As Chiropractors we see a lot of people in pain! In fact, pain is so pervasive in society that it is now considered the 5th vital sign. Vital signs are body measurements that represent the state of a person’s essential functions – so pretty important! The World Health Organisation considers it a basic human right to humanely manage pain and any conditions causing it.
In practice we see a huge variation of which self-medications people take for relief as well as differences in dosages taken and periods taken for. The World Health Organisation published a pain medication ladder to bring more consistency to using pain medication and thus hopefully improve pain control outcomes.
The first step on the ladder includes popular painkillers like paracetamol and NSAID’s (non-steroidal anti-inflammatory drugs) like ibuprofen, diclofenac and naproxen. You can take 4000mg of paracetamol in 24 hours. It is recommended to start with 500mg 3 times a day (morning, noon and bedtime – reserving a dose for during the night if you wake up and need it). Increase to 1000mg at each dose if you don’t find the 500mg dose effective at controlling your pain. Often it is too low a dose or not taking the dose regularly that results in it being ineffective. As you experience relief reduce the dose. Paracetamol is a very safe drug with few side effectives (usually very mild) and few interactions with other medication. If you are experiencing swelling, heat and redness around the site of your pain then add a NSAID dose to the paracetamol. Aspirin (Disprin) – 4000mg in 4 doses over 24 hours, Ibuprofen (Nurofen) 1200mg in 3 doses of 400mg in 24 hours, Diclofenac (Voltaren, Cataflam) 150mg in 3 doses over 24 hours and/or Naproxen (1000mg in 2 or 4 doses in 24 hours). Choose 1 of the aforementioned NSAID’s and stick with it – try not to mix. Again NSAID’s are very safe. Some people may experience a rash or respiratory stress – stop the NSAID immediately – if your rash or respiratory distress continues then see a medical professional. If you suffer from stomach ulcers or have a platelet disease (such as haemophilia) then you might be better off getting a prescription NSAID such as Celecoxib. If you have a history of cardiac disease or thrombosis/embolism then you may be better off excluding diclofenac from your choices.
If you still experience pain after implementing the first step then you can consider adding a weak opioid (Codeine – 60mg in 24 hours) to the medications above. In South Africa you can obtain codeine without a prescription and it is present in many combination medications (Paracetemol, NSAID’s + codeine) such as Mybulen, Myprodol, Genpayne and SinutabES. The weak opioids are unfortunately addictive so I discourage patients from taking them. If it is necessary to control pain then I recommend seeing your GP for a prescription for Tramadol as it is less addictive.
The third step includes Morphine and its derivatives and would only be prescribed under specialist care.
There are prescription medications, called adjuncts, that are complementary to the first step possibilities. These include muscle relaxants like Robaxin (or over the counter ones like Spasmend), Pregabalin (Lyrica) and Amitriptyline (Trepiline) amongst others that can be effective in specific cases.
When you experience pain a chiropractor can help you determine the nature of your pain and recommend an effective intervention.
https://professionals.wrha.mb.ca/old/professionals/files/PDTip_AnalgesicLadder.pdf
https://www.ncbi.nlm.nih.gov/books/NBK554435/
https://en.wikipedia.org/wiki/Pain_ladder
https://www.sciencedirect.com/science/article/abs/pii/S1754320708600085
