Pain medication and injections
Pain medication
Painkillers come in different strengths such as Paracetamol for
milder forms of pain, as well as weak or strong (Morphine-type)
opioid medications for more severe pain.
They can be useful in helping to reduce pain, but they are not
usually the complete answer for longstanding pain problems.
Maintaining as much fitness as you can, and moving as normally
and as much as possible - even if it can, in the short term, make
pain worse - is very important.
Painkillers can help to reduce pain levels enough to allow
individuals to move better, enabling their bodies to recover more
normally, as well as allowing some patients to tackle certain
activities they need or want to do e.g. work, household duties or
recreational pursuits.
Painkillers are often prescribed in combination. Even though more
severe pain sometimes requires stronger medication, continuing to
take Paracetamol can still usefully contribute to reducing overall
pain levels.
In addition, taking small amounts of one, two or on occasion three
or more painkillers can be more effective in reducing pain, and
give you less of the side effects that would be more likely with a
large dose of a single painkiller.
We will normally advise patients to take painkillers on a regular
basis i.e. by the clock. A good example of this is ‘slow release’
preparations, which can be taken first thing in the morning and last
thing at night.
This gives pain relief on a 24-hour basis and may result in fewer
side effects. In addition, it stops the patient focusing too much on
their pain during the day, when pain levels will naturally rise and
fall according to activity levels.
By and large it’s not a good idea to take a painkiller every time
there is a spike of pain. Not only are you more likely to get ‘used’
to the medication – so making it less effective - you may also get
more side effects.
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Indeed, some people reasonably feel they are better off with their
pain untreated, rather than with a slight reduction in their pain but
with side effects due to a particular medication.
Very importantly, the biological basis of pain means that it is
sometimes made worse by our thoughts and feelings and lack of
physical activity. Medication will not work for this aspect of pain,
which requires a different approach: helping individuals cope or
self manage better.
Caution should be exercised in prescribing and taking strong
Morphine-type medication. Hard evidence on its long-term benefit
or usefulness is absent, and such medication cannot be routinely
recommended for most persistent pain patients.
The Pain Doctor and GP will work together to decide when these
are appropriate, what medication to trial and how it should be
monitored.
Injections
A doctor may advocate injection treatment. This will always be on
an individual basis weighing up the potential benefits and risks of
the procedure.
While some chronic pain patients find injections reduce their pain
for a period of time, allowing other treatments to work better, most
injections are unlikely to be effective in the long term.
A good example of where injections can be beneficial is where
they can provide enough relief to allow the patient to work better
with a physiotherapist – stretching and regaining better use of a
part of their body.
The Pain Doctor will discuss with each patient the appropriateness
of injections if he/she thinks it could be useful in reducing pain and
improving function and potential risks.
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