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We’ve all been there; you’re having a
somewhat normal day, and then you find yourself
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suddenly wracked by an inexplicable and unignorable
pain.
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Maybe it’s a headache that seems to have
come out of nowhere or a sensation of soreness
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that just won’t leave you alone.
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So, you head to the medicine cabinet or down
to your local pharmacy to grab yourself something
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to reduce these uncomfortable symptoms as
quickly as you can.
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Your best option?
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Well, in most cases, that would be painkillers.
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Over-the-counter medicines like these are
some of the most common and affordable treatments
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for alleviating various forms of acute or
chronic pain.
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But there’s such a variety of painkillers
out there, how are you to tell which one is
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actually right for your current ailments?
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Which types of painkillers are safest, and
which ones can lead to potential danger if
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not taken correctly?
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And most importantly of all, what do painkillers
actually do to your body in order to reduce
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or treat pain?
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Let’s start with arguably the most widely
used over-the-counter painkiller: paracetamol.
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Also known as acetaminophen here in the United
States, it’s commonly taken to alleviate
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headaches or relieve mild to moderate pain.
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Paracetamol can also lower a raised temperature,
which makes it handy for tackling a fever
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that might come as the result of a cold.
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It achieves this by blocking the chemical
messengers that travel from the body to the
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brain in order to alert the brain of the presence
of painful sensations.
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When it comes to lowering temperatures, paracetamol
does much the same thing; it affects these
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chemical messengers in the area of the human
brain that is responsible for regulating body
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temperature.
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Paracetamol is usually taken in the form of
pills or capsules.
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However, it’s also the key ingredient in
many brands of over-the-counter combination
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painkillers or cold and flu medicines.
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It’s because of the presence of paracetamol
in other remedies that being aware of how
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much you are taking is crucial, as it’s
possible to take too much and cause yourself
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potential harm – or even death!
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Usually, an average person can take paracetamol
without issue, however, doctors and pharmacists
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say you should avoid this painkiller if you’re
pregnant, currently taking other medicine
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prescribed to them by their doctor, experiencing
an issue with the way their liver is functioning,
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or if you’re outright allergic to paracetamol.
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For most adults, the recommended dosage is
five hundred milligrams taken every four to
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six hours, but never exceeding the maximum
of four grams within a single day.
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When taking paracetamol, it’s important
to leave at least four hours between each
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dose and not to take more than four in the
space of twenty-four hours.
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This is where taking too much paracetamol
can potentially become lethal, as too much
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can cause damage to a person’s liver.
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Paracetamol poisoning occurs not directly
due to the painkiller itself, but one of its
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metabolites – the small molecules produced
by metabolism.
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Known as N-acetyl-p-benzoquinone imine, this
can directly damage the cells within the liver.
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Side effects of a paracetamol overdose can
include tiredness, abdominal pain, and nausea,
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and can set in within a day of taking the
overdose.
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This is followed by an absence of any noticeable
symptoms, then by yellowish skin, blood clotting,
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and confusion as a result of liver failure.
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Kidney failure, pancreatitis, and low blood
sugar can also occur as a result of paracetamol
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poisoning.
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Without medical treatment, the toxicity caused
by a paracetamol overdose normally occurs
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within four days to over two weeks later.
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While it’s often fatal, if treated you will
survive, albeit in a great deal of pain, after
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a couple of weeks.
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In the United States alone, there are over
100,000 cases per year of paracetamol poisoning.
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In the UK, it’s the medication responsible
for the highest number of overdoses, given
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how readily available it is in most stores
and pharmacies.
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However, the reason it’s so readily available
is that paracetamol is relatively safe for
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most people to consume for pain relief without
suffering any potential side effects or risks
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of danger if taken in the recommended dosages.
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Often, the largest influencing factor on what
type of painkillers a person needs comes down
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to the type of pain they’re experiencing.
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Ibuprofen is another similarly widely available
type of painkiller, much like paracetamol.
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However, unlike paracetamol, it has different
uses – specifically, it’s more appropriate
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for different types of pain.
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For example, aches and pains like back pain,
toothaches, period pains, and symptoms related
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to colds and flu are normally better treated
by ibuprofen than paracetamol.
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It can also help to treat inflammation, sprains,
and strains, as well as pain brought on by
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arthritis.
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Much like the aforementioned everyday painkiller,
ibuprofen is also typically found in the form
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of pills or capsules, but there are versions
that come in the form of granules that can
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be dissolved in water and swallowed.
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Ibuprofen-based gels and sprays that can be
absorbed through direct contact with the skin
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also exist.
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Also, similar to paracetamol, ibuprofen is
often found in products that combine it with
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other painkillers and is another common ingredient
in cold and flu medicines.
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The way ibuprofen actually works is by reducing
the hormones in the body that are responsible
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for causing pain and triggering swelling.
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It focuses on one of the key chemical pathways
of the body that causes pain, and reduces
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the body’s ability to make what is known
as prostaglandins.
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These are the specific chemicals released
by the body that trigger pain, inflammation,
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and fevers.
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With a reduced amount of prostaglandins in
the body, these uncomfortable symptoms are
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reduced.
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When taking ibuprofen orally, this can normally
take around twenty to thirty minutes to take
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effect.
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Using a product that requires ibuprofen to
be absorbed by the skin takes a lot longer,
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usually within a couple of days.
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Ibuprofen is typically used for short-lived
pain triggered by inflammation, such as period
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pain, toothache, or back pain, and the maximum
dosage is around six hundred milligrams, or
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two standard two hundred milligram pills taken
orally three times a day.
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If someone is suffering from a more consistent,
recurring pain, then their doctor might prescribe
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them slow-release ibuprofen, which is taken
fewer times throughout the day, with large
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gaps of around ten to twelve hours between
each dose.
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It’s recommended that ibuprofen – when
in capsule, granule, or liquid form – should
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be taken alongside food or drink to reduce
the possibility of the painkillers disrupting
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the stomach.
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Most doctors will tell you not to take it
on an empty stomach.
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There are a number of other known side effects
of ibuprofen, too, and these can affect more
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than one in every one hundred people.
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It can occasionally trigger temporary headaches,
and it’s advised that you shouldn’t use
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other medicines to alleviate these headaches
should they occur.
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Ibuprofen does not mix well with some other
medicines, especially in any of its orally
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taken forms.
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If ibuprofen makes a person feel dizzy, then
it's recommended that they avoid coffee, cigarettes,
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and alcohol and instead lie down.
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Ibuprofen can also cause nausea in some people,
in which case they need to stick to simple
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meals and avoid rich or spicy foods.
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Being sick, experiencing gas, or suffering
indigestion are also known to be caused by
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ingesting ibuprofen.
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If any of these side effects persist, a person
should contact their doctor and avoid taking
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any other medicines to treat these side effects.
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When applied to the skin, ibuprofen is less
likely to have an effect on any other medications
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present in a person’s system, but when taken
orally, it can.
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This is why it’s worth, for the sake of
safety, to mention to a doctor any other medication
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you may be taking before you start taking
ibuprofen.
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There’s also not a lot of evidence to suggest
that it’s safe to take any herbal remedies
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or supplements alongside ibuprofen, as these
are not tested in the same way as pharmaceuticals.
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However, ibuprofen can be taken safely alongside
some other painkillers, like paracetamol or
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codeine.
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However, it should not be taken with others
from the same group, such as aspirin.
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Both ibuprofen and aspirin belong to a particular
family of painkillers known as NSAIDs.
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This stands for non-steroidal anti-inflammatory
drugs, and if taken together, too many NSAIDs
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in a person's system can increase the risk
of developing side effects.
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Speaking of aspirin, this is highly similar
to ibuprofen in a lot of ways.
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Both are NSAIDs, and both are everyday painkillers
used to treat similar types of pain caused
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by inflammation, as well as cold and flu symptoms.
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And, much like its fellow NSAID, aspirin is
often found as an ingredient in cold and flu
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medicine; you’ll find aspirin as an ingredient
in medicines like Anadin, Alka-Seltzer, and
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Beechams Powders.
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Aspirin mainly comes in pill form or as suppositories,
which are…
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well, we probably can’t say on YouTube,
but those are pills that go in ‘the other
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end’ from the mouth.
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Aspirin gel also exists, and can be used on
mouth ulcers and cold sores.
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Where this particular painkiller starts to
differ from ibuprofen is in how aspirin is
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typically prescribed and to whom, as it is
not suitable for everyone, as well as how
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quickly it takes effect – and spoiler alert,
it’s a lot faster than ibuprofen.
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While most types of aspirin can be purchased
from pharmacies and supermarkets, aspirin
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is only suitable for people over the age of
sixteen.
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There is a potential link between aspirin
and Reye’s syndrome in children, a condition
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that can cause severe damage to the liver
and brain.
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As a result, aspirin shouldn’t be given
to a child unless prescribed by a doctor.
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Those also experiencing symptoms of high blood
pressure, indigestion, liver or kidney problems,
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or gout should also first consult a doctor
before taking aspirin.
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Normally, aspirin is found in pills of three
hundred milligrams, and one or two should
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be taken at the same rate as paracetamol – which
is to say, every four to six hours.
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A person should not exceed more than twelve
doses over the course of a single day.
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There also exist low-dose forms of aspirin
that can be prescribed to those who have suffered
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heart attacks or strokes or to some pregnant
people.
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However, this is different from taking aspirin
for pain relief and should only be done when
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recommended by a medical professional.
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Aspirin works by blocking a particular enzyme
in the body known as cyclooxygenase.
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This enzyme is responsible for producing a
range of hormones known as prostanoids.
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These are present within our blood and regulate
the activity of blood platelets, the cells
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that allow blood to flow through the narrow
vessels of the lungs.
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These prostanoids also affect inflamed areas
of the body, like sprains or damaged joints.
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So, by reducing the amount of cyclooxygenase,
aspirin prevents these blood platelets from
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sticking together, thus reducing pain and
inflammation.
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However, because of the effect it has on the
blood, one of the most common side effects
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of taking aspirin is the increased risk of
bleeding.
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Without the platelets sticking together, patients
may occasionally experience minor or severe
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bleeds, commonly within the stomach or intestines.
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Severe bleeds can also occur in the brain,
which can lead to a stroke.
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While a rare outcome, this is a potentially
very dangerous side effect of taking aspirin.
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As a result, doctors will not prescribe it
to just anyone, especially those known to
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have a sensitivity to this painkiller, for
their own safety.
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In those with asthma, aspirin can also trigger
asthmatic attacks.
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Generally, it is not recommended that anyone
who is otherwise healthy takes over-the-counter
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aspirin unless told to by a doctor to treat
a specific pain.
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Additionally, those taking other medications
should seek professional advice before taking
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aspirin, as taking it alongside medicines
that are intended to prevent blood clots can
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also lead to bleeding problems.
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There are non-steroidal anti-inflammatory
drugs other than aspirin and ibuprofen, the
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third belonging to the NSAID family being
naproxen.
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This painkiller specifically targets pain
in the joints and muscles, and as such, is
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used to treat rheumatoid arthritis – caused
by the swelling of the lining of the joints
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– osteoarthritis – arthritis caused by
a breakdown of the lining of the joints –as
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well as gout, period pains, and muscular or
bone disorders, including back pain, sprains,
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and strains.
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Naproxen is typically only available by obtaining
a prescription, either as pills or in a liquid
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form.
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Much like the other aforementioned NSAIDs,
naproxen works by blocking certain enzymes
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– in this case, cyclooxygenase.
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This prevents a process called prostaglandin
synthesis, those same chemicals that are reduced
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by ibuprofen.
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Prostaglandins elevate the body’s temperature
and make nerve endings more sensitive to pain
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transmission, so naproxen seeks to reduce
pain by blocking the enzymes relating to it.
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While it is considered to be effective at
alleviating short-term pain, naproxen comes
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with the same risks as other NSAIDs, in that
it can have adverse effects on the stomach,
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as well as potentially increasing bleeding
tendency.
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It can interfere with other forms of medication
and may even increase the risk of a stroke
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or heart attack, so should only be taken under
the advice of medical professionals.
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That brings us to opioids, and don’t worry,
that’s not the sound of the police on their
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way.
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The word opioids, or opiates, does bear some
relation to opium, which is the plant that
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certain narcotics, like heroin, are derived
from.
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The difference is that, for one, an opiate
is naturally occurring while an opioid has
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synthetic elements to it; for another, there
do exist weak opioids that won’t land you
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in trouble with the law.
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And some of these are even used as painkillersixt
A few common examples of so-called weak opioids
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include codeine and dihydrocodeine.
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While they might commonly be described as
being ‘weak,’ these opioids can be highly
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effective when it comes to treating more severe
pain.
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However, they come with their own share of
potentially adverse effects – including
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the risk of dependency and addiction – and,
as a result, should be handled with care.
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There also exist stronger opioids, including
morphine, however, these are rarely made available
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to the public and are usually only administered
to patients in a hospital rather than being
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prescribed by a doctor.
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One of the aforementioned weaker opioids,
codeine, is perhaps the most well-known of
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this particular painkiller family.
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It’s often combined with paracetamol in
pills known as co-codamol.
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Typically, codeine is used to treat ongoing
pain after other options like paracetamol,
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ibuprofen, aspirin, or other NSAIDs have proven
ineffective.
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In particular, codeine can be prescribed after
a patient has suffered an injury or following
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a surgical procedure, as well as given to
those suffering from diarrhea.
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However, rather than blocking specific enzymes
like NSAIDs do, codeine and other opioids
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like it will instead affect a person’s central
nervous system and brain.
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They block the pain signals sent from the
brain to the rest of the body, and this can
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often have a calming effect, reducing the
natural stress that the brain goes through
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in response to an injury.
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Dosages of codeine are often considerably
lower than those of other painkillers like
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aspirin or paracetamol, and it is usually
found in pills of only fifteen, thirty, or
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sixty milligrams.
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The standard dosage for adults is one or two
thirty milligram pills every four hours, with
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no more than eight being consumed in one day.
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Much like the others we’ve mentioned, codeine
comes with potential side effects, and the
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higher the dose, the more likely someone is
to experience these.
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This can include feeling constipated, sick
or nauseous, sleepy or dizzy, as well as experiencing
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confusion and headaches.
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However, there is also the risk of becoming
addicted to codeine, a danger it shares with
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its fellow opioids.
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Most doctors, when prescribing codeine, will
be able to offer advice on how to avoid this
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outcome, but signs of an addiction can include
feelings of agitation if someone misses a
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dose.
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It’d probably be irresponsible to discuss
opioids without briefly touching on some of
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the wider effects that the proliferation of
opioids has had in the United States specifically.
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Improper prescription of opioids, often after
major surgical treatments, have resulted in
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a national opioid crisis - Where thousands
of addicts, particularly in rural areas, have
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been forced into inescapable spirals of addiction
that often lead to overdose.
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Globally, over 100,000 people die of opioid
overdose every year - with an increasing number
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of these being due to fentanyl, an extremely
potent synthetic opioid.
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In 2019, opioid overdose has been declared
responsible for 15.8 deaths per 100,000 people
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in the USA.
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Experts suggest that one of the biggest drivers
- and therefore, one of the most potentially
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valuable angles of attack against the opioid
crisis - is overprescription, often driven
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by pharmaceutical companies.
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Tighter regulations on opioid prescription
are needed in order to curb this issue, but
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until such regulations are passed, there are
good reasons to feel a little skeptical if
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you find your doctor is a little too eager
to prescribe the latest synthetic opioid.
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These are some of the most commonly available
painkillers, and exactly what they do to our
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bodies to help us out.
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As we mentioned, if you find yourself experiencing
any pain beyond that which an ordinary paracetamol
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can help with, then it’s always worth consulting
your doctor.
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They’ll be able to advise you best on what
painkillers are right for what ails you!
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