What works, what’s safe, and what to avoid
Painkillers – everyone can name a few off the top of their head. Their use in the medical world is widespread, adding up to billions of doses a year. Painkillers can come in different names, dosages, and sizes and some can be bought at stores while others require a doctor’s prescription. The most well-known painkillers worldwide are paracetamol, ibuprofen, diclofenac and naproxen. Just about everyone has used at least one of these painkillers in their lifetime. But what makes one pill better suited for a specific pain than the other? Which pill is safest for you to take? And how do you know which one to choose?
In this article I will focus on painkillers like naproxen, ibuprofen, and diclofenac, which belong to a group called NSAIDs or non-steroidal anti-inflammatory drugs. For this group, it is always advised to take painkillers with food to reduce possible side effects. NSAIDs are commonly prescribed for joint pain, often due to hard physical work done by the people of St. Maarten. This article will thus mostly focus on treating joint pain and leave out NSAIDs like metamizole (used for acute pain) and indomethacine (used for gout). People here often rely on these painkillers for temporary relief. This allows them to keep working their jobs, but NSAIDs should not always be used.
For joint pain, the painkiller that has lowest effect but the highest safety profile is paracetamol. Paracetamol can be taken in divided doses up to 2500mg daily. Paracetamol is the safest painkiller available, and is therefore preferably used for all sorts of pain. If paracetamol alone does not provide enough relief, a topical NSAID like diclofenac gel can be used for some extra relief. If this combination does not work, oral NSAIDs can be taken in otherwise healthy individuals. In these people, short-term relief ibuprofen is often preferred in doses of 400-600mg twice daily with meals. If you are looking for longer term relief, you can discuss long term alternatives with your doctor or pharmacist. They are preferred for longer use because they offer lower risk for stomach and intestinal problems. For people who have or have had heart, kidney, intestinal or stomach issues not all NSAIDs are safe to use, especially in individuals who need long term pain relief.
For people with heart problems, it is best to avoid diclofenac, celecoxib and ibuprofen long term. So, for these people it is best to first try paracetamol in divided doses of up to 2500mg per day and if that does not work a topical NSAID like diclofenac gel. If more short-term pain relief is needed, naproxen is the first choice oral NSAID. It is extra important for the doctor to monitor potassium levels and for the patients to drink enough water starting from this step. For longer-term pain relief, these patients should be monitored and advised by their doctors.
For patients who have had stomach and/or intestinal problems like ulcers or bleeding in the past, the advice for NSAIDs also changes. The preference for pain relief starts with paracetamol again, followed by topical NSAIDs. Oral NSAIDs like ibuprofen, naproxen and diclofenac should be avoided. For longer-term pain relief, celecoxib in combination with a stomach protectant is advised. This combination has the lowest risk of causing further damage to the stomach.
For patients with kidney problems, paracetamol up to 2500mg in divided doses followed by a topical NSAID remains the preferred choice. In these patients all oral NSAIDs are preferably avoided as much as possible, especially longer term. For short-term, celecoxib in a low dose is the best choice. For longer term pain relief these patients should ask the doctor about alternative options for painkillers.
All in all, NSAID use, especially for longer term, should not be taken lightly. These painkillers can cause heart, stomach, intestinal and kidney problems when used for longer periods of time. That is why chronic use of these medications should be limited if possible. Understandably, when joint pain prevents people from working, we should look for treatment options. Oftentimes weight loss, swimming, cycling, yoga, walking, daily stretching and light strength training can cause some relief. Furthermore, heat can be used to reduce stiffness and a cold pack can be used to decrease inflammation. The right equipment can also treat or prevent joint pain in people working physically demanding jobs. Assistive devices like gloves, knee pads, ergonomic handles, back support belts and wrist braces can definitely help. When these aids do not help in treating the pain, always try to treat with paracetamol up to 2500mg in divided doses and topical NSAIDs first. When these medications still don’t help, remember to always take NSAIDs like ibuprofen, naproxen, diclofenac or others with food. Also, remember to avoid drinking alcohol when taking these medications, as alcohol will increase the chance of side effects. I wish all the best to the hard-working people of St. Maarten and hope that these tips will help them treat and maybe even prevent the torment that is joint pain.
Note:
This is general advice. For personal questions about painkillers, please speak with a qualified healthcare professional.
This information is provided by the Pharmacist Association of St. Maarten (PAS). PAS is dedicated to improving the quality of pharmaceutical care on the island.
All pharmacies on the Dutch side of St. Maarten are proud members of PAS.
