Why painkillers could make the problem WORSE

MOST GPs don’t have the time or resources to discuss the complexities of persistent pain, so do the best they can and write a prescription. Patients expect to leave the surgery with a solution, so readily accept the drugs.

Medication can help you through difficult days, enable you to sleep better and dampen pain in the short term. But much medication prescribed for back pain can, in some cases, make matters worse.

For a start, calling anything a ‘painkiller’ sets us up for frustration: no drug can ‘kill’ pain, it can only relieve or ease it. And while pain-relieving drugs can help some people for a time, they can’t help everyone, and never consistently. Also anything described as ‘strong’ may trick your brain into concluding your pain must be very serious indeed — even incurable. This can exacerbate stress.

IBUPROFEN OR DICLOFENAC:

These anti-inflammatories can alleviate episodes of acute pain, but are best used short-term. Not only can they trigger gastric problems such as ulcers but, with back pain, their effect swiftly becomes redundant.

Inflammation occurs when tissue is damaged and chemicals are released which activate nerve endings that fire ‘danger-alert’ messages into the spinal cord (which transmits them to the brain).

These chemicals also trigger the healing process. But the inflammatory response only lasts days before the regenerative phase of healing takes over — so anti-inflammatories can’t help long term. Persistent pain, as discussed, is not about tissue damage, but faulty pain messages within the nervous system.

PARACETAMOL:

Reliable for common pain conditions (though a recent study shows it’s no more effective for back pain than a placebo).

OPIOIDS:

Prescription drugs such as tramadol or co-codamol contain a form of morphine that suppresses pain, but can be addictive. Your brain remembers the ‘reward’ (the pain relief) and lays down neural pathways to encourage you to repeat it. Over time, the original dose provides less reward, and needs to be raised to obtain the same effect. If the brain doesn’t receive this reward, it alerts you with an increase in pain intensity. They can also lead to ‘opioid-induced hyperalgesia’, which means they can increase the sensitivity of the nervous system and wind up the pain.

ANTIDEPRESSANTS AND ANTI-EPILEPTICS:

Amitriptyline, pregabalin and gabapentin are widely given in low doses for persistent pain. They can take a while to show a benefit.

If you get no benefit from amitriptyline within two to four weeks, stop taking it. If it helps, use it to get active again and tail off use after two or three months.

Gabapentin and pregabalin are anti-epileptics — if they don’t ease symptoms enough to get you functioning within eight to 12 weeks, they’re unlikely to help long-term.

If you are in any doubt about medicines you have been prescribed, talk to your GP.