Dr Sean Ng, a consultant orthopaedic surgeon at Ardmore Orthopaedic Clinic, answers common questions on taking painkillers. By Foo Jie Ying
Photo: Denis Ismagilov/123rf.com
How do I know what type of painkiller to take?
There are many types of medicine available for pain management. It depends on the severity of the pain, the patient’s underlying medical conditions and sensitivity to certain drugs or conditions.
For mild pain: Simple non-opioid analgesia such as paracetamol, which is safe for those who are pregnant or breast-feeding. It is the safest drug, but the dosage should be limited for those with kidney or liver problems.
For moderate pain: Non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen, diclofenac or aspirin. For patients with gastritis, gastric, duodenal ulcers and asthma, beware. Another option is cyclo-oxygenase (COX)-II inhibitors such as celebrex. It reduces gastric side effects by targeting COX-II, an enzyme that deals with inflammation and pain.
For severe pain: Opioids such as morphine, codeine and tramadol. These can cause many side effects – nausea, constipation, drowsiness, confusion and breathing difficulties.
Can one become overly reliant on painkillers?
Yes, people can become over-dependent on painkillers and should seek further medical advice. Either titrate (adjust the dosage) or change the medicine, or treat the underlying pathology.
When should I start taking medicine for pain management?
The easiest scale to use is the visual analogue scale (VAS), where patients are asked to score their pain on a scale from zero to 10. Pain is subjective, and different people have different thresholds of pain. The point where one will need medicine also varies from person to person.
For mild pain (VAS 2 to 4), paracetamol usually suffices. Those in moderate pain (VAS 5 to 7) can take NSAIDs or COX-II inhibitors. Opioids can be added on for those in severe pain (VAS 8 to 10).
Some studies have linked a certain brand of painkiller to cardiovascular risks. Is it safe for cardiovascular patients to take painkillers?
Studies have shown that some painkillers had clinically significant higher risks of cardiovascular side effects. An example is Vioxx, which has been withdrawn from the market.
Many arthritis patients who have chronic pain do benefit from painkillers such as NSAIDs, but there has to be caution in prescribing such medicine.
One commonly-held view was that classical NSAIDs were safer in terms of cardiovascular risk profiles, compared to COX-II inhibitors. But a recent study has shown that celebrex is actually just as safe as ibuprofen and has a much safer gastrointestinal risk profile with fewer adverse side effects.
A version of this story first appeared in the online edition of The New Paper on January 9, 2017, with the headline, ‘Which painkiller works for your ailment?’.