What are Painkillers?
Painkillers, or analgesics, are medications specifically designed to alleviate or reduce pain. They work by targeting the body’s pain receptors or interfering with transmitting pain signals to the brain. A wide variety of painkillers is available, including nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and opioids, each with different brand names and formulations. Using painkillers under a healthcare professional’s guidance and following the recommended dosage and usage instructions to ensure their safe and effective use is essential.
They can be taken:
- By mouth as liquids, tablets, or capsules.
- By injection.
- Via the back passage (rectum) as suppositories.
Some painkillers are also available as creams, ointments, gels, or patches.
Types of painkillers
Even though there is a wide variety of painkillers available, they can be categorized into three main types, each working differently.
They are:
- NSAIDs like ibuprofen, diclofenac, and naproxen, along with low-dose aspirin, are used to reduce inflammation and prevent blood clotting, especially for individuals with a history of heart attacks.
- Weak opioids like codeine and dihydrocodeine are effective. Still, they can lead to addiction and adverse effects, while solid opioids like morphine, buprenorphine, oxycodone, pethidine, and tramadol are also used for severe pain.
Combining different types of painkillers into one tablet is a common practice. For example, a widely used combination is paracetamol plus codeine, known as co-codamol. This combination is often prescribed for more potent pain relief than either medication can provide alone.
In addition to the previously mentioned treatments, certain antidepressants and antiepileptic medications may also be prescribed to manage neuropathic pain. However, these types of drugs are not further discussed in this leaflet.
Other alternative methods for pain relief include transcutaneous electrical nerve stimulation (TENS) machines.
How do painkillers work?
Nonsteroidal anti-inflammatory drugs (NSAIDs) help relieve pain and inflammation by blocking the activity of cyclooxygenase (COX) enzymes. These enzymes produce prostaglandins, which cause pain and inflammation at injury sites. By reducing the production of prostaglandins, NSAIDs effectively alleviate both pain and inflammation. It’s interesting to note that NSAIDs have different ways of working, with some acting differently than others.
Paracetamol. Although its mechanism of action is not fully understood, it is thought to function by inhibiting COX enzymes in the central nervous system. It is commonly used to relieve pain and reduce fever, but it does not exhibit anti-inflammatory effects.
Opioids function by binding to specific receptors, known as opioid receptors, located in the central nervous system, the gastrointestinal tract, and other areas of the body. This action reduces the perception and response to pain while increasing tolerance to painful stimuli.
Which painkiller is usually prescribed?
The type of painkiller a doctor will prescribe depends upon:
- The type of pain.
- Any other health problems.
- The severity of the pain.
- The possible side-effects of the medicines.
Painkillers like paracetamol are recommended or prescribed for mild to moderate pain without inflammation.
If you’re dealing with pain and inflammation, NSAIDs can be helpful, especially for joint or back pain. However, they’re not the best option for everyone and can have some side effects. For example, if you’ve had stomach ulcers, NSAIDs may not be the right choice for you. In this case, your doctor may suggest a safer option like paracetamol, even though it may not be as strong. Also, consider using NSAIDs alongside heat and ice treatment for joint, muscle, or ligament injuries. Take care!
Weak opioids, such as codeine and tramadol, are often prescribed for moderate to severe pain that is not adequately managed by non-opioid medications. These medications are typically considered when non-opioid options have been ineffective in providing relief.
More potent opioids are typically used to manage severe pain, such as pain related to cancer, post-operative pain, or pain following a severe injury.
Anti-inflammatory medicines used as creams (topical painkillers) mainly treat soft tissue and muscle pain.
How should I take painkillers?
People experiencing persistent pain are often instructed to take pain relief medication regularly. For example, if paracetamol is the recommended medication, it is typically taken four times a day, every day, until the pain subsides. Alternatively, individuals should only use painkillers as needed rather than on a regular schedule.
For certain chronic pain conditions, such as fibromyalgia and chronic tension headaches, the utilization of regular painkillers is not advisable. This is because non-pharmacological treatments have demonstrated greater efficacy for these conditions, whereas painkillers might exacerbate the underlying condition.
In 2021, the National Institute for Health and Care Excellence (NICE) significantly updated its recommendations concerning painful conditions. The revisions focused on conditions such as low back pain and sciatica, shedding light on the potential risks of pain medications. Specifically, the updates emphasized the dangers of side effects from these medications, including the elevated risk of addiction to potent opioid-based painkillers.
Medical professionals advise using painkillers for the briefest duration and in the most effective dosage possible. If you have any concerns, it is essential to discuss them with a doctor or pharmacist.
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac should be taken with food or after a meal. These medications have the potential to irritate the stomach lining, leading to discomfort and, in some cases, even bleeding. Therefore, in certain situations, a healthcare provider may also prescribe a proton pump inhibitor (PPI) alongside the NSAID to provide added protection for the stomach and reduce the risk of irritation.
What is the usual length of treatment?
Remember, pain relief medications should only be used for the shortest time possible and at the lowest effective dose to lessen the risk of potential side effects. Some people may need pain relief medication for short-term relief, like toothaches or muscle strains, lasting only a few days or weeks. However, individuals with chronic conditions like osteoarthritis or ongoing back pain may need to use pain relief medication in the long term to manage their pain.
Side-effects of painkillers
The information presented in this leaflet does not encompass all potential side effects associated with each painkiller. Diverse side effects have been documented for different classes of painkillers, a phenomenon commonly observed with all medications. For more exhaustive information, please consult the accompanying information leaflet specific to the medication in question.
NSAIDs
Most individuals who use anti-inflammatory medications, particularly for short-term use, typically do not experience any side effects or may only experience minor ones. When used appropriately, the benefits of these medications usually outweigh the potential risks. Many individuals resort to a brief course of anti-inflammatories to alleviate various types of pain. However, it’s important to note that serious adverse effects, such as gastrointestinal bleeding, cardiovascular issues, or kidney problems, can potentially occur.
