In 2014 we became one of the first physiotherapy practices in the UK to be able to prescribe pain medication. While very helpful in treating pain, there is often confusion as to which is the best medication for a given problem. Below we’ll try and offer some insight.
Paracetamol is the most commonly used drug for pain relief. It has no impact on the cause of pain, instead it blocks the messaging of pain travelling from the source to the brain. Paracetamol is a generally safe and cost effective option for clients experiencing mild to moderate pain. It is effective for relieving pain as a result of minor sports injuries, headache and back pain.
However, because of its widespread availability and how easy it is to acquire over the counter, paracetamol is also one of the most common causes of drug overdose. Just because it can be bought for spare change at a supermarket doesn’t mean it isn’t incredibly dangerous if not used properly.
While most people don’t suffer side effects, when taken in doses above those recommended, it can severely damage the liver, so must always be used according to the dose advised.
Nonsteroidal anti-inflammatory drugs, or NSAID’s for short, have a more direct effect on the cause of pain than paracetamol, but only if the cause is inflammation. Common, over the counter NSAID’s include ibuprofen, aspirin and naproxen and can be found in brands such as Nurofen and Voltarol.
NSAIDs work by inhibiting the production of an enzyme required in the inflammatory process. The chemicals involved in inflammation are quite provocative, making nerves in the area extra sensitive, which can cause pain. So, by stopping or reducing inflammation, you can directly relieve the pain at the source. This is very effective for people suffering from headaches, menstrual pain, sports injuries, or arthritis.
However, like paracetamol, NSAIDs can be dangerous, particularly in older people where it can have an increasingly adverse effects on kidney function, or in asthmatics where they can cause an attack. They can also interfere with stomach function in people of all ages, contributing to stomach ulcers, acid reflux and gastrointestinal irritation.
There’s also the healing function of inflammation to consider. The discomfort and pain are side effects of your body’s natural healing response, so while NSAID’s may make you feel better in the short term, they can slow the rate of healing in the affected area. This is an area of ongoing debate in the medical community, but I generally suggest patients avoid NSAID’s in the first 24 hours after muscle or ligament injury.
However the advice is stronger for bone injuries. NSAID’s should definitely be avoided in any bone injury as they have been shown to inhibit bone growth, and delay fracture healing.
Like paracetamol, many NSAID’s are easily available over the counter. Yet that doesn’t make them safe for everybody, particularly if taking them for an extended period. So while they are often very helpful in reducing pain, it’s always sensible to discuss their ongoing use with your GP or prescribing Physio.
Codeine can be found in over the counter medicines such as co-codamol and Sulpadine. Like paracetamol, codeine is an analgesic that blocks pain messaging in your nervous system but is more powerful, used in situations where paracetamol or NSAIDs are unable to relieve the pain or are not recommended.
The down side is that codeine is an opiate like morphine. Like its stronger cousins, it can have adverse effects on your mental state and – unlike paracetamol or NSAIDs – prolonged use can lead to dependency and addiction.
While very effective at relieving moderate to severe pain, due to its addiction risks, and potential side effects such as constipation, codeine should preferably be used in the short term only.
How We Use Pain Relief Medication
Though we were the first private practice to be able to independently prescribe medication, our objective has always been to cure you of your pain rather than just treat it. Pain isn’t something you should usually have to live with and for most of our clients the methods for curing it are relatively simple and, most importantly, long lasting.
The less pain you have, the better you will move, and the better you move, the sooner you will recover. We use pain medication to provide a window where you feel more comfortable exercising and progressing through your rehabilitation. This exercise will eventually strengthen your body so that the causes of pain are naturally relieved, with the bonus of making you less susceptible to further injury.
Exercise also provides its own natural pain relief through the release of endorphins, though in many cases telling someone who’s in pain to go for a run will result in nothing but a dirty look!
So remember, paracetamol, NSAIDs and codeine may provide temporary relief, but if the pain keeps coming back then taking drugs won’t solve it. If your aches and pains are stopping you living the life you want, get in touch with us at firstname.lastname@example.org or 0207 937 1628 to find out how we can help you get back on your feet, for good.
Clinical Director, West London Physiotherapy