Don’t endure the pain anymore, take painkillers when necessary!

Many people's first reaction to pain is not to take medicine, and they even try to avoid taking medicine. They are more willing to choose "endure it and it will pass". The reason for this phenomenon is not only the concept that "all medicines are poisonous", but also a special situation "fear of addiction to painkillers". Even if they have a splitting headache or backache, they try not to take painkillers.

However, enduring pain is not a wise move. Pain is a warning signal from the body, and long-term neglect will only make the problem worse. In fact, as long as painkillers are used scientifically, they can not only avoid unnecessary pain, but also effectively improve the quality of life, and there is no risk of addiction.

Instead of enduring it, it is better to understand how to use medication correctly and learn to reconcile with the pain.

1. What does pain represent?

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or the sensation of such damage. [1] This unpleasant experience, if left untreated, can have a number of adverse effects on the body.

Acute pain of a shorter duration, such as toothache or sports injury, can seriously reduce quality of life if not treated properly, including disrupting sleep, affecting daily activities and social functions. Some pain can even make it difficult for people to participate in daily life or complete basic tasks, such as talking and eating when suffering from toothache. In addition, pain can have a negative impact on patients’ mental health, increasing the risk of anxiety and depression. [2]

Chronic pain that lasts longer, such as back pain or migraines, has a greater impact on life. Long-term pain and sleep disorders interact with each other, significantly reducing the patient's mental health and quality of life, and often causing emotional problems such as anxiety and depression. It often severely limits the patient's physical function and daily activities, making it difficult for them to do high-intensity exercise and housework. Severe cases may even be unable to complete simple movements such as bending, squatting, and sitting down. It often causes patients to be absent from work or retire early, or even completely lose their ability to work. In some cases, even if patients continue to work, their work efficiency will be significantly reduced. It also increases medical expenses and increases the economic burden. [3]

We need to understand that pain does not mean we have to endure it, but rather it reminds us to take action. Scientific and reasonable pain relief can help the body recover better. The rational use of painkillers is a very important part of pain management.

2. Are painkillers addictive? — Debunking misunderstandings

Let’s go back to the original question: Are painkillers “addictive”?

Professionally speaking, we divide painkillers into two categories: narcotic analgesics and non-narcotic analgesics.

The former refers to powerful painkillers such as morphine, fentanyl, and pethidine. If used for a long time and in large doses, there is indeed a risk of addiction. However, these drugs are controlled prescription drugs in China and are strictly controlled by the state. Even if they are purchased with prescriptions, the amount is strictly limited. Moreover, they are only allowed to be used to treat moderate to severe pain such as postoperative pain and cancer pain. If used in a short period of time and at normal doses, they will not cause addiction. [4]

Commonly used ibuprofen, acetaminophen, etc. are non-narcotic analgesics. These drugs are not addictive and can be used safely according to the instructions or the doctor's guidance.

Therefore, the key to using painkillers is to use them in a standardized and rational manner and to avoid and eliminate abuse.

3. How to take painkillers in a standardized and reasonable manner?

When facing acute pain, if it is new, you should seek medical attention promptly to avoid delaying potential serious conditions; if the acute pain has occurred before and the common treatment options cannot provide relief, you should also seek medical attention as soon as possible to avoid worsening of symptoms.

The treatment of chronic pain requires the selection of drugs based on the specific type of pain, such as nociceptive pain, neuropathic pain, or nociceptive plasticity, to ensure that the drug is used for the right condition[5]. Here are two examples:

Inflammatory pain: For pain caused by arthritis, nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended, but one must be wary of their gastrointestinal and cardiovascular side effects. If necessary, gastric mucosal protectants can be used in combination [5].

For neuropathic pain such as postherpetic neuralgia or diabetic neuropathy, ion channel drugs such as pregabalin or gabapentin can be used as a first choice, and if necessary, antidepressants such as duloxetine can be used in combination to enhance the analgesic effect [5].

Therefore, for long-standing chronic pain, it is recommended to first go to the hospital for a clear diagnosis, rather than enduring the pain without treatment or taking medication at will; both may bring health risks.

For common NSAIDs, such as ibuprofen, acetaminophen, diclofenac, and aspirin, it is recommended to use only one drug at a time. If the effect is not obvious within two weeks, you can switch to another type, but it is not recommended to take multiple NSAIDs at the same time to avoid increasing the risk of side effects [6].

During use, liver and kidney function should be checked regularly to avoid long-term use (generally recommended not to exceed three months) [5,6]. In addition, physical therapy or minimally invasive interventions can be used to assist in pain relief, thereby reducing the need for drug dosage [5,6].

Through rational use of drugs, personalized adjustments and multimodal treatment, not only can the quality of life of patients be effectively improved, but also the side effects of drugs can be reduced and patients' concerns about side effects can be reduced.

As long as you follow the principles of standardized and reasonable medication, you can use painkillers when needed without worrying about side effects. Pain should not be an obstacle to life. As long as it is managed scientifically, it can be controlled within an acceptable range and help patients resume a comfortable life.

References:

[1]Raja SN, Carr DB, Cohen M, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976-1982.

[2]Sinatra R. Causes and consequences of inadequate management of acute pain. Pain Med. 2010;11(12):1859-71.

[3]Dueñas M, Ojeda B, Salazar A, et al. A review of chronic pain impact on patients, their social environment and the health care system. J Pain Res. 2016;9:457-67.

[4] Peng Ping. Misconception: Cancer patients worry about becoming addicted to morphine. Hunan Provincial Health Commission. 2015. https://wjw.hunan.gov.cn/bsfw/ggfw/zsyd/201506/t20150629_4022028.html

[5] Expert Group of the Pain Disease Diagnosis and Treatment Special Capacity Improvement Project of the Capacity Building and Continuing Education Center of the National Health Commission of China. Chinese Guidelines for the Treatment of Chronic Pain with Non-opioid Analgesics. Chinese Medical Journal, 2023, 103(39): 3088-3102.

[6]Ma K, Zhuang ZG, Wang L, et al. The Chinese Association for the Study of Pain (CASP): Consensus on the Assessment and Management of Chronic Nonspecific Low Back Pain. Pain Res Manag. 2019;2019:8957847.

Author: Jiang Yongyuan, Master of Internal Medicine, Third Military Medical University

Reviewer: Tang Qin, Director of the Science Popularization Department of the Chinese Medical Association, National Health Science Popularization Expert

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