Symptom common to many diseases, pain is an important alarm bell that warns that something is wrong.
It is not true that we were born to suffer, but pain is undoubtedly part of everyone’s life. This observation, however, should not be seen in a completely negative way because, sometimes, acute pain can prevent us from incurring serious damage or even save our lives.
Any examples? If we didn’t feel pain when we put our hand on fire by mistake, we wouldn’t withdraw it and it would continue to burn. If we didn’t feel that excruciating pain in the lower right corner of our abdomen, we wouldn’t know we have an inflamed appendix that needs to be removed. If we don’t feel the toothache caused by an abscess and we don’t treat it right away, we could be facing a serious systemic infection.
Seen from this perspective, pain represents an important defense mechanism of the organism, which unequivocally signals the presence of a problem (even if it is not always easy to understand what it is) and which must induce us to react appropriately, removing shortest possible time the cause that induced it and treating the pain itself as soon as it has exhausted its function of organic alert , given that suffering further would be completely superfluous.
On the other hand, pain is not always sharp or helpful . Let’s take the case of headache : in the vast majority of cases the headache appears in the form of an acute attack, but (fortunately) it does not indicate any significant disease affecting the head or the central nervous system. It is a “trivial” impromptu event , which causes unnecessary discomfort and prevents you from carrying out your usual activities peacefully for a few hours or days. When acute pain of this type occurs, it simply needs to be countered as quickly as possible with effective analgesic drugs.
Another type of pain with no appreciable function is chronic pain , such as that which people suffering from osteoarthritis , rheumatoid arthritis , fibromyalgia, forms of back pain or chronic/recurring headaches have to endure more or less constantly. In these cases, the patients are well aware that they are suffering from a certain pathology for which there are no completely resolutive therapies and the associated pain has the only effect of generating physical and psychological discomfort, considerably reducing the quality of life and transforming itself into a disease . In similar situations, fighting pain as effectively and safely as possible is a priority.
Fortunately, over the decades medicine has developed countless pharmacological and non-pharmacological remedies capable of relieving acute and chronic pain of various origins and types. For each form of pain there are today different treatment possibilities, from the simplest and most accessible medicines even without a medical prescription, to the more demanding and “powerful”, reserved for the management of particularly severe pain . Some analgesic therapies can in fact be used following the instructions on the package leaflet or provided by the pharmacist, while others must necessarily be prescribed by the doctor or specialist, after careful evaluation of the present disorder and the general clinical picture.
Immediate practical remedies against pain
Acute pain, caused by a minor trauma such as a bruise or an ankle sprain after an accidental fall, can initially be tackled with the strategy that the Americans call RICE ( Rest, Ice, Compression, Elevation), i.e. keeping the painful part at rest, applying ice and possibly a compression bandage and keeping the foot or leg elevated.
The reasons and effects of these interventions are soon explained:
Rest | Rest avoids further stressing the compromised area and allows tissue repair processes to act undisturbed |
Ice | The cold acts as a mild anesthetic, interfering with the transmission of painful stimuli from the traumatized area to the brain; it also reduces vasodilation, the formation of hematoma and edema ( swelling) and the onset of excessive inflammation |
Compression/Elevation | Compression bandaging and leg lifting have the same effect of containing the arrival and stagnation of fluids and blood in the tissues, preventing the traumatized part from swelling too much, hurting more than it should. |
The RICE strategy is considered a cornerstone of orthopedic emergency intervention because in the common experience of athletes and non-athletes, it allows adequate management of the immediate period after a musculoskeletal trauma, reducing the associated pain and other sequelae.
Sometimes, however, the cold is not the most suitable solution, in some situations the heat is more indicated , especially if the damage is not related to an inflammatory state, but rather is the result of a muscle contracture.
Why is the heat better in this case? The heat is preferable in these situations because it promotes the dilation of the blood vessels, thus bringing more oxygen to the muscle fibers which relax, reducing the contracture which is the origin of the pain.
Therefore, depending on the problem, it is possible to intervene with heat or cold, but in both situations, if necessary, these treatments can be accompanied by the use of analgesic drugs, such as non-steroidal anti-inflammatory drugs (NSAIDs ) , which have a good analgesic and anti-inflammatory activity and which therefore act both on the symptom and on the cause. However, if after a few days of treatment the pain persists in an intense and annoying way, it is advisable to contact your doctor, who will evaluate the possibility of prescribing something stronger.
Painkillers are useful on a case-by-case basis
When you are in circumstances of this type, based on the intensity of the pain present, you can refer to different classes of painkillers , namely:
– non-opioid analgesics (first tier drugs), non-steroidal anti-inflammatory drugs (NSAIDs), indicated for mild to moderate acute or chronic pain
– opiate active ingredients (second level drugs), to be used in moderate to severe forms or which do not respond to treatment with first level drugs. Also this second category of drugs can be used for the management of both acute and chronic pain.
Opioid drugs , often seen with a certain diffidence, actually represent a valuable therapeutic weapon for relieving pain resistant to other pharmacological solutions and are, in fact, the only way to counteract the severe suffering associated with forms of cancer in the advanced or terminal. It should also be noted that the category of opioid drugs includes not only powerful active ingredients, but also the so-called “weak opioids”, characterized by a milder therapeutic action and good tolerability.
However, while for the majority of low-dose NSAIDs (ibuprofen, naproxen, ketoprofen, diclofenac, etc.) the free purchase and use in self-treatment is permitted, for opioid drugs it is always necessary to obtain a medical prescription and to adopt some caution more during intake to avoid facing the typical side effects of these active ingredients, namely: nausea , vomiting, constipation , drowsiness, tiredness, as well as addiction and dependence in case of prolonged or inappropriate use.
Another first-level analgesic drug, which can be purchased without a medical prescription and is widely used to counter pain and reduce fever in adults and children, is paracetamol: an active ingredient characterized by different properties from both NSAIDs and opioids and by a mechanism of peculiar action, not yet fully specified.
Paracetamol is a good analgesic and antipyretic remedy that is well tolerated at the gastric level and, unlike NSAIDs, can also be taken during pregnancy and in the first years of life, always respecting the recommended dosages and treatment times. However, being substantially devoid of anti-inflammatory activity , it is less indicated than NSAIDs when the pain to be relieved has a significant inflammatory component, as in the case of rheumatoid arthritis, acute attacks of back pain or neck pain or joint pain that arises immediately after a trauma .
A group of very powerful anti-inflammatory drugs, also characterized by a high analgesic power (ie capable of reducing or eliminating pain) is, on the other hand, that of corticosteroids . However, the use of active ingredients of this class should be limited to cases of inflammatory pain not controlled by NSAIDs (also in combination with paracetamol) at an adequate dosage, since their intake for periods longer than a few days is associated with side effects significant enough. For this reason they must always be prescribed by the doctor.
Self-medication painkillers: which one to choose?
Most NSAIDs are available in pharmacies in dosages called self-medication. These are the so-called OTC drugs, which can also be purchased without a prescription because, if you follow the instructions on the package leaflet, they have a very high safety profile.
The best-selling NSAIDs in the treatment of pain are acetylsalicylic acid, naproxen sodium, diclofenac and ibuprofen , which are characterized by a similar mechanism of action. In fact, all of them participate in the synthesis of prostaglandins, the molecules involved in inflammatory and painful states, reducing their activity and extinguishing the symptoms.
This inhibition takes place through the blocking of the enzyme cyclooxygenase (COX), of which there are two forms, 1 and 2, both involved in the production of prostaglandins.
In addition to preparations for oral use , such as swallowable tablets, buccal tablets or powders to be dissolved in water, local preparations are also available : creams, gels or plasters to be applied to the sore part. The choice must be made taking into account the characteristics of the pain, the site and the individual sensitivity.
In general, it is preferred to use topical remedies, such as creams and gels, especially for muscle and joint pain, sprains and contractures, to be applied to the inflamed part, perhaps with a light massage which favors its absorption.
Topical formulations have the advantage of not being absorbed, if not minimally, systemically, therefore they generally have fewer side effects especially in the long term.
The important thing is to focus on formulations capable of guaranteeing good absorption, such as those in which the active ingredient is linked to a lysine salt, which facilitates its passage through the skin.
NSAIDs, in addition to having a pain-relieving action, also have anti-inflammatory properties; they are therefore very useful when the pain is linked to an inflammatory state (as in the case of musculoskeletal pain, back pain, sprains) as, in addition to soothing the symptoms, they also act on the cause of the same, bringing a more generalized benefit .
Painkillers: safe, with some precautions
NSAIDs that can be purchased in pharmacies without a prescription are analgesic, anti-inflammatory and antipyretic drugs that are safe if used for a few days (3-4 maximum) at the recommended dosages and following the directions for use on the package.
If the first intakes do not help relieve the pain present or you have doubts about their correct use, you need to consult your doctor to promote effective and safe use or change the posology or treatment approach. The doctor’s opinion should also be requested when pain of a certain importance occurs for the first time, if it tends to persist for more than a week or often recurs, or if pain that is already known and usually controlled by analgesic therapy worsens.
Although safe, NSAIDs can cause some side effects, particularly at the gastrointestinal level , especially in sensitive people and in those who already have pathologies at this level ( gastritis , ulcers , gastroesophageal reflux , etc.). In general, if you fall into the latter category, you should avoid taking conventional NSAIDs for pain relief, preferring other painkillers.
Those who do not have specific gastrointestinal problems, on the other hand, can avoid possible slight discomfort simply by taking NSAIDs on a full stomach and slightly modifying their diet (in particular, avoiding acidic foods and drinks such as tomatoes, citrus fruits, fruit juices, carbonated drinks, coffee etc.).
Particular attention should be paid if heart disease is present or if cardiovascular risk is higher than normal . There are NSAIDs that have a better cardiovascular safety profile than others. When in doubt, to learn more about heart health and the use of these molecules, it is advisable to ask your doctor or trusted pharmacist for advice.
It is also advisable to avoid lying down before at least 15 minutes have passed since taking it, in order to reduce the risk of irritation to the esophagus, and it is a good rule (as for all medicines) to abstain from drinking alcohol during treatment.
In general, unless a very large meal has been taken shortly before taking it, the analgesic action of NSAIDs taken by mouth appears about half an hour after ingestion. Conversely, it may take a few tens of minutes longer.
Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.
The blog covers a wide range of topics related to health and wellness, with articles organized into several categories.