+ DOCTOR’S ORDERS

PAINKILLERS

Chronic pain is very common and is defined as pain lasting for longer than 12 weeks. In some cases there may be a known underlying cause, such as arthritis, but in others, the original injury may have resolved but the nervous system has upregulated and is still sending pain signals to the brain. In this case, the pain itself is the disease.

There are lots of medications available over the counter, the most common being paracetamol and ibuprofen. Doctors then gradually prescribe according to what is called the analgesic ladder, where the medications increase in strength and dose, perhaps to include an opiate containing codeine or tramadol. However, these medications are addictive and have side effects, such as headaches, which may actually worsen your condition.

Other types of painkillers may be used, including antidepressant or anti-seizure medication such as amitriptyline or pregabalin. This doesn’t mean your doctor thinks you’re depressed or have epilepsy; they simply work for pain as well. If your pain is not improving despite treating the initial complaint and using painkillers, your doctor may advise you reduce the painkillers themselves and refer you to a pain clinic, where treatments may include steroid injections, epidurals, or use of a TENS machine.

Pain clinics will often offer a referral to a specialist psychologist for cognitive behavioural therapy (CBT), too, because if a doctor cannot cure the pain itself, a psychologist can help understand and manage your pain to improve your quality of life.