An overview of Pain Medication
This article draws together all the information on pain medication from the question posts into one article.
Paracetamol is commonly used as a painkiller and to reduce high temperatures. The way paracetamol works is not fully understood but it probably reduces the production of prostaglandins in the spinal cord and brain. Prostaglandins are produced in response to injury and some diseases and increase the sensitivity of nerve endings. If paracetamol reduces the levels of prostaglandins it essentially raises your pain threshold so you are less sensitive to pain. It doesn’t alter the cause of the pain, simply the response.
Paracetamol does not reduce inflammation.
It takes up to an hour to be effective.
The evidence for the effectiveness of paracetamol for reducing pain is very poor for back pain, nerve pain, migraine, post-operative pain and osteoarthritis.
Contrary to long-held beliefs, paracetamol can have side-effects. It is associated with increased mortality, heart problems, ulcers and effects on the kidneys. Side-effects are rare and the effects of long-term use are still being researched.
There are many anti-inflammatory medications available. They are called NSAIDs – non-steroidal anti-inflammatory drugs. They are often used to treat episodes of pain. The most commonly used are:
They do have side –effects and are unsuitable for some people. You need advice if you have asthma, or a history of stomach problems and other health problems.
Side-effects from NSAIDs include stomach pains and nausea, headaches, tiredness and other more rare side effects.
There is very little difference between the medications but people tend to vary in their response to anti-inflammatory medications. One person prefers aspirin, another naproxen. Pain relief begins with the first dose and increases to maximum within a week. The anti-inflammatory benefits may take up to 3 weeks.
Opioids for pain have been in the news a lot recently because of reports of increasing dependence on these addictive medications. They are prescribed for severe or persistent pain.
They are very effective at relieving pain but there is a risk of addiction when used long-term.
Side effects include sleepiness, constipation and nausea.
The most commonly prescribed opioid is codeine. Other opioids include tramadol, fentanyl, morphine, and heroin. Opioids are often prescribed as combined medications such as co-codamol which is paracetamol and codeine combined. This is so you get the benefits of both medications and can have a lower dose of codeine.
Codeine is a medication used to treat pain and diarrhoea. It is not surprising therefore that a lot of people who take codeine for pain experience constipation.
Opioids should only be taken under the supervision of your GP.
Pain relief gels
There are many pain relief gels and creams available -some work by heating, others cooling and some claim analgesic (pain relief) effects. You will see shelves full of gels in the supermarkets and pharmacies it can be bewildering.
How do they work?
There are lots of different types of gels which work in different ways:
Pain killing gels include voltaren gel (which contains diclofenac) or ibuprofen gel. These gels interupt the production of chemicals in the cycle that causes inflammation and therefore reduce the amount of pain felt in an area. All NSAID painkillers including tablets, such as neurofen, aspirin and ibuprofen, work in a similar way. There are less side effects with applying gels to the skin compared to taking tablets.
Salicylates are heat gels. They cause heat by local skin irritation. It is not known how they actually do this.
Cold gels contain menthol which triggers cold receptors in the skin.
Capsaicin is the active ingredient from chilli peppers that makes them taste hot. It’s not known exactly how capsaicin works but it is thought to reduce the chemical that transmits signals along sensory nerves to the brain.
Are there any side effects?
There can be redness at the site of application. Around 1 in 20 people experience this mild, short-lived symptom. It is uncommon to get stomach upsets or feeling sick with gels.
Capsaicin causes side effects, mostly skin irritation, in 4 out of 10 people.
Which pain relief gel should I use?
To answer this question I am going to use the results of some Cochrane research reviews. These reviews gather together the results of lots of research projects on a subject to provide evidence based healthcare advice. Usually the experiments compare the gel to a placebo (fake) gel. If the gels give the participants significantly pain relief and substantially more than the placebo treatment they are considered effective.
Acute (new) pain
Using diclofenac gel (voltaren), ketoprofen gel, ibuprofen gel or diclofenac plaster on acute (new) pain.
7-8/10 people with a painful strain, sprain or muscle pull had much reduced pain after 7 days. 2-3/10 had the same effect with a placebo gel.
All other gels are not much better than placebo for acute pain.
Conclusion: Voltaren or ibuprofen gel may help with relieving a new painful strain, sprain or muscle pull.
For hands and knees in OA
Diclofenac gel (voltaren) and ketoprofen for 6-12 weeks reduced pain by at least half for a modest number of people.
The gel needs to be used for a long period to reduce pain for some people with OA.
Heating and cooling gels
Heating and cooling gels do not make enough of a difference for researchers to be able to recommend them. They are probably more likely to have an effect in acute pain than chronic. This does not mean they won’t work for you but it means that they do not make a big enough difference for a significant number of people compared to placebo for relieving pain.
Nerve pain after shingles
Capsaicin helps about 10% people who are experiencing nerve pain. It is most often used for the nerve pain that can linger after shingles.
As you can see the results are mixed. The research compares the effectiveness of the gels to placebos. For some people a placebo gel produces a positive effect. It may be worth trying the gels to see if they work for you. Even if it is a placebo effect. If it gives you some relief it can be worth it.
ALWAYS SEEK MEDICAL ADVICE BEFORE TAKING PAIN KILLING MEDICATION IF YOU HAVE OTHER MEDICAL CONDITIONS OR YOU TAKE REGULAR MEDICATION. THIS ARTICLE IS NOT FOR MEDICAL ADVICE.