I don’t have a problem with painkillers. Just with their side effects
Pain killers have always put us in a frenzy — we’ve fought wars over opiates, charged the streets demanding regulation for opioids and then done the opposite for policy around THC/CBD. This is because chronic pain… has always been a part of human lives. As we live longer lives, as well as increasingly large proportions of our years in ill health, the ability to manage pain on an every day basis is becoming more, rather than less, relevant and important.
We wrote in more depth about the multi-faceted implications of painkillers on women here (in brief — none of the painkillers were developed with women in mind); however the focus here is about one specific issue — the fact that we have become too tolerant of side effects in general.
Specifically, when it comes to painkillers, we have had some attention being paid in recent years to the risk of dependency on opiates and the vast communities it has left in shambles. However, in those discussions and beyond, I noticed a striking lack of discussion about how many people need to take excessive doses of painkillers to manage their pain, how little research is still done in a gender- and race-sensitive way, and how not managing pain in its early stages can lead to progressions that are much more challenging to deal with down the line.
As I was searching for an example, I continue to be struck by not being able to find a single comparison of dosages and proportionate side effects.
Specifically, as a medical technology company, something that is drilled into any clinical professional is the concept of risk versus benefit. This means, essentially, that whenever a treatment or clinical course of action is recommended, its potential benefits need to be weighed against potential risks. When thinking of risks, one must account for both the severity of a particular risk, as well as the probability of it occurring.
However, what seems to go completely unnoticed, is that painkillers are usually prescribed as a first line treatment with seemingly no discourse on benefit versus risk. This is because, for many people with severe pain, the doses they would need to take for painkillers to be effective may actually severely change the ratio on the packaging, but the patient or physician, even, may struggle to make that distinction given that no such information is provided.
Pushing it all further, many physicians (and certainly — patients) don’t know that many use cases where there have been harmful side effects to NSAIDs don’t get recorded — they are immediately written off as anomalies and not studied further. Therefore, we don’t really know how addictive they are either, and there are increasing reports on their addictiveness, as they can be used by patients to “get high, to feel elated, to get a ‘buzz,’ or to change [their] mood” (check out here and here). While this isn’t the right place to expand, from a neuropharmacological perspective, any form of external effect that leads to a rapid form of relief that isn’t long-lasting will lead to addictiveness, as the brain centres focused on rapid relief responses (like the nucleus accumbens) will get reinforced by quick “highs” followed by low “lows”. And while behavioural if not chemical addiction in relation to standard/i.e. non-opioid, NSAID relievers is rarely spoken about, it is well established that many side effects associated with the use of painkillers are still not understood, given that most side effects or adverse drug reactions often happen due to drug interactions & that’s again something physicians try, but can rarely account for, given patients’ frequently low reliability in their medical history as well as the fact that most drug-drug interactions still remain unknown (see here).
Furthermore — much of that information cannot be provided — because there’s insufficient research of what a benefit-risk ratio means for using painkillers for most degrees and types of pain. And this is even more pronounced when it comes to issues that disproportionately affect women.
So, for the people reading this who turn to painkillers as their default form of pain management: next time you seek a pill out, do check the recommended dose as well as the side effects associated with taking that dose. And don’t assume these side effects account for your own individual risk if a) you are a woman, b) you are a person of colour, c) you don’t weigh 80 kg, d) you’re not 30 years old. And when you increase that dose (which is especially common for conditions like endometriosis, severe menstrual pain, uterine fibroids, etc), never assume that the risk will increase proportionally. In fact don’t assume anything beyond what the wording on the box says, because chances are it hasn’t been tested.
And for the clinicians reading this — how many times have you actually discussed the risk-benefit trade-off when prescribing “harmless” OTC painkillers?
