By the way . . . No painkiller is risk-free but they’re still useful

EVERY prescription medicine comes with a data sheet. Required by law, this document gives the user information, including possible sideeffects. They can make worrying reading.

But this information must be considered carefully and understood in the context of the needs and circumstances of the user rather than seen as a reason to avoid that drug.

This applies to painkillers, too. I was reminded of this after the recent warning that ibuprofen, along with other non-steroidal anti-inflammatories, may raise the risk of heart failure.

Many people will have been frightened by this. But the devil is in the detail.

The study, published last month in the BMJ Open, found that long-term regular use of these drugs may damage heart function. That is, it’s not the odd dose here and there that’s potentially risky. This includes the pain that follows an operation, or a sore throat, which require only a week or two of treatment. It’s the use of painkillers for chronic conditions where we must focus our attention.

For older people, who are most at risk because they tend to take painkillers long-term, it is the pain of arthritis that presents the greatest challenge. The difficulties lie with how to cope with relentless daily pain for conditions in which there is little prospect of cure.

During my career I have seen promising painkillers come and go, dogged by concerns over long-term use. Some readers may remember Phensic, an over-the-counter pill containing the painkiller phenacetin, which was banned decades ago because it damaged kidneys. This led to a push to find new options.

We have since seen Fortral, a synthetic type of morphine; Acupan, a non-morphine painkiller; Dolobid, a non-steroidal anti-inflammatory; and Benoral, a combination of aspirin and paracetamol, all come and go. Though not banned outright, none found permanent favour due to side-effects. So what are we left with? The cupboard is almost bare. Apart from ibuprofen, there is good, old-fashioned aspirin — very effective, but it often causes stomach problems. There is paracetamol — recently reported as ineffective against serious pain.

There is codeine — rarely prescribed now, maybe because it is addictive (and constipating). Every one has drawbacks in long-term use: there is no one-size-fits-all option.

And this is where caring doctoring comes in to play — in this context, that means offering pain management techniques, from physiotherapy and massage to advice about the benefits of counter-irritation (where you use heat to irritate the skin to disrupt pain signals — such as a hot shower for a stiff neck).

The problem is that it all takes time and trouble, which are in almost as scarce a supply these days as effective and totally trouble-free painkilling drugs.