Ow, that hurts! Managing pain
It’s impossible to go through life without hurting some part of you at some point. But the best treatments for pain will depend on the part of your body affected, the side-effects they cause, other conditions you might have and what you have taken in the past. Fortunately, these days there are lots of options available – so there’s no need to suffer in silence.
‘The pain ladder’
Paracetamol is an effective painkiller for mild pain and can be added to other painkilling medicines to increase their effectiveness. It is often used with drugs from the ‘opioid’ family, which includes codeine and morphine-based drugs.
To keep side-effects to a minimum, the World Health Organization has devised a ‘pain ladder’. If pain is not controlled at one step of the ladder, you move to the next step. The three steps are:
- Mild opioids (codeine-based tablets).
- Stronger opioids (morphine-based).
NSAIDs – you may not recognise the name, but you’ve probably taken them!
NSAID stands for ‘non-steroidal anti-inflammatory drug’. They include ibuprofen (brufen or nurofen), diclofenac (voltarol), naproxen and several others. NSAIDs reduce pain and inflammation. They are especially effective for:
- Joint and muscle pains, including arthritis.
- Period pains.
- Pain caused by kidney stones.
- Bone pain caused by cancer.
They also help with the achiness and fever of bad colds and ‘flu-like’ illnesses. But beware – in the long term, NSAIDs can cause quite a lot of side-effects (see below).
The medical name for nerve pain is neuralgia. It can happen when a nerve is cut – such as after an amputation, after an infection affecting the nerve endings - such as shingles, in chronic conditions affecting the nerves - like diabetes, or if the nerve gets inflamed for no obvious reasons, as in conditions like trigeminal neuralgia (which affects one side of your face). Nerve pain often doesn’t improve with ‘normal’ painkillers. However, two groups of medicines can be particularly effective for nerve pain:
Amitriptyline - this drug is usually used to treat depression, but can work wonders in nerve pain.
Anti-epilepsy drugs - two drugs in particular (gabapentin and pregabalin) are often tried if amitriptyline isn’t effective. We know they work on the nervous system (which is why they help with epilepsy) but they’re being used more and more for nerve pain.
Risks and benefits
All tablets have side-effects. On the whole, the stronger the medicine, the worse the possible side-effects (think of the side-effects of cancer chemotherapy compared to paracetamol, for instance). Common side-effects of different drug groups include:
- Aspirin – inflammation of the stomach lining and stomach ulcers, possible bleeding from the stomach.
- Paracetamol – very few side-effects in recommended doses, although very dangerous for the liver in overdose.
- Opioid painkillers – constipation, confusion.
- NSAIDs – inflammation of the stomach lining and stomach ulcers, possible bleeding from the stomach; occasionally they bring on asthma, kidney failure.
- Amitriptyline and anti-epilepsy drugs – drowsiness.
Pain clinics – who needs them and why?
Most areas of the country now have specialist pain clinics. Although the staff who work there are experts in all sorts of pain, they mostly deal with long-term pain. You may benefit from referral to a pain clinic if you have:
- Back pain.
- Neuralgia (see nerve pain above).
- Nerve problems in diabetes.
The doctor in charge of the pain clinic is very likely to be an anaesthetist. Anaesthetists don’t just put people to sleep for operations – they are trained to stop people feeling all kinds of pain. Sometimes they use local anaesthetic injections or nerve blocks. They are also experts in pain medicines and nondrug treatments for pain. These include:
- Counselling techniques to help you cope better with your pain.