Painkillers — Short-Term Gain, Long-Term Risk

In our culture of instant gratification, the temptation is to look for quick and easy answers to pain. However, the evidence reveals that this tendency comes with a high risk. Are painkillers helpful? Is so, what’s the long-term risk? Let’s look at the answers to these problems as well as alternatives that can help you deal with pain.

Problem of Pain

One of the difficulties associated with the treatment of pain is how we define pain. For instance, some doctors ask their patients to rate their pain on a scale of one to 10, but a three for one person might be a 10 for another. This means that the perception of pain is highly subjective. For some people, even the slightest discomfort is perceived as severe pain.

Another obstacle to treating pain is that the cause might be multifactorial. Let’s say you hurt your back lifting a heavy box. If you’re also stressed out about job or family issues, then your perception of pain might be amplified. If you only get treated with painkillers, you might not get the relief you need since other factors like social or emotional are still bothering you.

The multifactorial nature of pain makes it hard for doctors to diagnose and treat the problem. Surgeons, for instance, focus more on physical signs and symptoms and aren’t fully trained in the psychological causes of pain. It requires a diverse set of skills to treat pain. However, many physicians lack this kind of holistic training.

Types of Painkillers and How They Work

Long-term Risk of Painkillers: There are several classes of commonly used painkillers. The variety of medications available adds yet another layer of complexity to the treatment of pain. Different types of painkillers have different mechanisms of action and potential side effects. The major categories are:

• Paracetamol (acetaminophen): Thought to inhibit cyclooxygenase (COX) enzyme activities in the brain, which leads to pain relief. Might also modulate the endogenous cannabinoid system in the brain to help reduce pain.
• Nonsteroidal anti-inflammatory drugs (NSAIDS): Include aspirin, ibuprofen, and naproxen. Block COX enzymes in the brain and the body, which not only treats pain but also decreases inflammation.
• Opioids: Binds to opioid receptors, which are found in the central nervous system (brain and spinal cord) and the peripheral nervous system (nerve endings in the body).
• Corticosteroids: Not technically a painkiller but used to treat some chronic pain disorders like arthritis. Mainly works by decreasing inflammation.

Sometimes, the medications listed above may be used in combinations. Some formulations even combine two classes of medication into a single pill to take advantage of different mechanisms to reduce pain.

Effects and Side Effects of Painkillers

Long-term Risk of Painkillers: Every class of pain medication has a primary goal to reduce or eliminate pain. Some also reduce inflammation which can also help with pain relief. However, like any medication, every class of painkiller has potential side effects. In some cases, these side effects may occur immediately or over a certain time period. Let’s look at each class of painkiller and their potential side effects.

Paracetamol Side Effects

Long-term Risk of Painkillers: One of the most widely used painkillers worldwide, paracetamol is generally considered to be quite safe. Still, if used for a long period, or if you take too much, this drug can cause liver damage or even liver failure. The risk of liver damage is increased if you already have liver problems or if you consume alcohol. Also, the combination of paracetamol with other medications metabolized by the liver can increase your risk for toxicity.

In 2013, the United States Food and Drug Administration (FDA) issued a warning about paracetamol stating the drug could cause rare and possibly fatal skin reactions such as Stevens-Johnson syndrome and toxic epidermal necrolysis.

Nonsteroidal Anti-inflammatory Drugs Side Effects

Long-term Risk of Painkillers: The most commonly reported side effects of NSAIDs are in the gastrointestinal tract. For starters, these drugs directly irritate your stomach lining upon contact. Also, NSAIDs relieve pain by COX enzyme inhibition, but in the GI tract, this can cause problems. COX inhibition decreases protective prostaglandins, which leads to increased stomach acid secretion and other changes that make your stomach lining more vulnerable.

Common GI side effects of NSAIDs include:

• Nausea or vomiting
• Dyspepsias like heartburn and indigestion
• Gastric ulcers and bleeding
• Diarrhea

Other potential adverse effects of NSAIDs are:

• Kidney damage
• Increased risk of heart attack, although aspirin may be heart protective
• Bleeding disorder
• Photosensitivity or increased sensitivity to sunlight
• Problems with pregnancy
• Allergic reactions
• Interactions with other medications

Opioid Side Effects

Opioids can cause nausea, vomiting, drowsiness, constipation and breathing trouble. Still, the most concerning side effect of opioids is drug dependence and addiction. A recent analysis from Blue Cross Blue Shield revealed some chilling numbers about the problem. From 2010 to 2016, the number of their members diagnosed with an addiction to opioids — including legal prescriptions and illicit drugs — climbed 493 percent. In 2010, there were 1.4 opioid use disorders for every 1,000 people. In 2016, that rate had soared to 8.3 incidences per 1,000 members.

Once you get addicted to opioids, it’s extremely hard to quit the drug. Once addicted, even if your original pain problem has been resolved, your body demands the drug. If you stop taking the medication, you feel horrible and can have nausea, vomiting, sweating, irritability and chills. This creates a vicious cycle since these unpleasant symptoms go away if you take more of the drug. In the end, this may lead to drug-seeking behavior. In some cases, people end up obtaining opiates from street dealers, even to the point of consuming injectable drugs, such as heroin.

Corticosteroid Side Effects

Corticosteroids like prednisone are not technically painkillers. However, they can provide great relief to chronic pain problems such as arthritis. For the short term, this might be useful, but long-term steroid use is very dangerous and not recommended. The side effects of corticosteroid use include:

• Glaucoma and cataracts
• Fluid retention and leg swelling
• High blood pressure
• Mood, memory and other behavior problems, including psychosis
• Fat accumulations around your abdomen, face and the back of the neck
• High blood sugar or diabetes
• Higher risk of infections or a weakened immune system
• Thin bones (osteoporosis) and bone fractures
• Suppressed adrenal gland function
• Thin skin, easy bruising, and poor wound healing

Worth the Risk?

As you can see, even the safest painkillers have risks for serious side effects. One has to ask then, is it worth the risk? Can I stand some discomfort to avoid risk? Maybe an even more important issue is to know about other methods of pain relief.

Alternative Pain Treatments

If you want to minimize the number of pain medications you are taking, consider these pain treatment alternatives.

• Controlled breathing: Take long slow breaths in and out, with pauses in between. Concentrate on the act of breathing to reduce pain.
• Muscle relaxation: Contract and then relax a specific muscle in your body one at a time, such as those in the hands, arms, legs, stomach, and face. Tighten the muscle hard for 10 seconds, relax for 10 seconds and then repeat. Focus on the muscle and release tension.
• Cognitive behavioral therapy: Mental health therapist helps you change how you perceive and react to pain.
• Psychological counseling: A mental health specialist who specializes in pain disorders may help identify how to decrease pain without depending on the medication.
• Sleep: Adequate rest may help reduce pain levels. You should try to get seven to nine hours of sleep every night.

Also, specific disorders might need different treatment. For instance, those who suffer from fibromyalgia might benefit from therapies, such as:

• Exercise: Regular exercise may diminish pain in the long run.
• Physiotherapy: Therapist directed treatment involving exercise, movements, massage and local heat.
• Cryotherapy: Using extreme cold to parts of the body to relieve pain.
• Trigger point injection: Specific areas of pain are injected with a local anesthetic, saline, or corticosteroid. May change how nerve endings react to pain.
• Massage therapy: Muscles and joints are rubbed and manipulated to bring relief.
• Biofeedback: You have sensors applied to your muscles. They help you know when you have muscle tension.
• Transcutaneous electrical nerve stimulation (TENS): Uses low voltage electricity applied to the skin. May work by a similar mechanism as trigger point injection.

Conclusion

Modern society constantly tries to make things easier and faster. The issue of pain relief, however, can be very complex. Short-term solutions like painkillers might give you rapid relief, but the long-term effects may not be worth the risk.

When you have pain, look into all the potential treatment options. Don’t just reach for a pill. Look for more complete solutions instead.

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