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Chronic Pain

First, understand it.

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The technical term for painkiller is “analgesic” which is a term from the 18th Century having Greek origins: “an” meaning “not” and “algeein” meaning “feel pain”.

Painkillers can be broken down into two groups: Opioids and non-opioids. The word opioid might remind you of the word “opium” which is a substance derived from the seeds of poppies. This substance is a strong painkiller, and has been used for centuries both for medicinal and also recreational purposes. Morphine comes from opium, hence the word “opioid” or “opiate”.

Anti inflammatories

Anti-inflammatory medicines may involve steroids or may not. Steroids are chemicals found naturally in our bodies. They are actually hormones. Steroids are powerful anti-inflammatory chemicals, and for pain, they are commonly provided as injections into inflamed areas, such as bursitis of the shoulder joint, or hip joint. We will discuss this group in the later part of this Chapter under ‘injections’.

There is a large group called “NSAID’s”. This is a term that stands for “Non-Steroidal Anti-Inflammatory Drug”. It is important to know how these types of drugs work, what they are, what they are called, and who should and should not take them.

NSAIDs can be valuable painkillers with a low risk of serious adverse effects when used appropriately and by those people who have been assessed by a doctor to be suitable to take them. There are a number of NSAID’s you may have used, many of them you can buy over the counter (OTC) even in supermarkets. The way these medicines work is they block chemicals called “COX”. The COX chemicals allow other chemicals to inflame an area of the body, so when they are blocked, the inflammation is reduced or even stopped, while the medicine is present. There are two types of COX chemicals, COX-1 and COX-2. COX-1 protects the stomach lining from harsh acids and other chemicals, while COX-2 is responsible for inflammation and pain.

COX-1 and COX-2 blockers

The older NSAID’s blocked both COX-1 and COX-2, which means that not only did they reduce inflammation and pain, they also blocked the protection of the stomach lining. These medicines became known to cause gastric bleeding in some cases. Some of these you can get over the counter in pharmacies or sometimes in supermarkets in Australia. 

COX-2 blockers

There has been quite a bit of media attention on this group of medicines. If you are not in the high-risk categories, these medicines can be helpful, however it is important to speak with your GP about the risks and benefits. These are newer medicines that target only COX-2 chemicals involved in inflammation, thereby leaving the COX-1 chemicals, which protect the stomach lining, to do their job. This means that using a COX-2 blocker is less likely to cause stomach problems such as ulcers and bleeding.

Here is a list of some of the COX-1 anti-inflammatories. Always speak to your GP about your medicines to make sure that medicines are the right type, the right dose and taken at the right time for YOU.

Name of Medicine Brand or Trade Names Common side effects Tops for managing side effects
Diclofenac Clonac , Diclohexal, Hexal, Dinac, Fenac, Diclac, Diclohexal, Genrx Diclofenac, Imflac, Voltaren, Voltaren Rapid Bleeding in stomach, kidney damage, high blood pressure, heart problems Always take medicine after eating, as this reduces the chance of having stomach problems, Contact your doctor immediately if you develop black stools or vomit that looks like coffee grounds
Diflunisal Dolobid
Ibuprofen ACT-3, Actiprofen, Advil, Brufen, Bugesic, Nurofen, Rafen, Tri-Profen
Indomethacin Arthrexin, indocid
Ketoprofen Orudis, Oruvail SR
Ketorolac Toradol
Mefenamic acid Mefic, Ponstan
Naproxen Aleve, Anaprosx, Crysanal, Inza, Naprogesic, Naprosyn, Naprosyn SR, Nurolasts, Proxen SR
Piroxicam Fedene/D, Genrx Piroxicam/D, Mobilis/D, Pirohexal -D
Sulindac Aclin
Tiaprofenic acid Surgam
Chronic Pain Australia

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