 Painkillers 101
How conventional pain therapies work
Over half of the people who experience chronic pain are taking prescription painkillers. Here’s a rundown of the most popular drugs for chronic pain and how they work:
NSAIDs
NSAIDs, or non-steroidal anti-inflammatory drugs, suppress the inflammatory process that results in pain. They make you feel better by reducing the amount of discomfort experienced but do not inhibit the actual disease process. In the case of arthritis, they do not help repair the damage associated with the condition, such as bone and joint impairment.
Potential side effects of NSAIDs include stomach pain, gastro-intestinal
bleeding, vomiting, rapid heartbeat, fainting, and blood in
the urine. In many cases NSAIDs can actually increase arthritic
inflammation due to their effect on the lining of the intestine.
(These drugs may increase the porosity of the intestinal wall,
causing "leaky gut" syndrome, which contributes
to the inflammatory process.)
Ironically, more people die from the gastro-intestinal bleeding
caused by NSAIDs than die from the diseases for which they
are primarily prescribed arthritis and other degenerative
disease of the joints. In the US alone, it has been estimated
that 107,000 patients are hospitalized each year as a result
of prescription NSAID use. Close to 16,500 die. Over-the-counter
NSAIDs, including ASA (acetylsalicylic acid or Aspirin®)
and other painkillers, account for a further 40,000 deaths
each year.
Since NSAIDs inhibit the blood's ability to clot properly,
they may interact with blood thinning medications such as
coumadin. Kidney disease has also been reported as a side
effect.
Due to the litany of side effects associated with NSAID use,
and the long list of patients for whom they are not suited
(people with stomach ulcers or elevated blood pressure, for
example), in the late '90s, drug companies brought to market
a new class of anti-inflammatory drugs known as Cox-2 inhibitors.
Caroline's story
At 39 years of age, Caroline Tilden of St. Catherine's
Ont., has plenty more life to live and, with six young
children to care for, she needs an abundance of energy
and mobility.
Due to severe arthritis, Caroline was told she would
need hip replacement surgery within five years. "I
thought I would have to spend the rest of my life crippled
and in agony, and would likely be in a wheelchair very
soon," says Caroline. "Bathing, dres-sing,
and using the washroom were all endurance tests."
" My children saw me crying and doubled over in
pain all the time, able to walk slowly and with a very
severe limp, while hanging onto something (e.g. a baby
stroller or one of them) for support. I tripped all
the time and have nearly fallen down more times than
I can count, to the point where I became afraid to walk
alone outside."
In her own words, Caroline found taking her children to the bus-stop each morning a painful and exhausting ordeal.
After using Recovery, Caroline reports that her life
has taken a major turn for the better. "No more
pain (well, almost none), no more exhaustion, no more
tears, limping, tripping and terror of falling. I've
lost weight and hope to lose more. I have energy and
feel happy and healthy once more. I'm looking forward
to a much better future, medically-speaking, than I
ever thought I would be able to have....My six kids
have their mom back the way she used to be."
(Caroline wrote an update, following this unsolicited letter, reporting that her health continues to improve, and that her mobility has increased even more.)
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Cox-2 INHIBITORS
Older NSAIDs reduce inflammation by blocking an enzyme known as Cox-2. In doing so, they also block another enzyme called Cox-1, which helps to protect the lining of the stomach. (The reason NSAIDs cause stomach bleeding in some individuals is due to the blocking of Cox-1.) Cox-2 inhibitors are more selective, blocking only the Cox-2 enzyme and leaving the stomach-protecting Cox-1 alone. In theory, less risk of bleeding should occur with use of Cox-2 inhibitors.
Unfortunately, the Cox-2 inhibitors have not proven to be the panacea they were first believed to be. They do little to reduce the incidence of stomach bleeding, and recent studies have confirmed that they increase the risk of heart attack and (in the case of Vioxx®), stroke.*
ACETAMINOPHEN
While acetaminophen is an effective treatment for moderate pain and fever, it is ineffective against inflammation and swelling. The side effects associated with acetaminophen are many and disturbing. They include anaemia and severe liver damage. Damage to the cells of the liver may accompany short-term use (high doses) or long-term use. Since many over-the-counter medications contain acetaminophen, including cough and cold formulas, backache medications and headache remedies, it is easy to exceed the recommended maximum dose. Liver damage is increased when acetaminophen is combined with alcohol.
CORTISONE
Cortisone may be injected directly into the joint to relieve
severe inflammation and swelling. Cortisone mimics the anti-inflammatory
effects of cortisol a hormone produced naturally in the body.
A cortisone injection can provide almost immediate relief
for a tender, swollen or inflamed joint. Since corticosteroids
can weaken cartilage and remove minerals from the bone (osteoporosis
and osteopenia), they should only be used rarely. Chronic
use of corticosteroids may result in immune suppression and
increase the risk of infection.
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