Painkillers are drugs that ease pain and by sdfsb346f


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									                                                                                               as (in increasing strength) codeine,
  Spotlight on...                                                                              morphine and heroin.
                                                                                                 Opioid painkillers work by imitating the
                                                                                               body’s own morphine-like endorphins

                                                                                               (natural painkillers produced by the body)
                                                                                               and are generally only used during periods
                                                                                               of intense pain as these chemicals can have
                                                                                               harmful effects on the body if they are not
                                                                                               carefully prescribed.
                                                                                                 As well as taking painkillers, another way
                                                                                               people with arthritis medically control
Chances are every one of us has reached for                                                    their pain is by using non-steroidal anti-
                                                                                               inflammatory drugs (NSAIDs), such as
the paracetamol when a headache kicks in.                                                      aspirin and ibuprofen. Whilst painkillers
                                                                                               are a class of drugs designed purely for
One or two can be harmless enough, but what                                                    pain relief, the main role of NSAIDs is to
if you take these drugs every day to control                                                   reduce inflammation, which in
                                                                                               turn relieves pain.
your arthritis pain? Minal Chande investigates
      ainkillers are drugs that ease pain and

P     can be a lifeline for many people with
      arthritis. ‘Painkillers are very useful
      for relieving pain and the knock-on
effect of doing that is to improve a person’s
mobility and help them to do exercises to
keep their joints and muscles strong,’ says
Rob Hicks, a GP. ‘They are not used to
medically treat depression, but a knock-on
effect means that people feel less depressed
as a result of the pain relief.’
   Painkillers – also known as analgesics –
do not reduce the inflammation in the            chemical messengers
joints that most people with arthritis          (prostaglandins), produced
experience. ‘Painkillers will not cure the      when your joints become inflamed or
disease,’ warns Dr Hicks.                       damaged, to the brain.
   Paracetamol is the most readily available       A prescription is required to take
and commonly used painkiller by people          stronger painkillers as these are made up of
with arthritis, and is available over the       powerful chemicals known as opiates.
counter without a prescription. It is           Opiates are derived from the opium poppy
thought to work by blocking the passage of      and chemically processed into drugs such

 Some of the most common painkillers used for arthritis pain
 Brand name                     Drug name                      Availability
 Alvedon, Panadol,              Paracetamol                    Over the counter
 Panaleve, Paramol,             Paracetamol with
 Remedeine                      dihydrocodeine tartrate        Depends on the dose of
                                (co-dydramol)                  codeine. All listed are           Like paracetamol, NSAIDs work by
                                                               available over the counter      blocking the body’s production of
                                                               except Remedeine and            prostaglandins, but they work near the site
                                                               Solpadol which contain a        of the pain to reduce swelling rather than
 Paracodal, Panadol             Paracetamol with codeine       high dose of codeine.           on the brain. Some people might not be
 Ultra,Solpadol                 (co-codamol)                                                   able to take NSAIDs because of allergies or
 Cosalgesic, Distalgesic        Paracetamol with                                               stomach problems. Although NSAIDs are
                                dextropropoxyphene             Prescription only               sometimes grouped with painkillers, they
                                (co-proxamol)                                                  are not part of this drug class.
 Dromadol, Tramake,             Tramadol                                                         The effectiveness of a painkiller depends
 Zamadol, Zydol                                                                                very much on the individual according to
                                                               Prescription only –
 Meptid                         Meptazinol                                                     Dr Hicks. ‘Paracetamol does work for
                                                               very strong painkillers
 Diconal                        Dipipanone                                                     some people whereas in others NSAIDs or
 Fortral                        Pentazocine                                                    a combination of both are more effective.

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It also depends on how severe the arthritis        alcohol and/or take them with food to         paracetamol and an opioid and can prove
is,’ he says.                                      minimise the chance of side effects. Some     to be fatal if the prescribed dose is
   Chris Jones takes painkillers alongside         of the stronger opioid painkillers may be     exceeded even slightly.
his NSAIDs. He has osteoarthritis and was          associated with undesirable side effects,        The withdrawal was crushing news to
prescribed co-dydramol, a combination of           such as constipation and nausea. There is     some of the 1.7 million people per year
paracetamol and an opioid, by his GP.              also a risk of addiction so opioid            who were relying on co-proxamol for pain
‘Once the painkillers kick in, which takes         painkillers are usually only prescribed for   relief – vast numbers were taken off the
about 20 minutes, I have reasonable relief         short-term use.                               medication as a result. Following a period
for about 30 minutes to an hour,’ he says.                                                       of confusion, the MHRA clarified
   When Kathleen Pemberton was                      Safe use of painkillers                      prescribing guidelines in January of this
diagnosed with breast cancer she was no             ● Keep a list of all drugs and               year, as explained on page 2. Whether
longer able to take her usual medication              supplements you are taking                 doctors and health authorities reassess who
for rheumatoid arthritis. ‘I had to rely            ● Consult your doctor if the pain            can benefit from co-proxamol as a result
solely on ibuprofen and paracetamol for               does not go away after a few days.         remains to be seen.
pain relief. I took the maximum doses,                You should also visit a doctor if             Another factor to consider when using
but they didn’t really control the pain,’             over-the-counter medications are           painkillers is the way in which they mask
      she says. ‘I also found I was                   not working or in case of any side         pain. It may be possible to overuse a joint
          constipated a lot.’                         effects                                    without noticing, and this can cause
               People do not always take the        ● Follow the instructions for taking         damage to the joint. In addition,
               right dose of paracetamol,             your medication, keeping to the            painkillers might also become less effective
                claims Dr Hicks. ‘Some                correct dose and times, and noting         if they are used long-term. Dr Hicks
                 people take one or two               whether your tablets are best              advises that paracetamol should be taken
                 paracetamol tablets once or          taken with or without food, and            ‘as and when’ pain hits. ‘The quicker you
                  twice a day. For real benefit        whether you need to avoid alcohol          get rid of the pain, the more mobile you
                  you need to take the full         ● If you miss a dose, don’t try to           become and that in itself is a good way of
                dose – two tablets four times a       catch up by taking more next time          keeping pain under control,’ he says.
              day,’ he states. ‘Many people are     ● Be careful not to accidentally             ‘Once you are mobile enough you may not
            frightened that if they use the full      overdose – for example by taking           need as many painkillers anyway.’
           dose their body will become used           too many other preparations                   If you have been self-medicating for a
           to it and they won’t be able to use        containing paracetamol such as             while (controlling your own pain relief by
           it again. In fact, with paracetamol        Night Nurse                                buying drugs over-the-counter), you
            and anti-inflammatories, there is a                                                   should visit your GP to check whether
            therapeutic dose that works, and         Finding a painkiller that works for you     your medicines are appropriate and safe.
       anything less is unlikely to have as        might not be the end of the story, as many       ‘It is important that people on long-term
much or any benefit.’                               people recently discovered. In January        medication are reviewed at least once a
   ‘People who take paracetamol rarely get         2005, the Medicines and Healthcare            year to make sure treatments are doing the
side effects. But one of the risks is              products Regulatory Agency (MHRA)             job for them and to review whether there is
accidental overdose,’ says Dr Hicks. There         announced the phased withdrawal of co-        something better available, as well as to
is a risk of liver damage or failure if            proxamol due to concerns about                make sure the medicine is not causing
paracetamol is taken in large quantities –         overdosing. Co-proxamol is a mixture of       problems,’ says Dr Hicks.
this risk is increased in people who drink
three or more alcoholic drinks a day.                Co-proxamol
   Many people do not realise that                   John Symons spoke to us before the MHRA’s clarification of guidelines for
 paracetamol is found in combination with            doctors was announced. He was deeply affected by the original MHRA ruling.
   other active ingredients in many cold,            ‘I have taken co-proxamol for 20 years – initially for spondylosis in the neck and
 sinus, and cough medications, such as               then when I developed arthritis of the ankles and knees after I was involved in a
Lemsip and Beechams. You should always               car crash,’ says John.
check the label and also keep a list of all              He has tried lots of different drugs to manage his condition, including anti-
the drugs you are taking, including herbal           inflammatories, which he stopped taking after he developed bowel problems.
or nutritional supplements.                          ‘Anti-inflammatory creams are a waste of time. I live on my own, like many
   It is very important to follow the                people with arthritis,’ he explains. ‘How are you supposed to rub cream on your
instructions. ‘Always read the information           own back?’
leaflets and keep an eye out for side                     When he first found out that co-proxamol was to be withdrawn, he was
effects,’ says Dr Hicks. ‘You should seek            devastated. ‘I never took the full dose. The fact that I’ve taken it for 20 years
advice from the pharmacist, GP or hospital           proves I am stable,’ he states.
specialist on the most appropriate                       Although some health authorities allowed GPs to continue supplying co-
medication, particularly if you are taking           proxamol in certain circumstances, John’s did not. After trying a whole host of
other medicines or have other health                 different painkillers, none of which were effective, John’s doctor eventually gave
conditions,’ he cautions.                            him tramadol, an opioid painkiller. ‘Tramadol works better for me than the
   Your doctor can also advise if your               others, but not as good as co-proxamol, with which the pain was manageable,’
painkiller doesn’t seem to be working.               says John. He has yet to find out whether the clearer prescribing guidelines
With a lot of drugs you need to avoid                since provided by the MHRA will change his situation.

april/may 2006                                                                                                                            23

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