Your Guide to Pain Medicine

Pain is the most common reason people seek medical attention, so it’s no surprise that there are so many different medicines designed to reduce or eliminate pain. Pain signals are sent to the brain through the body’s nerves after pain receptors on the nerve endings have been activated by chemical, mechanical, or thermal damage to tissue cells. Medication and therapeutic treatments aimed at reducing pain work through a variety of mechanisms, including removing/limiting the irritants that contribute to pain, raising the threshold of the nerve endings to delay pain signal transmission (you have to be in more pain before your nerves decide that it’s important enough to tell your brain about it), or preventing or removing the swelling that increases mechanical pressure on nerve endings.

Pain medicine covers a wide range of types of medication, including counterirritants, local anesthetics, analgesics (narcotic and non-narcotic), anti-inflammatories (including steroid-based and non-steroid-based), and antipyretics. This article only addresses oral medication (pills) that is available over the counter (OTC) (as opposed to prescription medications), focusing primarily on analgesics and anti-inflammatories.

Analgesics

Drugs are classified as analgesics if they are used to alleviate pain without causing the loss of consciousness. There are plenty of narcotic analgesics on the market, but they are only available through a prescription. The most common non-narcotic analgesic is acetaminophen (uh-SEE-tuh-MIN-uh-fin), the active ingredient in Tylenol. Like most OTC analgesics, acetaminophen is also classified into another drug category; it is both an analgesic and an anti-pyretic (fever-reducer). This is why many people advocate taking Tylenol or another acetaminophen-based drug for flu symptoms.

Anti-inflammatories

Anti-inflammatory medicines include corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs), and acetylsalicylic acid, the active ingredient in aspirin. These drugs are used to relieve pain and swelling associated with inflammation from an acute injury.  Corticosteroids and narcotic NSAIDs are only available with a prescription, so they will not be addressed specifically here, but all NSAIDs work on the body in the same manner.

NSAIDs are the most frequently used OTC drugs and have anti-inflammatory, analgesic, and antipyretic effects. NSAIDs are recommended by medical professionals primarily for reducing the pain, swelling, redness, fever, and stiffness associated with local inflammation. The most common OTC NSAIDs contain ibuprofen.

Aspirin also has analgesic, anti-inflammatory, and anti-pyretic effects and is used for the same things as NSAIDs. However, aspirin has been associated with negative gastrointenstinal side effects including difficulty digesting food (dyspepsia), nausea, vomiting, and gastric bleeding. Aspirin is also one of the most commonly abused drugs (sometimes unintentionally) and overingestion of it can lead to serious side effects including ringing or buzzing in the ears and dizziness.

Due to all of these side effects and the likelihood of abuse, most medical professionals recommend the use of NSAIDs over aspirin. Additionally, NSAIDs offer anti-inflammatory properties equal in effectiveness to aspirin’s that lasts longer and has fewer side effects. However, NSAIDs do not come without their own side effects; long-term use of NSAIDs can cause gastric irritation, ulcers, headache, dizziness, and reduced renal function. Many of these side effects can be avoided by taking the lowest dose required by your symptoms and taking anti-inflammatories only when you need their anti-inflammatory capabilities. If you are not experiencing new inflammation and swelling, you can likely relieve your symptoms through use of an analgesic like acetaminophen instead of using an anti-inflammatory. If you are going to need to use anti-inflammatories continuously for longer than a week, please consult with a medical professional to avoid long-term side effects.

5 Rules for Taking Pain Medicine

1. Always follow dosing instructions, whether from a label or from your physician.
2. Do not take more than one type of analgesic or anti-inflammatory drug at a time, unless instructed to do so by a physician who knows about everything that you are taking. Remember, “anti-inflammatories” are also analgesics. You’re not choosing between reducing your pain and preventing future inflammation, you’re choosing whether you want a drug that prevents future inflammation or not.
3. Be cautious of taking other drugs with the medicines discussed above, especially if you are taking prescription analgesics or anti-inflammatories. Some drugs interact and interfere with each other, reducing the effectiveness of at least one of the drugs.
4. Remember that pain is your body’s way of letting you know that something is wrong. The types of drugs discussed above are designed to decrease your pain, but if you take them before physical activity, you must be cautious – you may not be able to tell that you’re having a problem (either with your current injury or with a new one) until after you’ve caused substantial damage, since your pain sensations are being dulled by the medicine.
5. You must work to find and correct the cause of your pain, too. Simply alleviating your pain by taking an analgesic does not cure the underlying injury or disease and it does not repair the damaged tissue.