INTRODUCTION
Pain.
Humans will do all they can to avoid pain, except if it is a path to pleasure, long term pleasure, and even at that, they’d take some painkillers along. I believe that the need to eradicate pain led to the discovery of painkillers.
What are painkillers?
What is their mode of action?
Why is it bad, why or how could it be killing you?
What are the alternatives?
These questions surround all painkillers, and while I will share a little about many painkillers, I will focus mainly on one of the deadliest drugs, and yet the most abused… Paracetamol.
What are Painkillers?
Painkillers are used to treat pains. Prescribed or not, the basic duty of the drugs is to interfere or block the pathway of pains in the body system. They interfere with pain signals from the nerves in the nervous system. Sometimes, with this interference comes an additional stimulation of pleasure. So, what these drugs do is to shut the signal of pain, and some go a step further to activate the signal of pleasure… and that is how many people get ‘high’ from painkillers.
Painkillers can generally be administered through three main avenues
- Orally, in form of capsules, tablets, and liquids
- Through the rectum (as suppositories)
- Intravenously
Apart from these avenues, painkillers are also available for topical applications in form of creams, ointments or patches.
Types of painkillers
Painkillers are of three main types:
Non-steroidal anti-inflammatory drugs (NSAIDs)
Opioids
Paracetamol
Each of these painkillers work in different ways.
NSAIDS
Of the NSAIDS are Ibuprofen, Naproxen, Diclofenac and the popular Aspirin. I will talk briefly about two popular ones; Ibuprofen and Aspirin.
Ibuprofen: Ibuprofen is usually used for muscle pains, menstrual pains and other kind of pain. Its mode of action is to shut off the production of Cyclo-Oxygenase (COX) enzyme. These enzymes are natural chemicals which aid in the production of prostaglandins. Some prostaglandins get produced at the sites of injuries and/or damage, and this production cause pain and inflammation. So with the production of COX enzymes blocked, the production of prostaglandin is reduced, hence pain and inflammation is also reduced.
Aspirin: Aspirin is usually used to treat headaches, toothache, or flu-like symptoms, and should not be taken by children below 16 years. Low strength Aspirin is used to prevent unwanted blood clots from forming in the body, for example it is administered to people with a history of heart attack
When taking NSAIDS, there are precautions to be taken. People with stomach and duodenal ulcers, asthma, liver or kidney problems, issues with thyroid gland, a blood disorder like glucose -6-phosphate dehydrogenase (G6PD) deficiency, should visit the doctor before using.
OPIOIDS
Opioids sometimes called Opiates, can be classified into weak and strong categories. The weak opiates include Codeine and Dihydrocodeine, while the strong opiates include Morphine, Oxycodone, Pethidine, and Tramadol. I will talk briefly on the Codeine and Morphine, because they are more popular than others.
- Codeine: This drug, although called a weak opioid, is usually used to treat severe pain, and should not be underestimated. It also has significant addiction effects, and that is part of the reason of its popularity; its abuse.
Codeine works by binding to opioid receptors in the Central Nervous System (CNS), which is made up of the brain and the spinal cord. What this binding does is to affect the reaction to pain, or plainly reduce it. Codeine is usually administered where paracetamol and ibuprofen have been ineffective, and is contained in some over-the-counter medications which can be bought without prescription.
- Morphine: Morphine is a strong opioid. This drug, which serves as a precursor to other Opiates like Codeine and Heroin (Diamorphine), also works on the Nervous System and brain to reduce the amount of pain felt. Its side effects which include respiratory depression, nausea and vomiting, constipation, sedation, and euphoria are reasons why it is avoided, despite its effectiveness in reducing pain. But the side effect of euphoria is the reason it is being acquired illicitly.
Under normal circumstances, people who need morphine should be in the hospital, as it used to manage severe or chronic pain.
When taking Opioids, there are precautions to be taken. People with prostate problems, or who have difficulty passing urine, people with low blood pressure, constipation, muscle weakness, people dependent on drugs or alcohol, people who have epilepsy, people who have ever had an allergic reaction to any medicine, people who have problems with their thyroid, pancreas, or adrenaline glands should see and let their doctors know.
PARACETAMOL
Paracetamol, also called Acetaminophen or APAP, is used to treat mild to moderate pain and it also reduces fever. It is about the most popular painkiller, but has a danger which is over-looked by many. It should be taken every 4-6 hours if and when needed, but not more than four doses in 24 hours.
Paracetamol is used to manage osteoarthritis, low back pain, headaches, post operative pain, and dental pain. It is contained, in small doses, in many other over-the-counter medications, so the possibility of its overdose is high. To avoid an overdose, do not take Paracetamol with any other Paracetamol containing products.
The sneaky thing about Paracetamol, which is said to be ‘harmless’ enough to be taken without or before food is that it can cause damage to the liver, and let’s not talk even about the skin reactions and possible asthma connections.
While the mechanism of action of Paracetamol is not fully understood, it is known that the very metabolism of Paracetamol takes place in the liver, and dissociates into toxic and non-toxic components.
While it has been said that the risk comes in taking overdose of the drug, it is known that Paracetamol is deadly, as N-acetyl-p-benzoquinone imine (NAPQI) attacks proteins and nucleic acids which is primarily what all tissues, organs, and cells are made off. So being ‘produced’ in the liver, it attacks it first.
In Nigeria, Paracetamol tablets and capsules can be seen in most homes, as a quick fix for pain and aches. This is dangerous and over time, the effects are seen, and they are nothing beautiful.
ALTERNATIVES
While it is far easier to just pop in two of those tablets or capsules and wait for it to act, the thought of the effect should serve as a warning. While I could list natural options to take for pain, like ginger, turmeric and garlic… okay I’ll stop, I won’t do that (I already have). But I can only advise that you take painkillers when there is no other option to do so, and that can only be determined by the doctor.
I think Paracetamol should be given the same attention as codeine, heroin and morphine get when used illicitly. It may not make anyone high, but it also kills, albeit slowly.
CONCLUSION
So before you take the Paracetamol, ensure the headache is not simply from stress, meaning you need to rest, and not to take them drugs.
Before you take the Paracetamol, maybe you need a glass or two of water or just need some sleep.
The increasing rate of liver problems may be linked to the abuse of Paracetamol and should be looked into by individuals and health bodies.
Now, while this is mainly about the hidden dangers in Paracetamol, I could not ignore other painkillers. With the precautions listed to be mindful of before their administration, it shows that they may be killing you while appearing to kill the pain.
Before you take any painkiller - or any medication actually - you should consult your doctor to be sure it is actually killing the pain, and not simply killing you
That painkiller may be killing you.
REFERENCES
Drug Free World
Patient.info
Pain Community Center
Wikipedia