Pain Medication: Friend or Foe?

I’ve been getting this question a lot in clinic recently. “What medication should I take to help fix me and/or decrease my pain?”

I figured this is a perfect topic to unpack and give my thoughts on. First off, this question is obviously a loaded one. There are a lot of different medications that are aimed to affect different tissues/bodily processes. For example, we have:

  • Acetaminophen (pain relievers; eg. Tylenol)
  • Ibuprofen (NSAIDS – anti-inflammatories; eg. Advil/Motrin)
  • Methocarbamol (Muscle relaxants; eg Robaxacet, Robaxin)
  • Topical Analgesics (pain relieving creams; eg. Voltaren, Rub A535, Bengay)

It’s important to realize that with every drug, there are various possible side effects and issues when it comes to long-term use. A quick Google search will give you lists upon lists of potential side effects of each category of pain relieving drugs.

This is the FIRST thing I warn patients about, along with the fact that you can become dependent on medications to be the source of your pain relief. Sole dependence on over the counter pain relievers to relieve your pain is, in my opinion, a sub-optimal way of managing your pain. In reality, none of these drugs will resolve your pain; rather they work to reduce severity of symptoms caused by potential or actual tissue damage and nociception.

Now, I don’t personally take painkillers so I wouldn’t be able to give my preference of which ones work and which ones do not. However, throughout my extensive research on the topic I did in preparation for this blog post, the overwhelming consensus concludes that the placebo effect from these drugs will depend on how the medication is perceived to help, and past experience with pain relief from a certain brand/type of medication. So the main takeaway would be, experiment with various over the counter drugs and find the one that provides you with the most perceived pain relief (if you so choose to use pain relieving medications). Consult a physician first and do everything you can to make sure the use of said medication is used in the short-term as a supplement to aid in pain relief/recovery.

Throughout my research, I tried to answer a seemingly obvious question in my eyes;  “Wouldn’t decreasing inflammation via the use of anti-inflammatories slow the overall healing time of the tissue damage, therefore increasing the amount of time spent in pain?” The use of anti-inflammatories to reduce inflammation as a cause of the pain sounds appealing. However, when you stop and realize that inflammation is THERE FOR A REASON, it sounds backwards and counterproductive. Reason being that your body sends healing factors via the blood/fluid pathways to the area that sustained damage (hence why it swells up). There was no research supporting, or disputing my question, so I can’t provide proper evidence to my hypothesis. My educated guess would be that the use of anti-inflammatories for an injury that has occurred within the past 2 weeks (acute stage of healing) would be counterproductive and it would be hard for me to preach its benefits/efficacy. That being said, psychologically speaking if you wanted to use anti-inflammatories after the initial acute stage of healing, it may help decrease perceived pain and get you back into moving without fear of pain or injuring yourself further.

Broadly speaking, other medications are aimed at simply decreasing perceived pain. They work in various ways to accomplish this task, but bringing you back to my previous point of the consensus of the body of literature, the placebo effects of these medications are likely to be the driving factor to the decrease in perceived pain. Here is a list of times I would and wouldn’t promote the use of painkillers.

Would

  • To help decrease pain when trying to fall asleep (considering sleep is essential in recovery)
  • To help decrease pain when you’re not doing anything active (wherein your pain is caused by tissue damage or a fatigue issue that would be provoked with activity)

Wouldn’t

  • To get you through a physically active day or physical activity
  • Using it everyday as the sole dependent for your pain relief
  • If, when the medication wears off, you’re left in MORE pain than you were previous to taking the medication

The reason I say to NOT use it to get through a day full of activities is that pain is an evolutionary necessity that warns us about potential or actual tissue damage. If you take a painkiller to help you get through a physical activity, you’re likely to not experience any pain that would normally be present to warn you to alter the way you’re performing that task or stop it completely for a shirt while. So now when the painkiller wears off, you may be in MORE pain because you’ve been unknowingly irritating your tissue for an extended period of time.

In summation, if you choose to use medication(s) do so sparingly and short-term to help you relieve symptoms felt from sustained or potential tissue damage and only do so to help you when pain is felt at rest or before bed. Sleep is important in tissue healing so I’m not opposed to using it as a sleep aid if more “natural” remedies don’t help, ie. melatonin, regular sleep schedule, etc. Secondly, I believe it may be counterproductive to use anti-inflammatories to decrease actual or perceived inflammation, rather let your body runs its natural course of healing. Thirdly, understand that placebo effects rather than actual physiological effects likely cause most pain relief effects you obtain. Lastly, understand that pain is normal, so seeking to be in a constant pain-free state may be psychologically CAUSING more pain than relief you’re getting.

DISCLAIMER: This is obviously not medical advice, simply my educated guess and opinion on painkillers through my own clinical practice and review of the scientific literature.

Tyler Paterson RMT

@tyler_motusstrengthhc

tylerpatersonrmt@gmail.com

Photo Credit: http://www.israelpharm.com/blog/what-pain-medication-are-you-taking/

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