Thursday, 26 June 2014

Pain, a guide to relief.

Disclaimer: This is meant to serve as a rough guide, if you have any queries consult a pharmacist or quack. Remember to read this post all the way through before you act.

If you're ever in pain here's a good flowchart of what questions you should ask and how you should act according to the answer to said questions:

Figure 1: Paracetamol
Where is the pain? If the answer is you have a headache, then paracetamol (brand names: Panadol, Panamax, Tylenol) is usually the safest bet. If not ibuprofen (brand names: Advil, Motrin, Nurofen) or aspirin (brand names: Aspro, Solprin) are usually safe alternatives, but remember that you shouldn't take it for any more than a couple of days at a time as the longer you take it for the more likely you'll suffer serious side effects like stomach ulcers.1,2 Whereas if the answer is you have chest pain, you need to call an ambulance. If you have stomach pain, then I'd probably see a quack. If you have some sort of injury (like a sports injury) and there's swelling near your site of injury then ibuprofen is usually the best choice. Although it is also prudent to see a quack in these situations as it's always better to be safe than sorry with these injuries. If the pain doesn't go away with these simple measures then see a quack.
Figure 2: Ibuprofen
Figure 3: Aspirin

Is it accompanied by other symptoms? Like for instance, diarrhoea, swelling, stomach cramps, nausea, vomiting, fever, etc. If it is you should probably find a quack as it is probably best handled by them. Diarrhoea is also important if it's a symptom as it might indicate that a product containing codeine (e.g. Panadeine) might be advantageous as codeine relieves diarrhoea and the paracetamol in such a product would relieve the pain.

How severe is the pain? If it's severe you need to see a quack. If it's mild-moderate it can probably be managed with over-the-counter remedies.

How long has the pain persisted? If you are having recurrent bouts of headaches or other pains without any apparent reason (like for instance, if you go cold turkey off caffeine or smoking it can cause headaches) it's best to see a quack as it could be something serious, plus, of course, quacks are better equipped to help you with pain relief.

Do you have any pre-existing conditions or are you on any other medicines? If the answer is yes you should consult a pharmacist or a quack before you take anything, just to be safe. But if you don't have the time and are in a rush then paracetamol is usually the safest bet. Just remember to read the instructions on the box as paracetamol overdose (which can occur accidentally if you take several medicines that contain paracetamol that you are unaware of; usually a paracetamol tablet will contain about 500 mg paracetamol, it's usually advised that you take no more than 4 g of paracetamol in a single day) is one of the leading causes of living failure requiring a transplant in the developed world, but if taken the way it is supposed to it's probably the safest non-prescription painkiller available.

Examples of how pre-existing conditions or prescription-only medicines can affect which painkillers you can take include the following: if you are taking lithium for bipolar disorder, or blood-thinning medicines to prevent blood clots, or if you regularly take a low dose of aspirin to prevent heart attacks, strokes or cancer or if you're on antidepressants you should probably avoid non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin. Likewise if you have stomach ulcers, kidney disease, high blood pressure, have suffered a heart attack or stroke or are afflicted by chronic indigestion you should avoid NSAIDs as they can aggravate these conditions. If you have asthma then avoid the NSAIDs, especially aspirin, as they can provoke an attack.

If you are pregnant then paracetamol is usually the safest choice, although, it is worth noting that there is some evidence to support the possibility that consuming paracetamol while pregnant may increase your baby's risk of developing asthma later in life.3 NSAIDs should be avoided past the 30th week of gestation as it can increase your baby's risk of a rare and potentially fatal heart defect.4

Figure 4: Ralph Douglas Reye
Are you under the age of 20? If so you should avoid taking aspirin, where possible, as if it is taken by somebody under the age of 20 it can cause a rare condition called Reye's syndrome, which is a characterised by swelling of the brain and/or liver and has a 20-40% fatality rate. It is coincidentally named after a Townsville-born quack named Ralph Douglas Reye.

Paracetamol rarely ever causes any side effects but can rarely cause rashes and blood disorders. NSAIDs commonly cause the following side effects: nausea, indigestion, stomach ulcers or bleeding, diarrhoea, headache, dizziness and high blood pressure.1,2

Reference list:

  1. Rossi, S, ed. (2013). Australian Medicines Handbook (2013 ed.). Adelaide: The Australian Medicines Handbook Unit Trust. ISBN 978-0-9805790-9-3.
  2. Joint Formulary Committee (2013). British National Formulary (BNF) (65 ed.). London, UK: Pharmaceutical Press. pp. 267–269, 665-675. ISBN 978-0-85711-084-8.
  3. Thiele, K; Kessler, T; Arck, P; Erhardt, A; Tiegs, G (March 2013). "Acetaminophen and pregnancy: short- and long-term consequences for mother and child.". Journal of Reproductive Immunology 97(1): 128–39. doi:10.1016/j.jri.2012.10.01. PMID 23432879.
  4. Adams, K; Bombardier, C; van der Heijde, DM (September 2012). "Safety of pain therapy during pregnancy and lactation in patients with inflammatory arthritis: a systematic literature review.". The Journal of Rheumatology. Supplement 90: 59–61. doi:10.3899/jrheum.120344. PMID 22942331.