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Painkillers are drugs that ease pain and
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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
painkillers
(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.
22 arthritis news
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
