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Feb 12, 2008

Picky about pain relief

WHETHER you need to get on with life or with work, pain is one of those things that can easily derail the best-laid plans.

There are two main categories of people who need relief from pain – most of us need it occasionally when headaches and toothaches strike, or when we’re down with a fever.

The other category involves people who need pain relief on a more regular basis, whether this is daily, for weeks, months or even years.

Long-term users require ongoing relief because they suffer from chronic conditions such as osteoarthritis, or muscle and joint pain as a consequence of ageing.

In situations like these, it’s important to understand the concept of pain management, which requires medication to be taken on a regular basis to provide better control and sustained relief so that a person can go about his/her daily business.

But whether you’re using pain relief for a day or a year, you need to be aware that not all pain relievers are the same.

Many people self-medicate when they are in pain, either using leftover medication or borrowing some from a friend. Others may purchase medicine from a pharmacist or get their supply straight off the shelf.

In itself, self-medication is not a problem so long as people are careful in selecting suitable medication and following the instructions on its usage, particularly where dosage is concerned.

Taking less than the recommended dose will not provide sufficient relief, and waiting too long before the next dose will allow pain to flare up again, thus making it more difficult to control or manage. Hence, the problem is not with the medication per se, but how it is taken.

The evolution of pain relievers, or analgesics, over the years has led to a wide selection of different classes of medication, from the tried and trusted paracetamol to newer versions of non-steroidal anti-inflammatory drugs (NSAIDs) called COX-2 inhibitors.

Although NSAIDs and the newer COX-2 inhibitors are effective drugs, there is also clear evidence that they contribute to an increased risk of cardiovascular events and gastrointestinal bleeding, making them unsuitable for:

  • The elderly
  • Patients with congestive heart failure
  • Patients with liver disease
  • Patients with kidney disease (e.g. chronic renal failure)

    In the US alone, the cost of treating complications from NSAIDs amounts to more than US$2bil (RM6.8bil) a year.

    Hence, it’s advisable for patients to be aware of the kind of medication they consume, whether it’s an over-the-counter treatment or a prescription medication.

    It’s also crucial for patients to inform their doctors of any medication they have taken, as NSAIDs have the potential to interact with other medications3.

    As a general rule, patients should visit one regular doctor so that their complete healthcare records are in one place.

    Furthermore, any patient leaving the doctor’s office should know the name of their medication, what it’s for, how frequently they should take it and what kind of side effects are associated with that particular medication.

    In any situation where pain relief or any other medication is required, it’s important that patients try the safest option first. Doctors often refer to this as the risk-benefit ratio, where in simple terms, the benefits of the treatment should far outweigh the risks.

    In pain relief, paracetamol remains the analgesic with the best safety profile as it has a low risk of side effects, a long history of safe use and established clinical data that shows its effectiveness in relieving pain.

    In addition, paracetamol does not interact with other medications, making it safe and effective even when used concurrently with other drugs.

    For these reasons, it is commonly listed in patient educational material as well as clinical practice guidelines as the recommended first line therapy for pain.

    At the end of the day, any long-term usage of pain relief should come under the advice of a doctor, with regular follow up to determine that the patient is receiving optimal care with optimal results.

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