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Myth Busting 10: Painkillers

· 3 min read

Part of the "Myth Busting" series

We saw in the last blog post that pain is an experience, which is the result of different biological, psychological and social factors, that can influence many areas of our lives. In this blog, we're going to talk about the role of painkillers in managing pain.

It's estimated that around 70% of women always have painkillers in their handbag. We've almost certainly all got some in a cupboard or medicine cabinet at home. But what role do they play in managing pain?

Painkillers all work in different ways, but essentially they're all trying to make nerves less likely to fire. Some of them do this by blocking receptors that would activate a nerve. Some of them reduce inflammation, because inflammation makes a nerve more likely to fire. Some of them do this by mimicking substances that make nerves less active.

But the first point that I want to make in this post is:

There is no "off switch" for pain#

We've already discussed how thousands of different nerves are involved in pain. Some of them are nerves which sense things (like heat, cold, touch, pressure, chemical, etc) but not all. Some of them are nerves involved in movement. Some of them are nerves involved in memory. Some of them are involved in understanding health information. Some of them store beliefs about your body and its abilities. And all of these play a role in pain.

So targeting one group of these, or one aspect of them is very unlikely to work as a magic "off-switch" for pain. Especially if that pain has been persistent.

For this reason, I've always thought that calling them painKILLERS was a bit odd. Because they don't actually kill pain.

There is a role for painkillers#

Pain medication (known as analgesics/analgesia) can play a really important role in managing long-term pain. But on its own it often isn't enough, because of the multi-faceted nature of pain. It works on a chunk of the biological inputs, but not on all of them. And very little on the psychological and social aspects.

And painkillers can cause problems too#

Certain types of painkillers, such as morphine, oxycodone or fentanyl, can cause Opioid Induced Hyperalgesia. This is where, after prolonged use, the medication actually starts to make the nerves more sensitive to painful stimuli. This could manifest in a few different ways:

  • painkillers start becoming less and less effective
  • as the dosage increases the pain also increases
  • the pain starts to spread more widely and diffusely, even though the disease or condition itself is no worse

And, of course, many types of painkillers can be highly addictive if used for prolonged periods. This, in part, fuelled the opioid crisis in America.

In summary#

Painkillers can play a very useful role in managing pain, but they are unlikely to work in isolation. It's recommended that, alongside pain medication, tailored exercises and pain management programmes are used to help address all the different features of pain. And stronger painkillers should be used with caution.

See other posts in the "Myth Busting" series