About pain medication
The name ‘pain killers’ tends to give people the wrong idea. It implies that the drugs can and should eliminate all pain… and this is blatantly not true. In fact, when we compare most pain reliever medicines and even most pain procedures, to placebo treatments, we find they really only tend to help about 1 person in 4 improve their pain by 50% (or more). So, if a pain medicine is given to 4 people, we expect that one person will get 50% or more relief (when compared to the placebo treatment). Therefore, the name ‘pain killer’ really is a bit of an overstatement.
All medicines, interventions and procedures have a placebo effect; and this demonstrates the power of our brain to control pain naturally, and that’s a very good thing. Placebos exert a positive effect because our bodies are ‘wired’ to release our own natural pain modifiers from our own internal drug cabinet in the brain. And if truth be told, it would seem that these internal pain modifiers are much more effective that anything we’ve manufactured to date.
Generally speaking, it probably doesn’t matter too much if a positive treatment response is a result of the drug or placebo. What matters most is that we take the opportunity to capitalise on any benefit to reintroduce safe movement. We know this is one of the most effective strategies for further reducing pain and preventing recurrence of pain. Many therapists would go so far as to say that the goal of pain modifying medications should be to give you enough relief to allow you to get moving, to improve your physical function, mood, sleep and your ability to manage your pain.
When it comes to giving yourself the best chance of relieving pain, especially chronic pain – there is much to be said for working with your doctor or a pain physician to ensure you get the right pain medicine for you. Not all pain is the same and not all pain medicines work in all pain conditions.
Sometimes your doctor may even advise combining medicines. Combining drugs can mean you require lower doses of each, with less risk of side effects while ensuring pain relief.
Making the right medicine choice for your pain
The medication options you discuss with your doctor, physician and pharmacist will depend on the type(s) of your pain. Once you have good information from your care team, it is up to you to decide whether, ‘on balance’, the medication does you more good than harm.
Clinically we often consider that there are 4 broad pain types:
- ‘Nociceptive’ pain –is commonly acute pain when there is tissue damage liked a torn muscle or sprained ankle
- ‘Nociceptive Inflammatory’ pain – can be acute or ongoing, chronic pain. This is usually worse in the mornings, for example, like rheumatoid arthritis pain
- ‘Neuropathic’ pain – is pain associated with nervous system disease or damage. It is often burning, electric shock-like pain, with acute hypersensitivity that makes even light touch painful. People often get this type of pain when they have shingles, sciatica, trigeminal neuralgia, or diabetic neuropathy
- “Other Pain” is pain that largely occurs when the nervous system becomes persistently hypersensitive despite there being no specific evidence of ongoing tissue damage or disease.
Pain does not feel the same for everyone. Describing your pain clearly will help your care team find the best treatments for you. We need to know where the pain is, what it is like (for example dull, sharp, burning, tingling), how bad it is and when it happens. What tends to make it better and worse and what treatments have been tried.
There are three main groups of pain medications
What is most appropriate for you will depend on the type of musculoskeletal pain you are experiencing and any other health conditions you and your family might have. It is really important that you discuss the benefit and risks for each with your care team.
1) Traditional pain medicines – Analgesics
These include a variety of medications you may already know such as – Paracetamol, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), Tramadol and combinations such as Panadeine (paracetamol and codeine), Panadeine Forte (higher dose paracetamol and codeine).
While simple analgesia can be appropriate at times, the most recent, high-quality evidence indicates that paracetamol alone is not effective in the treatment of acute or chronic low back pain and it provides minimal short-term benefit for those with osteoarthritis. Recent evidence on hip and knee osteoarthritis shows that exercise helps to significantly reduce pain and that the benefit of exercise is in fact, much larger than using paracetamol.
2) Anti-neuropathic pain medicines
These medications can be tried for neuropathic pain to reduce nerve activity and reduce pain hypersensitivity associated with conditions like shingles, diabetic pain, sciatica, fibromyalgia and some headaches.
These medications are often prescribed if you have burning or shooting pain (nerve injury or ‘neuropathic pain’). They help somewhere between 10-35% of people with neuropathic pain. They don’t tend to help acute nociceptive pain or inflammatory pain.
3) Opioid pain modifiers
If you’ve just had surgery or a severe injury, or if you have chronic pain, your doctor may prescribe you opioids to lessen your pain and distress. These medicines tend to be very effective in decreasing pain but only about 20% of patients get effective relief without side effects.
Opioids are never really a first line choice in pain management. This is the case for several reasons, because of the risk of side effects with both short- and long-term use and the risk of dependence. It is also because we know that short-term relief comes with increased risk of long-term pain persistence.
All in all, there is no one-size-fits-all approach for pain relief and your best course of action is to always consult with your doctor and your pharmacist. Talk through any risks and benefits as they relate to you and ensure that any medicines are only one part, of a more comprehensive care plan that focuses on getting you active and participating in life again.
Are you living in pain and not sure what treatment you need? Book a consultation with our osteopath, Dr Nicola Stevens. Nicola will help you understand what sort of pain you have and what sorts of treatments are most likely to help you recover.