Painkillers: Use them to kill your pain; not you

Apr 15, 2018 Dr Zulfikar Bux, Features / Columnists

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By Dr Zulfikar Bux
Assistant Professor of Emergency Medicine

Painkillers are very helpful when we are having pains that may be caused by headaches, arthritis, injuries or many other painful conditions. They are often safe for short term use, but can have potentially deadly effects if used for prolonged periods. I have seen many cases where misuse of painkillers have caused lives to be lost or permanently affected. In most of the cases, the patients did not know of their effects and used them for too long. Today we will discuss painkillers and try to educate you on how they function.

WHAT ARE PAINKILLERS?
Painkillers are obviously medicines that are used to treat pain. There are a large number of painkillers available and they all come in various different brand names. 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 a creams or ointments.
Even though there a large number of painkillers available, there are only three main types (each works in a different way). They are:
• Non-steroidal anti-inflammatory drugs (NSAIDS): examples of NSAIDs include ibuprofen, diclofenac and naproxen. Aspirin is also an NSAID. However, it is mainly prescribed (in low doses) to help to keep the blood from clotting – for example, for people who have had a heart attack in the past.
• Paracetamol: common brands are Panadol and Tylenol.
• Weak and strong opioids: examples of weak opioids include codeine and dihydrocodeine. Examples of strong opioids include morphine, oxycodone, pethidine and tramadol. Many people who need strong opioids are in hospital.

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WHICH PAINKILLER IS USUALLY PRESCRIBED?
The type of painkiller your doctor will prescribe depends upon:
• The type of pain you have.
• Any other health problems you may have.
• How severe your pain is.
• The possible side-effects of the medicines.

Paracetamol is normally prescribed if your pain is not too serious and you do not have inflammation.
NSAIDs are generally prescribed for people who have pain and inflammation – for example, if you have pain in your joints (arthritis) or muscles (back pain). This is because there is likely to be some inflammation present and NSAIDs work well to treat pain as well as inflammation. NSAIDs have a number of possible side-effects and they are not suitable for everyone. For example, they are not suitable for people who have or have had stomach ulcers. In this case a doctor may prescribe a safer medicine (paracetamol) even though it may not work as well.
Weak opioids are usually prescribed for more severe pain, or if you have tried paracetamol and/or ibuprofen and they have not worked.
Stronger opioids are normally used to treat severe pain – for example, cancer-related pain, pain after an operation, or if you have had a serious injury.
HOW SHOULD I TAKE PAINKILLERS?
People who are in pain all the time are usually recommended to take painkillers regularly. For example, if you have been prescribed paracetamol you will normally take it four times a day, every day until the pain is better. Otherwise, you only need to take painkillers when you need them.
If you are taking an NSAID such as ibuprofen or diclofenac, you will need to take this with or after food. This is because they can irritate the lining of your stomach and sometimes cause bleeding in your stomach.
WHAT IS THE USUAL LENGTH OF TREATMENT?
Like all medicines, painkillers should be taken for the shortest period of time possible, in the lowest dose that controls your pain. This is to help avoid any side-effects. Most people only need to take painkillers for a few days (for example, for toothache) or weeks (having pulled a muscle). However, some people have painful conditions and need to take painkillers on a long-term basis. Examples include people with rheumatoid arthritis, osteoarthritis, or chronic back pain. In these cases, you should let your doctor determine how you should take them and regular follow ups will be necessary to ensure that the painkillers are not affecting your organs.

WHAT ARE THE POSSIBLE SIDE-EFFECTS?
Painkillers rarely cause serious side-effects but they can have potentially serious side effects if they are improperly used.
• NSAIDs: Most people who take anti-inflammatories have no side-effects, or only minor ones. When taken appropriately, the benefit usually far outweighs the potential harms. In particular, many people take a short course of an anti-inflammatory for all sorts of painful conditions. However, side-effects, and sometimes very serious possible adverse effects, can occur. These include bleeding into the stomach and gut, and heart problems. Using them for months without proper follow up can lead to massive stomach bleeding or kidney failure. Persons with diabetes and hypertension are at risk higher risk of getting kidney failure earlier with their use.

• Paracetamol: This is a safe medicine and side-effects are rare if you do not take more than the maximum recommended dose. However, paracetamol can be very dangerous if you take too much. Overdoses of paracetamol can happen by mistake, but some people intentionally overdose to try killing themselves. The main problem with taking an overdose of paracetamol is that it can damage your liver permanently and you can die from this.
• Opioids: Opioids tend to cause drowsiness and confusion and may make some people nauseated. Some people can become tolerant to opioid painkillers (needing to take more to get the same effect) and then depend upon them. This includes opioids that can be bought in pharmacies. If you think you are depending on opioids and need to take higher and higher doses, discuss this with your doctor.
Do not use painkillers for prolonged periods without consulting your doctor; you will be risking your life if you do.

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