Not every painkiller is right for you
PHARMACISTS EXPLAIN TO ABI JACKSON WHY DIFFERENT PAINKILLERS CAN SOMETIMES BE MORE SUITABLE THAN OTHERS
IT’S easy to assume the only difference between painkillers is their strength. Or that any painkiller you can buy without a prescription is always safe to use, but that isn’t necessarily the case. Always speak to a doctor or pharmacist if you have concerns or queries, and anybody with existing health problems, allergies, or who is already taking other medications and supplements, should check that a drug is safe and suitable for them.
We asked pharmacists to explain how the most common painkillers work and the main points to consider.
PARACETAMOL
“PARACETAMOL is probably the most commonly-used painkiller,” says Sandra Gidley, president of the Royal Pharmaceutical Society (rpharms.com).
A good all-rounder for relieving general aches and pains, it can also help reduce a fever. “It’s been used for about 100 years, but we still don’t understand exactly how it works,” says Sandra.
“We think it helps relieve pain by decreasing the amount of prostaglandins,” which are produced by the brain and spinal cord in response to injury or disease, for example. They stimulate nerve endings, causing us to experience pain.
■ The important stuff: COMPARED with other drugs, paracetamol isn’t associated with many side-effects – providing it’s used appropriately. It’s important not to exceed the maximum recommended dosage (for adults is up to eight 500mg tablets within any 24-hour period), as overdosing can happen quickly, and potentially cause devastating damage.
“People think, ‘Oh, it’s only paracetamol’,” says Sandra, but even slightly exceeding the recommended dose can lead to symptoms of paracetamol poisoning.
“The damage to your liver can be awful,” she adds.
If you’re taking any other medications alongside paracetamol, check the packets, as a number of other over-the-counter medications – for instance, cold and flu remedies – can also include paracetamol. If you’re ever unsure, speak to your pharmacist.
Another important thing to be aware of is the risk of ‘medication overuse headache’ or ‘rebound headache’. This is a vicious cycle where people who take painkillers to help manage headaches, end up developing a worse or chronic headache as a result.
This doesn’t just apply to paracetamol, but other types of painkiller too.
If you are taking painkillers regularly, see a doctor – especially if they are chronic headaches that aren’t getting better.
You may need to see a specialist who can ensure you’re being treated appropriately, or give guidance for breaking the ‘rebound headache’ cycle. Sandra advises trying self-help strategies and relaxation techniques to help take the edge off.
NON-STEROIDAL ANTI-INFLAMMATORIES
IBUPROFEN, another commonlyused over-the-counter painkiller, is a member of the non-steroidal anti-inflammatory (NSAID) family.
These also work by altering chemical activity in the body, but also reduce inflammation – which can make them particularly good for things like joint pain and injuries.
“There are a number of other NSAIDs, but they’re not all available over the counter,” says Sandra, who explains this is because of the risks and side-effects they’re associated with. Higher strength NSAIDs (such as naproxen and diclofenac) may be prescribed to help a number of conditions, but it’s important they’re appropriately managed and reviewed with your doctor.
■ The important stuff: “ALTHOUGH widely used, NSAIDs are not right for everybody,” says Sandra. “For example, for some people with asthma, NSAIDs can provoke an attack. Some have also been found to have a negative effect on the heart and they may not be a good idea for people with high blood pressure. Prolonged use can also cause kidney disease, so we’re much more careful about the use now.” Another key point with NSAIDs is that they can cause stomach irritation, sometimes even leading to a stomach ulcer. This can be avoided by ensuring you take the tablets with food, as advised, and taking an accompanying medication to protect the stomach.
“This is usually a PPI, a proton pump inhibitor,” says Sandra. “This is really quite important, especially if you’re taking a lot of them.”
OPIOIDS
THIS group of drugs includes strong painkillers such as morphine, and at the other end of the scale, codeine, which can be bought over the counter in a low-dose combination with paracetamol (co-codamol).
“They are very useful for treating short-term severe pain. They work by basically blocking pain messages to the brain and also cause a euphoria effect, which helps people forget about their pain too,” explains Sandra.
Other opioid painkillers are only available on prescription, including tramadol and fentanyl, which often comes in patches. While powerful, all opioid use – including co-codamol – should be very carefully managed and, says Sandra, “treated with extreme caution”.
■ The important stuff:
ONE of the biggest risks is addiction, which can sometimes happen very quickly. In recent years, opioid painkiller addiction has been a huge problem in the US, and there’s growing concern in the UK. Part of the problem, Sandra explains, is that you can quickly “get used” to a certain dosage, so need more to feel the effects.
“In my work as a community pharmacist, I have come across people who’ve become so addicted to prescription painkillers, they’ve had to go on a drug withdrawal programme to come clean,” she says.
However, addiction services are not widely available, so people can end up in a vicious cycle.
“There are other side-effects to be careful with too, such as drowsiness. “High doses can also depress your breathing and reduce your heart rate and you can lose consciousness,” says Sandra. “The depression of breathing is a particular concern for some people.”
CHRONIC NERVE PAIN DRUGS
PRESCRIPTION medications, such as gabapentin, pregabalin and amitriptyline, are sometimes used for managing certain types of nerve (neuropathic) pain. These drugs are traditionally used to treat conditions such as epilepsy and depression, but at a certain dose, can also be effective for more severe and complex neuropathic pain, including sciatica, fibromyalgia and complex regional pain syndrome.
“Traditional painkillers either reduce inflammation at the site of injury or reduce the sensations of pain centrally in the brain. However, these medicines are different and work by suppressing the nerve