Dr Sarah Jarvis Don’t Panic About Painkillers
My Weekly’s favourite GP Dr Sarah Jarvis from TV and radio writes for you
The National Institute for Health and Care Excellence (NICE) hit the headlines over new draft guidelines that suggest many commonly used painkillers don’t help chronic pain, and can do more harm than good. But should you stop taking yyour tablets?
Doctors talk about “acute” and “chronic” pain. Acute pain is short term; chronic pain lasts at least 3 months, despite treatment. It’s important to be aware that the new guidance only relates to chronic pain – and, more importantly, “primary” chronic pain where the un nderlying reason for th he pain should have se ettled.
We’ve all had acute pain, p whether it’s a banged b knee, or a t oothache. Acute pain is s usually caused by an i njury or underlying problem p and goes away a as the injury heals or the medical condition (such as infection or inflammation) is treated. Simple painkillers, such as paracetamol or ibuprofen, can be highly effective.
For some causes of acute pain, there are other things you can do. For instance, for a sprained ankle or foot, we recommend that for 2-3 days you think PRICE: Protect the joint, Rest as much as possible, apply Ice for 15-20 minutes (never direct onto the skin), Compress with a tubular compression bandage (not too tight) to support the joint and limit swelling, and Elevate by keeping your foot up when you can.
Headaches are a common cause of acute pain, often due to muscle tension. The cause of migraines isn’t clear but doctors now think an imbalance of brain chemicals plays a bigger part. For tension headaches ibuprofen can be very effective because it targets inflammation in muscles and joints. For migraine, medicines called triptans can work wonders. But trying to avoid triggers like stress, anxiety, tiredness, hunger or dehydration can make a major difference to keeping headaches at bay.
Doctors divide chronic pain into two main types, but there is a lot of overlap.
There are many conditions where pain persists because the problem hasn’t gone away. An obvious example is osteoarthritis (OA), the commonest cause of joint pain in the UK. Half of Brits over 65 have osteoarthritis, the
AVOID ANTI-INFLAMMATORY TABLETS LIKE IBUPROFEN IN HIGH DOSES FOR LONG ADVICE’’ PERIODS – SEE YOUR GP FOR
most commonly affected joints being knees and hips, then low back, neck and hands.
In OA the joint cartilage, which lines the joint, becomes damaged. This prevents the joints from gliding smoothly when you move them. It can also lead to inflammation in the tissues around the joint. Although symptoms of OA often come and go in the early stages, in severe OA the pain persists. Painkillers may help and replacement of the damaged joint often solves the problem almost entirely.
Primary chronic pain is different. The physical cause of the pain has settled but signals from pain receptors or nerves become altered, telling your brain there is pain when there shouldn’t be. This pain is absolutely real but standard painkillers that work on pain receptors, don’t help.
Instead, NICE recommends exercising as much as you can (in a supervised group if needed) and pain management clinics, including group or individual counselling to help you cope with the pain. This can often make the pain less severe.
Where painkillers are concerned, NICE doesn’t recommend paracetamol, ibuprofen, stronger codeinebased painkillers and the like for primary chronic pain. That’s because there’s little evidence they help this type of pain and they can cause harm, including addiction with stronger painkillers.
Instead, antidepressants and medicines first developed for epilepsy may help by damping down nervous system signals.
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