Pain Centre

Updated 28 November 2014

Using the wrong painkillers?

You've taken four tablets for a splitting headache, but they don't seem to be working. So you try two other types – painkillers are painkillers, right? Not so, say the experts.


You've got a headache, and have already taken four headache tablets, but they're not helping. You don't quite know what's in them, but a friend gave them to you, or you grabbed them off a supermarket shelf. You're still in pain, so you take another four, but no luck. In desperation you try two other types – painkillers are painkillers, aren't they?

This behaviour is frighteningly common. And potentially extremely dangerous.

Many South Africans not only use the incorrect type of painkillers for particular kinds of pain, but also take different types of painkillers together, increasing the dosage willy-nilly.

The Pharmaceutical Society of South Africa, pharmacologists, and doctors who have a professional interest in pain management, are "extremely concerned at the high level of misuse of painkillers" in this country.

Despite their lack of understanding of painkillers, some consumers have a tendency to take painkillers more or less at random.

Read: The different groups of painkillers

Vicious cycle of painkiller misuse

Research has shown that doctors are so aware of patients' indiscriminate use of painkillers, that one in every four doctors prescribes lower dosages than necessary for their patients. This causes a vicious cycle, in which the pain of up to 75% of patients is not properly managed, and they then increase their own dosages, or take additional over-the-counter painkillers.

“Too many consumers use painkillers for pains which those painkillers were not designed to relieve. If a tablet does not relieve the pain, it is natural to increase the dosage, but the only thing that happens is that they still don't work. The patient experiences an increasing number of side effects, such as stomach ulcers, as a result of the high dosages," says Professor Duncan Mitchell, director of the Brain Function Research Unit at the University of the Witwatersrand.

“According to the latest research, it is much more important to identify the type of pain than the intensity of the pain. A painkiller designed to relieve joint pain, will not, for instance, relieve leg pain in diabetics. The most effective medication against headache, will not necessarily be the most effective against muscular pain," explains Mitchell.

"In South Africa, the consumer has free access to painkillers, but very few of them have any knowledge of how these medications work or which medication is most effective for which type of pain," says Dr Luc Evenepoel, Cape Town anaesthetist with a special interest in pain management.

Read: Can painkillers be addictive?

Aspirin, Paracetamol and Combination medications – what do the experts say?

  1. AspirinIt is widely used as a painkiller, and even more widely and effectively (in low dosages) for the blood-thinning side effects to lower the risk of heart disease. People should not exceed the maximum prescribed dosage, especially not over a long period of time, as prolonged use of high dosages are associated with an increased risk of stomach ulcers. Aspirin is also an antipyretic and widely used to fight fever. This is one of the most well-researched medications of our time, and evidence of various positive side-effects such as a preventative role in cancers of the pancreas, colon and prostate now emerging. The long-term prophylactic use of this drug in low dosages to prevent heart disease and other illnesses makes this drug one the most widely-used drugs in the world.
  2. ParacetamolThe maximum dosage is 4g per day for adults. Always start off with one of these medications if you have pain, especially a headache. If the medication does not work effectively the maximum dosage should not be exceeded.
  3. Combination-type medications that contain codeine.
    The codeine levels in these medications are quite low, and may even be too low to relieve pain, but high enough to cause drowsiness. These medications are less effective against musculo-skeletal pain, and joint pain, but are often effective in the treatment of headache. South Africa is one of the few countries in the world where medicines containing codeine can be bought without a doctor's prescription.

According to Dr Evenepoel, many doctors apply excellent pain relief after an operation, but only continue it for 24 hours, while pain might still be acute for four or five days after the operation.

His research has also shown that the prescription of combination-type medications is often ineffective, because the individual dosages of painkilling ingredients are too low to provide effective pain relief.

Read: Painkiller overdoses on the rise

What should the consumer do?

  1. Use the painkiller as per the directions on the bottle.
  2. If you have a headache, first try aspirin, paracetamol or a tablet that combines the two. Do not exceed the maximum dosage of 4 grams paracetamol per day.
  3. People with chronic pain that lasts for months, should definitely see their doctor and speak to their pharmacist. They should not try to treat this pain themselves. Effective medications are available, so speak to your doctor.
  4. Treat pain in children differently. Consult your doctor or your pharmacist before giving a painkiller to your child.

    Read more:

    Using the wrong painkillers?
    400% increase in painkiller abuse
    Painkillers a miscarriage risk

Health24, updated November 2014


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