Buay Tia Blog

I have encountered a lot of patients who refuse to take pain medication although they are in substantial pain. Many people see pain medication as evil beings. Some feel that they are just treating the symptoms, and not the cause. Some are scared of being addicted to the medication. But these are not true. In fact, if used appropriately, pain medication are of great value for recovery. Let me explain why.

Some pain meds do treat the cause

First, we need to understand that there are different kinds of pain. Most commonly, we are dealing with either mechanical or inflammatory pain. Take for example, Jimmy twisted his ankle when walking on uneven ground. He experienced some pain but can still walk normally. He continue to feel pain in the following days, especially if he twists the ankle to a certain angle or walks a lot. But the pain goes away after rest. This is typical mechanical pain, which is aggravated by mechanical loading.

Let's say there is another unlucky Uncle Tan, who slipped on staircase, fell from height, and twisted his ankle. As a result, he broke a bone in the ankle. Uncle Tan could not put any weight on the injured leg because of the pain. The whole ankle gradually became very swollen. Even if he does not move, pain is also there. It is especially bad at night, and he just could not fall asleep. This is typical inflammatory pain. Injury leads to inflammation, and inflammation causes pain.

There are different kinds of pain medication for different kinds of pain. For inflammatory pain, the first line of medication is NSAIDs (Non-Steroidal Anti-Inflammatory Drugs). That includes Neurofen or Ibuprofen that is available over the counter. Some needs to be prescribed, such as Arcoxia and Celebrex. These medication reduce pain by reducing inflammation. Thus they ARE treating the cause of the pain.

Sometimes symptom relief is important for recovery

Some pain medication are indeed for symptomatic relief only, like panadol. Although they may not be treating the cause of the pain, they have important role in preventing pain from becoming chronic.

Pain is very complicated in that it may trigger a process called sensitization. When one body part is having persistent pain, our brain as well as the nerves in that area will gradually become more and more sensitive to the pain signals, meaning that pain threshold will gradually reduce. Many things fasten up the sensitization process, such as inflammation, poor sleep, stress, anxiety and depression. So if we take poor Uncle Tan for example again, he is having a lot of pain and a lot of inflammation that he could not fall asleep. And uncle Tan may be running his own shop. He will not be able to work for several weeks due to the injury, and there is no one else to help him take care of the shop. He is worried about the loss of income, and all the rentals and bills that he still have to pay. The lack of sleep and profound worries make his system more and more sensitive to pain, thus he will feel more intensive pain, and even worse sleeping quality, and even more worries about the condition. Everything spirals into a vicious cycle.

Without pain medication to break the vicious cycle, elevated pain sensitivity may extend beyond tissue healing time, meaning that even if the injury is healed, the body continue to feel substantial pain. Taking simple pain killer may not promote bone healing for Uncle Tan, but it helps to break the vicious cycle of sensitization. It promotes better sleep. This is important because sleeping time is when the healing activity peaks in our body. Thus by taking pain medication to relieve symptoms, the recovery process can be fastened up, and patients are returned to normal function in shorter period of time.

To conclude...

Pain medication are not evil. I am not encouraging everyone to take pain killer for every single pain they feel. Obviously for Jimmy with his mild ankle sprain, it is unlikely that he will need any pain medication. My recommendation is that, if the pain is severely affecting basic daily function, and especially affecting sleeping quality, then pain medication will be helpful. To make it work most efficiently, we will need to differentiate what is the cause and source of the pain, so that the most appropriate type of pain medication can be used. This may require help from medical professionals.

It is really unfair that all the medication treating pain are called "pain killers". They all work in different ways and treats different conditions. Our medical society and pharmaceutical companies can do better jobs in promoting the understanding of the use of these common medications.