First off, a few terms. Analgesic is the medical name for painkillers. An analgesic is any group of medicines used to relieve pain. If you need treatment for pain, you usually start treatment with simple painkillers, such as paracetamol, moving on to weak opioids such as codeine before getting to the stronger morphine type opioids. This is often called by doctors and nurses the 'analgesic (painkiller) ladder'.
Analgesic medicines can be split into three groups:
- combined analgesics
- ease moderate to severe pain, effect pain receptors
Opioids analgesics are also known as narcotic analgesics or opiates; first made from the juice of the opium poppy, but many are now made in a laboratory; they work directly on the site of pain receptors and through the spinal chord (to alter the way pain is perceived).
Dosing of all opioids may be limited by opioid toxicity (confusion, respiratory depression, myoclonic jerks and pinpoint pupils), but there is no dose ceiling in patients who tolerate this. Opioids may have some unpleasant side-effects - up to 1 in 3 patients starting morphine may experience nausea and vomiting (generally relieved by a short course of antiemetics); Pruritus (itching) may require switching to a different opioid; Constipation occurs in almost all patients on opioids and laxatives are typically co-prescribed.
When used appropriately, opioids and similar narcotic analgesics are otherwise safe and effective, carrying relatively little risk of addiction. Occasionally, gradual tapering of the dose is required to avoid withdrawal symptoms.
Some opioid analgesics are:
- Codeine - considered a weak opioid and often used in combo with aspirin or paracetamol (CoCodamol)
- Fentanyl - man made (synthetic), slow release opioid. The drug is absorbed through a patch stuck onto your skin, or via a lozenge that you suck. It can take up to 72 hours to get the right level of drug in your bloodstream, it takes another 72 hours for the body to recover from the drug
- ease mild to moderate pain, useful for muscular and joint pain
Useful for headaches, toothache, muscle and joint pains to period pains. Many non-opioid analgesics can be bought over-the-counter (OTC) at chemists and supermarkets (i.e. without prescription). Some non-opioids are:
- Mefenamic acid
- Paracetamol (acetaminophen) - overdose can cause liver damage
- a sub-group of Non-opioids, with pain relieving and anti-inflammatory properties
Non-steroidal anti-inflammatory drugs (NSAIDS) may lead to peptic ulcers, renal (kidney) failure, allergic reactions, hearing loss, and increased the risk of hemorrhage. The use of certain NSAIDs in children under 16 suffering from viral illness is thought to contribute to Reye's syndrome. In some people with asthma, symptoms such as wheeze or breathlessness are made worse by anti-inflammatories.
Anti-inflammatories can also sometimes cause high blood pressure or heart failure. Although, on the contrary, due to aspirin's blood thinning effect, it can reduce coronary heart disease events and stroke; and it is thought to reduce the progress of cancer in some circumstances.
There are over twenty types of NSAIDS including:
- Aspirin (Acetylsalicylic Acid)
- Diclofenac (Voltarol)
For added confusion, an Antipyretic is something that reduces fever or quells it. These drugs reduce body temperature in fever situations (but do not affect the normal body temperature if there is no fever). There are 3 classes of antipyretic medications that are sold OTC:
- Salicylates -- aspirin (acetylsalicylic acid), choline salicylate (Arthropan), magnesium salicylate (Arthriten), and sodium salicylate (Scot-Tussin Original);
- Paracetamol (Acetaminophen - Tylenol); and
- NSAIDs - ibuprofen (Advil), naproxen (Naprosyn, Aleve), and ketoprofen.
Do not combine NSAIDs (or any analgesic group drug) together, but an analgesic group can be used in combination with analgesics of a different group.
Some analgesics combine both mild non-opioid drugs such as paracetamol, with a small amount of opioid (such as codeine) in a single tablet. These combination analgesics are often prescribed to people who are not benefiting from non-opioids, like paracetamol, alone. People who experience migraines may use combination analgesics. Some combination painkillers can be bought OTC and contain smaller quantities of opioid painkiller than those available on prescription. e.g. CoCodamol is a mix of codeine & paracetamol.
The use of NSAIDS (aspirin, ibuprofen) together with weak to mid-range opiates (codeine) combats pain at multiple sites of action — NSAIDs reduce inflammation which, in some cases, is the cause of the pain itself, while opiates dull the perception of pain. So in cases of mild to moderate pain caused in part by inflammation, it is generally recommended that the two be prescribed together. e.g. Nurofen Plus is a mix of 200mg of ibuprofen and 12.8mg of codeine.
Analgesics are frequently used in combination, and can be found in combination with vasoconstrictor drugs such as pseudoephedrine for sinus-related preparations (e.g. Sudafed Dual Relief contains 300mg of paracetamol and 25mg of Caffeine, Sudafed Dual Relief Max contains 200mg of Ibuprofen, Sudafed Cold and Flu contains 500mg of paracetamol), or with antihistamine drugs for allergy sufferers. Care should be taken not to take too much of a drug by accident due to the use of a combination of different drugs.
A strong non-prescription solution to bad pain (such as back pain) is Nurofen Plus (ibuprofen and codeine) used together with CoCodamol (codeine & paracetamol) as doubles the codeine dose (i.e. a dose not otherwise available without prescription). Not recommended by some doctors as it is a big dose of codeine, which can cause some people problems, and it can be addictive (i.e. you should get medical advice before trying this!).
Anadin Extra is a triple mixture of:
- 300mg of Aspirin: to target the source of pain
- 200mg of Paracetamol: to help block the pain signals from reaching the brain
- 45mg of Caffeine: to accelerate pain relief
Natural / Supplements
Glucosamine and chondroitin has become the most widely used natural remedy for joint pain. One of the major discoveries in recent years is that supplementing with hyaluronic acid (also known as HA) can revitalize synovial fluid, a thick gel-like substance that surrounds cartilage, acting as a lubricant and shock absorber. Nowadays, a number of popular joint-support formulas contain some combination of glucosamine, chondroitin and HA.
1. White willow bark: This herb was the original aspirin. It contains a substance called salicin which converts to salicylic acid when in the stomach. Salicylic acid is the main component of Aspirin and when used synthetically it has irritating effects on the stomach. White willow bark is effective in relieving pain, inflammation and fever. A suggested dose is 1 to 2 dropperfuls of white willow bark tincture daily.
2. Capsaicin: This remedy is mainly used topically and is effective in relieving nerve, muscle and joint pain by interfering with a chemical in the body known as substance P which transmits pain signals to the brain. It is often found in gel or cream form and comes in a variety of potentcies. This remedy can be used three to four times daily. Since Capsaicin comes from chili peppers some first time users have reported a light stinging pain once initially applied. This does subside and often disappears with further use.
3. Boswellia: Hundreds of years ago in India, when people complained of aching joints and muscles, Ayurvedic healers prescribed an extract made from the unique bark of the Boswellia tree. Today, Boswellia serrata, has been proven to be a powerful inflammation fighter capable of providing fast, long-lasting relief. This is also known as “Indian frankincense” and is available as a supplement and a topical cream. It contains anti-inflammatory properties which come from the boswellic acids extracted from the tree. They help improve blood flow to joints and prevent inflammatory white blood cells from entering damaged tissue. The suggested dose for pain is 450 – 750 mg daily for 3 to 4 weeks.
4. Cat’s claw: Also known as Uncaria tomentosa, or una de gato, cats claw grows in South America and is known for containing an anti-inflammatory agent that aids in blocking the production of the hormone prostaglandin which contributes to inflammation and pain within the body. The suggested doses for cats claw are 250 to 1,000 mg capsules one to three times daily. If one were to take too much in a single day, they may experience diarrhea.
5. Omega-3 fatty acids: The omega-3 fatty acids are known to have anti-inflammatory properties proven to be beneficial for people who suffer with arthritis, other inflammatory joint conditions and inflammatory bowel diseases. Along with their pain and anti inflammatory properties, they are also known to reduce the risk of cardiovascular disease. Not only is this helpful for people with rheumatoid arthritis, which carries an increased risk for cardiovascular disease, but it also helps to stop the number one killer in the world which is heart disease. A suggested dose of omega-3 fatty acids such as fish oil is 1,000 mg daily.
For vegans looking for dietary Omega 3, try hemp seeds, chia seeds, flax seeds, various berries, seaweed, leafy greens and more.
6. Curcumin: Curcumin, a compound found in the curry spice turmeric, has been proven in studies to inhibit the synthesis of inflammatory substances throughout the body, decreasing pain and stiffness while enhancing immunity and even protecting the brain against cognitive decline. Like Capsaicin, it helps to block pain signals running to the brain. Studies have shown that curcumin is effective in receiving pain, even chronic pain and is effective when it comes to treating rheumatoid arthritis. One suggested dose is 400 to 600 mg of curcumin taken three times daily for pain and inflammation. Curcumin has also been found to be as effective as Prozac in treating depression, but comes with no nasty side effects.
Ginger is another powerful spice that has many of the same benefits as curcumin and demonstrates remarkable anti-inflammatory properties. Other anti-inflamitaries include tart cherry and bromelain.