You have 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 still 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.

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 leads to vicious cycle, in which the pain of up to 75% of the 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.

The four most common painkillers – and what the experts say about them:

1. Aspirin
   Disprin and Codis are well-known brand names. It 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. Paracetamol
   Panado and Tylenol are well-known brand names. The maximum dosage is 4gr 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, but NSAIDs (see group 3) should be added. Paracetamol increases the effectiveness of NSAIDs and those of opioids (which are used on prescription for more severe pain) by such an extent, that you only need to take three-quarters of the necessary dosage of NSAIDs.
3. Non-steroidal anti-inflammatory medications (NSAIDs).
   Voltaren and Brufen are well-known brand names. These medications are especially effective for musculo-skeletal pain. If you are feeling stiff or you are experiencing body pain after an operation or after exercise, or if your joints are arthritic and painful, these are the most effective painkillers. The combination of these medications with paracetamol often seems to be most effective.
4. 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.

What should the consumer do?

1. Use the painkiller as prescribed by your doctor.
2. If the medication and dosage are ineffective, contact the doctor, but do not increase the dosage by yourself, or use the medication together with other over-the-counter painkillers.
3. If you have a headache, first try the prescribed dosage of aspirin or paracetamol. Do not exceed the maximum dosage of 4 grams paracetamol per day. Even if you add an NSAID to the paracetamol, ensure that you never exceed the maximum dosage of either. If you take an NSAID on top of aspirin, calculate the maximum dosage as if you are using one type of medication. Don't just pop as many painkillers as you think you may need without taking the total dosage into account.
4. If you experience muscle pain or joint pain after exercise, an operation, an injury or as a result of arthritis, use the safest NSAID. Do not exceed the maximum dosage.
5. You should discuss pain relief with your surgeon before an operation, to ensure effective and ongoing pain relief after the operation, not just for the 24 hours after the operation.
6. 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.
7. Treat pain in children differently. Consult your doctor or your pharmacist before giving a painkiller to your child.

(Health24)

Share this page

• Laaik.it
• Yahoo
• Google
• Digg
• del.icio.us
• Facebook