I want to discuss the difference between pain management drugs as there is a wide scope of treatments available. Given that many methods of pain management are ‘Over The Counter’ (OTC) they are easily accessible and easy to abuse and misuse. There is also a bit of confusion about why certain medications are prescribed to coincide with others for specific pain relief, yet others cannot. I have to be reminded by medical staff often during my hospital visits that ‘it is okay to take paracetamol regularly as recommended without fear of becoming immune to it in these small doses or addicted to its use’ but this is only recommended for some people and in some circumstances.
My intention here is to dispel any myths and to reveal a little more information about health treatments and managements. I will try to cover the various types of pain regulation to the best of my abilities and experiences with accurate information from medical sources. Please be aware that I have intentionally not covered prescribed medications below as I will cover them at a later point.
I will only cover the three main types of OTC drugs that I am aware of. This is not to say that they are the only pain treatments available, it is more that these are the ones I have come in to contact with over the course of my Systemic Lupus Erythematosus (SLE or Lupus).
What are the options and how are they different?
- Acetaminophen or Paracetamol – A simple explanation of how these work was described to me as follows; nerves receive pain signals at the point of ‘injury’. These signals are sent along the nerves ( which are neural pathways) to the brain which decodes the message into pain type, severity, location, cause and other possible symptoms (bleeding, muscle cramp swelling). These drugs work by preventing or minimising the strength and frequency these messages are received by the brain. This is a very simplistic view of pain management and has gaping holes in it, but for all intents and purposes this is a very adequate way to explain paracetamols. While these are mainly targeting pain management they are also effective in reducing signs of fever, which is why they are beneficial in treating cold and flu viruses.
The medical explanation to follow and believe: ‘Paracetamol works as a painkiller by affecting chemicals in the body called prostaglandins. Prostaglandins are substances released in response to illness or injury. Paracetamol blocks the production of prostaglandins, making the body less aware of the pain or injury‘. (NHS.uk)
Brand names in Australia include Panamax, Paracetamol, Panadol.
- Anti-Inflammatories – As the name suggests, these relieve pain by reducing and eliminating inflammation. The simplistic comparison I was taught to understand how these vary from Paracetamols is that whilst the former only works on minimising the pain messages reaching the brain, these work by attempting to reduce signs of inflammation at the source of the ‘injury’. Now again, this is a poor explanation and not as accurate as I would like.
The medical explanation again should be followed, not my naive example: Prostaglandins are produced within the body’s cells by the enzyme cyclooxygenase (COX). There are two COX enzymes, COX-1 and COX-2. Both enzymes produce prostaglandins that promote inflammation, pain, and fever. However, only COX-1 produces prostaglandins that support platelets and protect the stomach. Nonsteroidal anti-inflammatory drugs (NSAIDs) block the COX enzymes and reduce prostaglandins throughout the body. As a consequence, ongoing inflammation, pain, and fever are reduced. Since the prostaglandins that protect the stomach and support platelets and blood clotting also are reduced, NSAIDs can cause ulcers in the stomach and promote bleeding. (Medicinenet.com)
Brand names in Australia include Nurofen, Ibuprofen, Naproxen, Aspirin, Diplofenac.
- Muscle Relaxants – Again as the name accepts these treatments work by relaxing muscles. There is more to it than this and one last time I will share my simplistic views before offering the official medical explanation. There is no drug that will target and relax a particular muscle or muscle group. Your brain and medicines are not that intelligent. Instead what this does is relaxes the brain so it is less affected by the messages that it receives. So in order to relax the muscles in one part of the body they relax the entire body. Please believe me when I say that this is my interpretation only and not nearly as accurate as below.
Once more for the cheap seats the medical explanation: Muscle relaxants are not really a class of drugs, but rather a group of different drugs that each has an overall sedative effect on the body. These drugs do not act directly on the muscles; rather they act centrally (in the brain) and are more of a total body relaxant. (Spine-health.com)
Brand name in Australia is Flexeril.
Why the simplistic summary if it is not accurate?
I find that I don’t retain the chemical reaction of each drug in the body for more than ten minutes, yet these three little analogies have helped me keep my head above water when trying to identify what I should take to manage particular pains. I know it is not good for me to share inaccurate information and I need to heavily stress that the medical explanations should be adhered to for an authentic understanding of the differences in the drugs. My simplistic view is just an analogy to help me remember them.
What if these do not work?
There are plenty more options for pain treatments available that can be described by a physician (doctor). I have intentionally not mentioned these as they cover a whole different area and are a lot more involved. However I felt that it was more prudent to begin at this level not only to cover the foundations first but also to shed some light on the differences between Panadol, Nurofen and Aspirin.
Given my recent experiences I am now no longer able to take any form of Ibuprofen or Aspirin and so I have been investigating this myself. My father and I have always taken different medications to manage our pains and he was forever bringing his own anti-inflammatories when he came to stay with me. He was a little perplexed how I would ‘be able to cope’ with my pain without these drugs. He now understands fortunately, but I wonder how many people out there are just that little bit too unaware of why they are taking certain medications to heal different forms of pain.
For more information about specific medication you can look at the below websites: