Which Painkiller?

The type of drugs that you need to treat your pain depend on what type of pain you have.

The type of drugs that you need to treat your pain depend on what type of pain you have.
Dr Alf Collins, a consultant in pain management at Musgrove Park Hospital, Taunton, says everybody who has pain should consider taking painkillers. But different painkillers work better for different types of pain.

For pain associated with inflammation, such as acute back pain or headaches, paracetamol and anti-inflammatory medicines work best.
If the pain is caused by sensitive or damaged nerves, as is the case with shingles or sciatica, it is usually treated with tablets that are also used for epilepsy and depression. These tablets change the way the central nervous system works.
The aim of taking medication is to improve your quality of life. All painkillers have potential side effects, so you may need to weigh up the advantages of taking them against the disadvantages.
Paracetamol, anti-inflammatories and aspirin

Paracetamol: 

Paracetamol is used to treat headaches and most non-nerve pains. Two tablets of paracetamol up to four times a day is a safe dose for adults. Side effects are not common and this dose can be taken regularly for long periods.
Overdosing on paracetamol can cause serious side effects. If the pain is severe, do not increase the dose.
If the pain lasts for more than three days, see your GP.

Anti-inflammatories:

Ibuprofen, diclofenac and naproxen seem to work better when there is clear evidence of an inflammatory cause, for example arthritis or an injury.
They should not be used for a long period unless you have inflammation. When taken for long periods there's an increased risk of stomach upset, including bleeding, and kidney and heart problems. Don't take more than the recommended dose as this will increase the risk of serious side effects.

Aspirin:

Aspirin produces the same type of side effects as other anti-inflammatories, but is not as effective as a painkiller, which means it is not usually prescribed for pain. It is dangerous for children under 12.

Codeine And Other Medium-Strength Painkillers:

Codeine doesn’t work very well on its own. It works better when combined with paracetamol in a single pill. You can buy co-codamol (paracetamol and low-dose codeine) over the counter. Higher dose codeine has to be prescribed.
Other medium-strength prescribed painkillers include tramadol (Zydol) and dihydrocodeine.
All these painkillers can cause dependency, which means that when you stop taking them you may feel unwell for a short period. If you need more and more of these drugs, contact your GP or other healthcare professional for advice.

Amitriptyline and Gabapentin:

Amitriptyline is a drug for depression and gabapentin is a drug for epilepsy. Each of these tablets can also be used to treat pain caused by nerve sensitivity or nerve damage, such as shingles, diabetes nerve pain and sciatica. You don’t have to have depression or epilepsy for these tablets to help nerve pain.
Amitriptyline and gabapentin both have to be prescribed by a GP. Side effects include drowsiness and dizziness.

Morphine:

Morphine and morphine-like drugs (for example, oxycodone, fentanyl and buprenorphine) are the strongest painkillers there are. Some come as a patch, but they all work in similar ways and should only be used for severe pain.
They will only be prescribed after consultation with your GP or a pain specialist. The dose and your response will be closely monitored. These drugs should only be used as part of a long-term plan to manage your pain.

Back Pain & Nutrition

Degenerative discs are a significant cause of lower back pain

Back pain and disc health 'linked' to lack of nutrients

Heavy lifting, twisting and bending can do damage to the discs in the back by reducing the flow of nutrients to the disc cells, a study says.

Disturbing the balance of nutrients in the discs can then lead to the onset of degenerative disease.

Writing in PLoS Computational Biology, Spanish experts say a normal level of physical activity helps cell nutrition.

Lower back pain, which is linked to degenerative spinal discs, could be caused by this lack of nutrients.

Previous research has shown that 80% of the active population suffers from low back pain at some point in their lives.

But little was known about the chain of events which changes normal, healthy ageing discs into degenerative discs.

Using computer models of the human disc in their study, a team of scientists from Barcelona's Institute for Bioengineering looked at the nutritional and mechanical effects of stress on the discs of the lower back.

By using the models, the researchers were able to see what happened when they changed disc height, cell density and made degenerative changes to the disc.

It would not have been possible to carry out this quality of research in a living person.

'Collapsed Sponge'

The results showed that external loads on the disc influenced the solute concentration - the amount of glucose and lactate present in the disc.

The cells need glucose but do not want too much lactate, an acid which hinders the nutrition process and can kick-start the degenerative process.

Dr Jerome Noailly, study author and expert in the biomechanics and mechanobiology group at the Institute, said the study showed that nutrients could be the key factor.

"If we know that lack of nutrition is involved in accelerating the degenerative process and the properties of a degenerative disc hinder nutrition, then this will increase cell death and the disc tissue will start to degenerate more and more.

"In order to bring back the function of the degenerated disc, we must address the nutrition problem.

"This means restoring the water content of the disc and the volume of the disc. A degenerated disc is like a collapsed sponge which needs to be restored to its normal size."

The research team says the findings could open up new areas of research in the field of disc regenerative medicine.

Dr Brian Hammond, chair of the charity BackCare, said: "We are what we eat and the spine is no exception. A balanced diet, adequate fluid intake and regular exercise are essential for a healthy back and neck.

"There is little doubt that poor diet, being immobile for long periods and bad habits like smoking contribute to spinal degeneration and the high incidence of back and neck pain in the UK."