Unless you are incredibly lucky, we have all experienced pain in one form or another. When in pain we expect painkillers to relieve our symptoms. After a recent game of rugby, I realised many people may not realise why you would take ibuprofen and paracetamol in different circumstances. In this blog post we will explore pain relief, how it works and when to take what.
With a growing opioid crisis across the Globe, it is important to understand pain relief and what to use when. Some pain is caused by inflammation, for example, arthritis, headaches, muscular damage etc. White blood cells release chemicals into the blood, or affected tissues, in an attempt to protect the affected area from foreign substances. Some of these chemicals can cause fluid to leak into the tissues, resulting in swelling and pain when the surrounding nerves are stimulated. Ibuprofen and Aspirin are non-steroidal anti-inflammatory drugs (NSAIDs) that inhibit an enzyme (COX), which is required in the production of prostaglandins. Prostaglandins increase blood flow to the affected area, are linked to increases in body temperature, and the release of chemotaxis (i.e. chemicals which summon white blood cells – leading to inflammation). By inhibiting the enzyme which aids the production of prostaglandins, we can reduce inflammation and body temperature in feverish patients, for example. On the other hand, the working mechanism of paracetamol is a relative mystery. Many researchers believe paracetamol works mainly in the central nervous system, reducing the intensity of pain signals to the brain. However, it is also possible that paracetamol has an effect on prostaglandin production.
NSAIDS (such as Ibuprofen and Aspirin) act at the site of pain, whereas paracetamol (an analgesic – a painkiller) works (probably) on the central nervous system, dampening the sensation of pain but not targeting the site directly. So when should we use them? Can we just use whatever is at hand, or should we choose one in particular? Paracetamol should be taken for mild to moderate pain, and can be taken between other NSAIDs doses if they have not completely relieved pain or if a fever is hard to break. NSAIDs should be taken for pain caused by inflammation and can effectively treat pain at the affected site. However, NSAIDs also help fevers and even reduce “flu-like” symptoms. Only when completely necessary should you double up on pain relief (i.e. take paracetamol and NSAIDs alternately) and ALWAYS read the medication guidelines.
What about topical applications, are they more beneficial than tablets? Many NSAIDs are now available as gels alongside their tablet form. NSAIDs have lots of side-effects if not used correctly, and if continually used they can lead to stomach ulcers and bleeding, in fact, 30% of drug-related hospital admissions in the US were linked to misuse of NSAIDs. After much debate and research, it has been shown that topical NSAIDs can penetrate into deeper tissue layers and produce a therapeutic effect. More topical NSAID use could alleviate the stress caused to the stomach seen with the use of oral NSAIDs. Greater use of these gels could help the elderly and prevent complications that oral NSAIDs can cause.
As well as relieving pain, aspirin has other surprising uses. Aspirin has been used in various forms for centuries, and the active compound can be found in willow bark. The first extra use of aspirin is in the treatment of some skin conditions, such as acne and psoriasis where it can reduce the swelling and inflammation of the skin. You can even make aspirin face masks! Dandruff relief: Aspirin mixed with shampoo can help to alleviate dandruff caused by inflammation of the scalp. Stain removal: Aspirin (apparently) can break down compounds in sweat and help to remove stains left in clothes. Blood thinning: In low doses, a daily aspirin can help to thin the blood and thus reduce the chance of heart attacks and stroke (note: this should be done with a doctor’s approval).
So there are many reasons to take aspirin and other forms of pain medication, including various ways in which you can take it. Gone are the days of chewing on willow tree bark. With the rising demand on NHS services in the UK, I just want to highlight one last thing: cost. Paracetamol, ibuprofen and aspirin can all be bought over-the-counter at pharmacies across the nation. These boxes can be as little as 30p, whereas an NHS prescription will cost you over £8 and the NHS, even more to buy. Next time you want over-the-counter painkillers from your GP, think about how much you could be saving by just buying them from the pharmacy. I hope this post has helped to inform your future pain relief choices.