID medications can have side effects for some patients such as:
- - including stomach aches, feeling sick and diarrhoea
- - can cause internal bleeding and , and additional medicine may be prescribed to protect your stomach and reduce this risk
- drowsiness
- allergic reactions
In rare cases, problems with your liver, kidneys or heart and circulation, such as , and
Depending on the type of pain, it is often worth trying paracetamol before taking an anti-inflammatory. Paracetamol is a good painkiller, and is less likely to cause side-effects
Painkillers for Nerve Pain
Nerve pain is also described as neuropathic pain and can develop when nerves in the extremities of the body, like the hands, feet and arms, are damaged.
These nerves form the peripheral nervous system, and the symptoms depend on which of these three nerves types are affected.
- sensory nerves - transmitting sensations, such as pain and touch
- motor nerves - controlling muscles
- autonomic nerves - regulate automatic functions of the body, such as blood pressure and bladder function
Over-the-counter pain medications, such as nonsteroidal anti-inflammatory drugs, can relieve mild symptoms. When patients have more-severe symptoms, doctor might prescribe opioid painkillers, anti-seizure medications such as pregabalin (Lyrica), or gabapentin (Neurontin).
These strong painkillers have an excellent safety profile and are unlikely to cause adverse reactions. Side effects are usually mild and go away by themselves and include:
- Sleepiness - this side effect tends to wear off within one or two weeks.
- Nausea - taking this medication after a meal can help prevent nausea.
- Headache - to reduce the likelihood of headaches, patients need good quality sleep, and stay well hydrated.
- diarrhoea
If any side effects persist and become a problem, keep taking the medicine but contact your doctor.
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We look forward to assisting you with your order and remind you that our customer service team is available 24/7 to answer any questions that you may have.
Last Reviewed: 10th July 2024
Next Review Due: August 2025