Know Your Pain Killers

Know Your Pain Killers

1) Non-Steroidal Anti Inflammatory Drugs (NSAIDs) are group of drugs used to inhibit a family of chemicals produced in the body called Prostaglandins. Prostaglandins are the cells that produce the inflammation necessary for healing but this same inflammation also causes pain and fever. Prostaglandins are also responsible for supporting blood clotting by platelet cells and producing the mucus necessary to protect your stomach lining from the acid within it.

The enzymes that produce Prostaglandins are COX-1 and COX-2, both are responsible for the promotion of inflammation, pain and fever but only COX-1 produces the Prostaglandins that support platelets and protect the stomach. This is why when you use NSAID’s they can irritate your stomach or promote bleeding as both COX enzymes are blocked and Prostaglandins are inhibited all through the body.

I regularly see NSAID’s used as a first line drug in cases of musculoskeletal problems. They are mainly used to treat inflammation and mild to moderate pain. Also they are prescribed for headaches and menstrual cramps. The choice of the best NSAID to use will be based on the symptoms/condition you are presenting with.

The most common NSAID’s prescribed in the UK are:

diclofenac, ibuprofen, naproxen, celecoxib, mefenamic acid, etoricoxib, indometacin and aspirin (in doses greater than 600mg)

2) Paracetamol belongs to a group of drugs called Non-Opioid Analgesics and is used for mild to moderate pain and fever. It is thought to also work by blocking the production of Prostaglandins like NSAIDs but its true mechanism of action is poorly understood. As Prostaglandins sensitize nerve endings so that when an injury occurs it causes pain – it has been postulated that Paracetamol my increase our pain threshold so we feel an injury less but again this has yet to be definitively proven.

It is used to ease mild to moderate pain such as headaches and sprains and to control a fever or to help ease the symptoms of a cold. Paracetamol is known as acetaminophen in the USA and some other countries.

For adults: 500 mg-1000 mg every 4-6 hours up to a maximum of 4000 mg daily, do not exceed this dose as overdose of Paracetamol is associated with Liver damage.

3) Opioid Analgesics

The type of Opioids I see prescribed for the conditions I treat are either:

Codeine or Dihydrocodeine is most often paired with Paracetamol in Co-codamol or on it’s own as Codeine Phosphate. Co-codamol preparations are either 8mg (over the counter) or 15mg or 30 mg of Codeine with 500mg of Paracetamol (by prescription). Co-codamol is used to relieve short-term painful conditions where Paracetamol alone is not sufficient, such as for muscular pain, nerve pain, toothache and period pain. It is considered useful for mild to moderate pain.

The main consideration is the side effects of nausea and constipation which limits their use long-term. Also, there is some concern about the ease at which people can become addicted to Codeine.

Codeine is metabolized at different rates depending on the person so it may vary in effectiveness between individuals.

Tramadol is stronger than codeine, it is a narcotic-like pain killer that is used to treat moderate to severe pain. Tramadol works like morphine and binds to receptors in the brain (narcotic or opioid receptors) that are important for transmitting the sensation of pain from throughout the body to the brain.

Commonly reported side effects include nausea, constipation, dizziness, headache, drowsiness, and vomiting. It is also associated with addiction if used long term.

Other names for Tramadol are:

Mabron®; Marol®; Maxitram®; Tilodol®; Tradorec®; Tramquel®; Tramulief®; Zamadol®; Zeridame®; Zydol®; Tramacet® (contains tramadol and paracetamol).


Lindley Horner - Osteopathy, Naturopathy, Cupping Therapy, Cranial Osteopathy, Medical Acupuncture and Nutritional Medicine

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