In its most benign form, pain triggers a realisation that something’s not quite right with our bodies. Today, pain is a global problem, a severe and expensive public health issue. Statistics are shocking: addiction to over-the-counter and prescription painkillers exceed heroin addiction in many countries worldwide.
Pain begins when receptors on the skin or in the body register a sensation such as a prick, tingle, sting, burn or ache, triggering an electrical impulse to the spinal cord. One area of the spinal cord in particular, the dorsal horn, acts as a relay centre where the pain signal can be blocked, enhanced or modified before it’s passed on to the brain. The most common destination in the brain for pain signals is the thalamus and from there to the cortex, the headquarters for complex thoughts.
Agony is the result of a complicated interaction between chemicals naturally found in the brain and spinal cord. These chemicals, called neurotransmitters, transmit nerve impulses between receptors found on the surface of cells, which act like gates or ports, either blocking or passing on the pain message to other cells. This process was first described by French philosopher René Descartes in 1664 as the ‘pain pathway’. Descartes illustrated how the sensation of heat in contact with the foot travelled to the brain. Pain medications specifically target certain receptors in the brain, switching on pain-inhibiting pathways or circuits, thereby blocking pain. Although painkillers may be regarded as miracle cures by some, they do have a sting in their tail and can produce adverse side effects.
The chemicals in painkillers, apart from dulling pain, cross the blood-brain barrier and act primarily on the central nervous system, resulting in an altering of consciousness that produces a pleasant effect called euphoria. Unfortunately, this doesn’t last. “Many people start taking prescription painkillers for a legitimate reason. As the sense of euphoria and relaxation provided by the drugs gets reinforced, they become increasingly reliant even when they no longer need them for pain,” says addictions psychiatrist Donna Yi.
Today, tens of thousands of ‘ordinary’ South Africans are addicted to painkillers and sedatives. Research conducted by the Medical Research Council (MRC) showed that 5-8% of patients in drug treatment centres countrywide abused analgesics (a collective name for painkillers) or benzodiazepines (prescribed tranquilisers such as diazepam, flunitrazepam and chlordiazepoxide).
To be effective, many painkillers use a combination of ingredients such as codeine, aspirin or paracetamol. With so many painkillers available on the market these days, it’s difficult to choose the right one. And while one ingredient may help a certain problem, a different ingredient may cause another.
The most frequently abused non-prescriptive medications contain codeine and are easily accessible over the counter (these include medicine used to relieve mild to moderate pain, codeine-containing cough syrups, and colds and flu medications). Codeine produces a calming effect, but as the body’s tolerance increases, so users need more and more to feel the same. Alarmingly, a number of users pop pills like sweets. “Some people are taking 10, maybe 15 a day, which can be lethal,” says David Bayever, deputy chairperson of the Central Drug Authority of South Africa.
Paracetamol is commonly used in multi-ingredient preparations for migraine headaches, typically including dextropropoxyphene or propoxyphene and sometimes containing codeine. Paracetamol, also known as acetaminophen in other countries, relieves fevers, aches and pains associated with many parts of the body. It has analgesic and anti-fever properties comparable to those of aspirin, while its anti-inflammatory effects are weaker.
Although it doesn’t cause euphoria or alter moods in any way, paracetamol is the foremost cause of acute liver failure in the Western world and accounts for most drug overdoses in the US, the UK, Australia and New Zealand. Symptoms of overdose may initially be absent or vague, but left untreated, can lead to liver failure and death within days.
Anti-inflammatories, such as ibuprofen and aspirin, are safe for most people, if they are taken at the recommended dose, after meals and for short periods. These medications, also known as non-steroidal anti-inflammatory drugs (NSAIDs), can cause stomach pains, ulcers or bleeding if abused or taken incorrectly.
Many herbal and nutrient painkillers can help relieve pain without producing the side effects associated with conventional painkillers. Nutraceuticals known to relieve pain aren’t usually as potent as conventional pain medications for relieving acute and severe pain. However, they can be better at addressing the underlying cause behind the pain (e.g. inflammation), while dulling the pain at the same time.
- Fish and krill oils contain two essential omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). These are known to block the production of inflammatory chemicals called cytokines and leukotrienes in the body, which are responsible for a range of painful conditions, including arthritis, gout and sinusitis
- Olive oil has been found to contain a natural active ingredient called oleocanthal, which influences the same biochemical pathway as ibuprofen
- Cherry juice can reduce muscle pain and damage induced by exercise, and may even be effective in the treatment of arthritis and gout, offering a potentially safer alternative to prescription medication
- White willow bark (Salix alba) decreases pain by blocking the production of inflammatory prostaglandins. It’s also very effective in reducing fever and providing the pain-relieving benefits of aspirin. It contains a compound called salicylic acid, a natural form of aspirin
- Glucosamine and chondroitin are nutritional supplements that reduce the pain of arthritic joints
- Boswellia, an Indian herb, is as effective as conventional medicine for both chronic and minor pains. The active ingredients, boswellic acids, decrease the production of inflammatory compounds, leukotrienes, which are implicated in diseases such as arthritis
- Devil’s claw (Harpagophytum procumbens), native to South Africa, is another herb that is best known for alleviating back pain and arthritis. The active ingredient harpogoside is responsible for producing its analgesic and anti-inflammatory effects
- Turmeric contains the compound curcumin, which is a powerful painkiller known to block inflammatory proteins and enhance the body’s ability to suppress inflammation. Various studies show that curcumin eases the pain of rheumatoid arthritis as well as decreasing inflammation by reducing prostaglandin activity
PLEASE NOTE: Products are ranked in decreasing order of potency. Products listed nearer the top of any particular health need are the most effective and have the most scientific research to support their use in respect of such health need. Multiple products, one from each bullet (•) can be combined with products from other bullets for added effectiveness, if needed, since products from different bulleted lines have different mechanisms of action. However, where more than one product is listed within a particular bullet (•), then only one of these products should be used, since all products listed within the same bullet share an identical or similar pharmacology (mechanism of action) for that condition. This is because whenever a particular condition is treated via multiple different mechanisms of action, the result is generally improved effectiveness. However, when products are combined that work via exactly the same mechanism of action, then no extra benefit is obtained.