Things you need to know about painkillers

Painkillers are a group of medications that are used to manage pain. These medications are also referred to as analgesics or pain relievers. The aim of using a painkiller is to decrease the unpleasant sensations that are causing physical and mental distress. There are different types of painkillers and some of them are over-the-counter (OTC) medications. However, it is important to always consult your doctor before popping a pill for the pain to actually try and find out where your pain may be arising from and to ensure the right kind of painkiller is being used.

What is pain?

Pain is a neurological phenomenon where your body perceives significant unpleasantness to an intense, even damaging stimulus. The perception of pain is both physical (sensory) as well as emotional. Pain is often reflective of some kind of underlying tissue damage, and is a sign to your nervous system that something wrong is going on in your body. Therefore, pain can actually be immensely helpful as it alerts doctors to the fact that there is a condition that requires attention.

Painkillers are an important part of treating any disease complex because this is often the most debilitating symptom perceived by a patient. If you have ever experienced severe pain, you know what a huge impact it has on daily life.

Pain can also be an after-effect of a surgical procedure. The treatment of pain can be as simple as prescribing a tablet, but can even escalate to a multi-speciality involvement with physicians, anaesthetists, psychiatrists, physical therapists, etc., all being involved. 

The painkillers usually belong to 3 categories of medications, namely:

1. Non-steroidal anti-inflammatory drugs (NSAIDs)

2. Paracetamol or Acetaminophen

3. Opioids

In addition to this, certain conditions also require the use of antidepressants and antiepileptics (anti-seizure medications) to manage, as conventional painkillers are unsuitable. 

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs are a very common type of over-the-counter (OTC) medication used to treat pain. Common examples of NSAIDs include Ibuprofen, Aspirin, Diclofenac, and Naproxen. This type of painkiller is particularly effective in combating bone, joint, and muscle-related pain. This medication is recommended to be taken after food.

Mode of Action

The pain mechanism involves certain chemicals called prostaglandins. NSAIDs work by blocking the action of an enzyme called Cyclo-Oxygenase (COX) which is involved in the production of prostaglandins. There are different classes of NSAIDs, all of which differ in their way of action, but all affect COX enzyme function. Reduction in prostaglandin levels decreases inflammation and pain. 

Risks

Common side effects of NSAID use include nausea, vomiting, GI distress, loose stools, headache, dizziness, and elevated liver enzymes.

The adverse effects of NSAIDs primarily occur with overuse. The most common side effect is gastrointestinal ulcer formation. NSAIDs, except for aspirin, can cause an increased incidence of heart attacks and stroke. They can cause kidney dysfunction. Aspirin is used to prevent blood from clotting, and overuse can cause clotting dysfunction and internal bleeding.

Paracetamol (Acetaminophen)

Paracetamol or Acetaminophen is one of the most commonly used over-the-counter painkillers, used mainly for the treatment of mild to moderate pain. It can be combined with other types of analgesics for managing more severe pain, like in cancer patients. It can be taken orally, intravenously, or per rectally.

Mode of Action

The exact mechanism of action of paracetamol is still not known, however it is understood to work by inhibiting the action of the cyclo-oxygenase enzyme. It differs from NSAIDs in that it has reduced anti-inflammatory effects.

Risks

Paracetamol is a safer drug, with a reduced adverse effect profile. Common side effects include nausea, abdominal pain, and deranged liver function tests. Paracetamol is metabolised by the liver, hence in events of overdose, acute liver failure occurs.

A lot of people indiscriminately take paracetamol whenever they have a mild headache, backache, etc. If you have chronic pain it is a much better idea to consult a doctor who can help find the cause and treat it rather than self-medicating.

Opioids 

Opioids are a group of medications that work similarly to morphine. Opioids are further grouped as either weak or strong opioids. Despite their name, weak opioids are very effective even in managing severe pain. Examples of this include codeine and dihydrocodeine. Strong opioids, like morphine, pethidine, tramadol, etc., are medications that are primarily used in a hospital setting only when dealing with severe and chronic pain, as well as in palliative care. They can be administered orally, intravenously, or through the skin via transcutaneous patches.

Mode of action

The human body has some receptors called opioid receptors, which are located mainly in the nervous system and the gastrointestinal tract. These medicines bind to the different kinds of opioid receptors to produce therapeutic effects such as decreasing pain sensation and increasing tolerance to pain.

Risks 

Common side effects include nausea, constipation, sedation, dry mouth, itching, and inhibition of respiration.

Opioid medications have a higher tendency to cause dependence and addiction in users. These medications tend to produce euphoric effects. The stoppage of opioids after extended use can also cause withdrawal effects. Both of these reasons contribute to a tendency for patients to keep using the medication.

However, long-term use can result in a phenomenon called tolerance, where the drug stops having its desirable effects at the same dosage, resulting in the intake of higher doses to feel the same effects. Opioids need to be carefully monitored by your doctor, and long-term usage must be avoided unless it is strongly indicated for your underlying condition. 

Important points to note about painkillers

• Sometimes, two different types of painkillers may be prescribed to you in combination as this can enhance their analgesic effect. NSAIDs and paracetamol are often available in combination for the same reason. Painkillers are also combined with other drugs such as antispasmodics to help with relief from cramps.

• Certain conditions, like diabetes, produce a type of pain called neuropathic pain. This occurs as a consequence of nerve damage. In this condition, other non-traditional painkillers are used, such as tricyclic antidepressants and anticonvulsants. 

• It is important to note that the use of any over-the-counter painkiller for more than 3 days without relief of symptoms is a definite sign for you to consult your doctor immediately. This could be an indication of:

1. The use of the wrong type of painkiller

2. A more insidious underlying condition requiring more investigation and treatment

3. Inadequate dosage being used

• If you have been prescribed strong painkillers by a professional, it is advisable to take them only as per the recommended guidelines. In case you continue to experience pain consult your doctor. It is risky to modify the dose yourself. 

Chronic pain is a very significant issue that has a deep impact on physical and mental health. It can affect one's ability to work, sleep, and perform regular activities.

Painkillers have a wide adverse reaction profile, and people end up with a multitude of issues because of their rampant overuse. Hence, it is advised that you consult your doctor for a proper evaluation before taking any medication.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. Please consult a doctor before making any health-related decisions.

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