Do you know your painkillers?

Did you know that one in five Australians live with chronic pain and this incidence rises to one in three for the 65+ age group? Or that 80 percent of people with chronic pain are missing out on treatment that could improve their health and quality of life? These startling statistic were revealed by Painaustralia, a peak body of health professionals and consumer organisations formed in 2011 to implement the National Pain Strategy.

This strategy emerged from the Pain Summit held in Canberra in March 2010 and recognises that chronic pain is one of the least understood and poorly resourced areas of healthcare.

For those of us who suffer from all sorts of pain, it is vital to know how best to deal with it, how we should properly use the variety of over the counter drugs that are commonly available and what alternatives therapies may help complement drug treatments.

Let’s take a closer look at the most common forms and their correct usage.

Paracetamol is a non-opioid painkiller, which is non-addictive and anti-inflammatory. A little known characteristic of non-opioid painkillers is that they have a “ceiling effect” meaning that an increased in dose will not increase pain relief, but may increases any side effects.

Paracetemol is normally appropriate for mild to moderate pain, due to headaches, toothache, muscle and joint pains and period pains. An adult dose of paracetamol is recommended to be 500mg to 1000mg every four to six hours, with a maximum 4g daily.

While side-effects are rare if you stick to correct dosage, an overdose can have serious effects. Paracetamol can be safely used alongside other medications but check with your doctor or pharmacist if you suffer from liver or kidney problems, as overuse can impact those organs. Cold and flu drugs will often contain Paracetemol too, so be careful not to accidentally overdose if taking those in conjunction with Paracetemol.

Aspirin is a non-steroidal painkiller with stronger anti-inflammatory properties that Paracetemol. This makes it suitable for treating pain and inflammation caused by rheumatic and muscular pain, sprains, backache, headache, sore throat, toothache and period pain. Its fever reducing effect makes it useful for treating flu symptoms in adults.  

An adult dose of aspirin is 300 to 900mg every four to six hours, with a daily limit of 4g. Aspirin may have adverse effects if you suffer from conditions, such as high blood pressure, bleeding disorders, asthma, stomach ulcers and liver and kidney disease, so medical advice is important in those cases.  

Aspirin is also not compatible with some other drugs, vitamins, or dietary supplements. While it is sometimes used in small doses to thin the blood in cardiovascular treatment, it can be dangerous if another prescribed blood thinning drug is already in use. Medical advice is vital in this situation, even if Aspirin usage is only occasional.

Ibuprofen is another non-steroidal anti-inflammatory drug like aspirin and is commonly used for the same pain relief, inflammation reducing and fever fighting effects. 

A possible minor side effect of Ibuprofen is drowsiness and dizziness, and advice from a pharmacist or doctor is necessary if taking it in conjunction with other drugs or herbal and complementary supplements. This is particularly the case if you have blood clotting problems, peptic ulcers, kidney or heart problems.

A recommended adult dosage is 200 - 400 mg, with a daily maximum 1200mg.

Codeine is in the Opioid family of drugs, which includes morphine and heroine and as such it is addictive. It is used to treat moderate to strong pain and is also available in combination form with other analgesics, such as Paracetemol and Ibuprofen. Usage needs to be carefully controlled, however, due to the wide range of side effects, which include nausea, vomiting, constipation, drowsiness, and reduced physical coordination and balance. Particular care is needed when used in combination with other pain relievers.

Abuse of codeine has led to stricter controls on its purchase and it is now only available through pharmacies and purchase details are recorded to avoid excessive supply. Dosage rate is 15 to 60 mg up to 6 times a day with a maximum of 300 mg per day.

Non-drug pain-management strategies
Successful treatment of pain may also be achieved with therapies that can complement drug therapies. These should always be used under medical supervision to avoid adverse effects and can include:

  • Heat or cold packs for chronic musculoskeletal injuries and associated pain.
  • Physical therapies, such as walking, stretching and strengthening may help relieve pain, depending on the cause. A physiotherapist or osteopath can advise on which activities may help your condition
  • Massage for soft tissue injuries
  • Acupuncture is believed to release natural pain-relieving compounds within the body
  • Relaxation techniques, such as meditation or yoga
  • Cognitive behavioural therapy may help as a method of self-managing chronic pain.

A cup of tea, a Bex and a good lie down
This well-worn adage was coined in post-war Australia as an advertising slogan for Bex powders; a strong compound analgesic, which was the housewife's drug of choice in the 1950s and 1960s. Bex was ultimately taken off the market when it was found to be addictive and a cause of kidney disease when taken in large doses.

While we may crack a smile over the slogan and how naïve society was back then, it is a sobering reminder of the potential danger of over the counter pain relief drugs if they are used carelessly.  

More information
Painaustralia offers a host of resources and information on pain management, making it a great source for those who want to explore further and become more informed on their pain management. Visit their site here