Painkillers: how to pick the right one

[jholmes800]

We spend more than £250m a year on painkillers to help us cope with everything from headaches to arthritis. This is hardly surprising when you think that, for most people enduring pain, nothing is more attractive than a "quick fix".
Yet the evidence suggests that most of us are too hasty in our bid to be pain-free. Instead of considering which painkiller is best - some work primarily to reduce temperature, while others are mainly anti-inflammatory - we go for the first thing we find, with too little care for dosages or side effects.
If you're using the anti-inflammatory drug ibuprofen (which is contained in Nurofen) to ease your joint aches and pains, are you thinking about the possible gastric irritation it could cause you? Or that this painkiller may raise the risk of heart failure in older people?
There's also a risk of becoming over-reliant. An estimated 30,000 people in the UK are addicted to over-the-counter drugs, including painkillers. Some of the main culprits here are drugs containing codeine and dihydrocodeine.
Dr Jane Flemming, a London-based GP, says: "These are very effective at reducing pain, but they are physically addictive if taken for too long." They can also make the headaches they are intended to cure worse if they are taken excessively.
Yet the right painkiller could have hidden benefits; choose aspirin for a headache, and you're also getting a blood-thinning drug that could protect you from heart attack, stroke and deep vein thrombosis.
So which painkiller is best for you? The key ingredients of the common ones work in a different ways. Here's our guide to choosing the right painkilling drug:
PARACETAMOL
Also sold under brand names such as Hedex and Panadol, and available in combined products such as Anadin Extra, which contains aspirin. Brands marked Extra or Plus don't necessarily contain more paracetamol; they may contain caffeine.
How it works
Paracetamol lowers temperature and kills pain, but doesn't reduce inflammation. It blocks molecules called prosta-glandins, which tell the brain the body is in pain.
Best for
General pain relief such as backache, toothache and headaches. Migraine medicines usually contain paracetamol.
According to Sean Woodward of the Royal Pharmaceutical Society, paracetamol has fewer side effects than aspirin; it can be used for children in syrup form. Unlike ibuprofen and aspirin, paracetamol doesn't cause stomach irritation. This makes it the best option for people who need to take painkillers regularly. However, it will not reduce arthritic swelling around joints.
If the pain is severe, as in migraines, you can take paracetamol at the same time as aspirin or ibuprofen. Unlike aspirin and ibuprofen, paracetamol can be taken without food, but drink water with it and lie down.
Side effects
Paracetamol in high doses is dangerously toxic to the liver; never exceed the stated dose and don't take continually for more than a few days. Watch out for paracetamol in cough, cold and flu remedies; taken with paracetamol tablets, they could push you over the limit.
Maximum 24-hour dose
For adults, 500mg to 1g every four to six hours, with a maximum of eight 500mg tablets in 24 hours. Children's doses depend on age and weight, so check the instructions and choose preparations formulated for children.
Don't take if
Avoid paracetamol if you have a weak or unhealthy liver; or if you are in chronic pain and need to take a painkiller regularly.
ASPIRIN
This painkiller was originally extracted from the bark of the white willow tree. Aspirin is now made synthetically and is sold under brand names such as Disprin and Aspro Clear, and is contained in combined preparations such as Anadin. Soluble tablets act more quickly than coated tablets, which partly protect the stomach from irritation.
How it works
Aspirin reduces temperature and pain. Higher doses act as an anti-inflammatory. It also prevents platelets in the blood from sticking, so make them less likely to clot or block blood vessels.
Best for
Aspirin is good for alleviating flu symptoms as it lowers temperature and relieves joint pain. Gargling and then swallowing soluble aspirin eases throat infections. Jane Flemming says aspirin is good as a "one hit" drug to relieve the pain of a sudden headache or toothache. In lower doses, aspirin thins the blood and helps to prevent the clots that can cause stroke and heart attack.
Side effects
Irritates the stomach lining, so can cause stomach ulcers and bleeding. Some people have allergic reactions to aspirin, developing a skin rash, breathing problems or swelling.
Maximum 24-hour dose
You can take from one to three 300mg tablets every four to six hours during a day. Doses for preventing blood clots are about 75mg daily.
Don't take if
You should avoid aspirin if you are already taking any anti-coagulant drugs, or if you have a stomach ulcer. As it increases bleeding times, don't take it before or after surgery. Shouldn't be given to children under 16 as it can cause Reye's syndrome, a rare brain and liver condition. Asthmatics should avoid aspirin as it can trigger attacks.
CODEINE
Codeine is mainly sold in combination with other painkillers - such as Nurofen Plus (ibuprofen and codeine) or Solpadeine (paracetamol and codeine).
How it works
Related to morphine, this opioid drug relieves pain without producing euphoria. It blocks pain receptors at the end of nerves, stopping pain from reaching the brain.
Best for
One-off relief for sudden pain - after an injury or tooth extraction, say. Helps to relax constricted abdominal muscles that can cause menstrual cramps, so can be good for period pain.
Side effects
Can cause sluggish bowel movements and constipation.
Maximum 24-hour dose
For treating pain, 120mg to 240mg daily. Tell your GP if you have liver, kidney or lung problems.
Don't take if
Not to be used regularly for chronic pain or recurrent headaches; you may become dependent, causing restlessness and irritation when you stop taking them. You may develop tolerance, making it less effective over time.
IBUPROFEN
This non-steroidal anti-inflammatory drug (NSAID) is sold under brand names such as Nurofen and Proflex.
How it works
Ibuprofen blocks the production of several types of prostaglandins, which cause inflammation and pain. It can also lower temperature.
Best for
Doctors recommend this type of painkiller for acute pain such as headaches, period pain and joint aches. It is also used to ease chronic forms of pain that come with rheumatoid arthritis and osteoarthritis.
Side effects
Like aspirin, ibuprofen irritates the stomach lining; long term, it can lead to gastric ulcers. Can cause indigestion and nausea.
Maximum 24-hour dose
Don't take more than 1,200mg - or six 200mg tablets, four 300mg capsules or three 400mg tablets - in a day.
Don't take if
Avoid if you suffer from stomach ulcers or gastric disorders. The Medical Research Council warned recently that NSAIDS such as ibuprofen can increase the risk of heart attacks in patients taking them in relatively high doses for chronic inflammatory conditions such as arthritis.
Nature's painkillers
Plant extracts and other techniques are proving effective at combating the inflammation that underlies painful conditions. So which are nature's best pain-busters?
PEPPERMINT
In a study, 95 per cent of headache sufferers who rubbed peppermint extract across their forehead found that it could cure a headache faster than conventional painkillers, producing an effect within two minutes. The active ingredient, levo-menthol (taken from the herb Mentha piperita), is thought to relax local blood vessels, causing a sensation of coldness or tingling, followed by pain relief. A peppermint painkiller called 4head (Diomed, £5.95 per stick) is available from pharmacies.
OLIVE OIL
A 50g helping of extra-virgin olive oil gives a similar painkilling effect to about 10 per cent of the ibuprofen dose recommended for adult pain-relief, say researchers at the Monel Chemical Senses Center in Philadelphia. The active ingredient, oleocanthal, affects the same biochemical pathway as ibuprofen and other non-steroidal anti-inflammatory drugs.
TURMERIC
Researchers are attempting to extract the "active molecules" in turmeric to turn into an anti-inflammatory drug. Researchers at the University of Arizona have found that molecules in turmeric called curcuminoids are effective at calming inflammation and pain, so may one day be developed into an arthritis drug. For now, sprinkle generously into your curry.
CAT'S CLAW
Research has now confirmed what traditional doctors have known for years - that cat's claw, or Uncaria tomentosa, contains powerful anti-inflammatory substances, making it effective for conditions such as arthritis or back pain. It's available from Rio Trading Company (01273 570987).
WARMTH AND RELAXATION
When pain is caused by stress, tight muscles and constricted blood-flow, the best remedy could be a hot-water bottle or a long soak in the bath. Heat increases the blood circulation to tight tissue, helping it to relax, so the application of heat is good for muscular pain, tension headaches and period pain. Also, by bringing blood, nutrients and oxygen to the affected area, heat helps to speed up healing.

http://news.independent.co.uk/uk/hea...cle2067865.ece

[darkglobe]

Good information, jholmes800. Someone's done their homework!

Not sure this really belongs here (although Codeine is mentioned), but meh, I'm a newbie and you're not so I'll shut up.

Nice to know how they work though. Well worth reading especialy for those in constant pain. Cheers