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Pain – When medication works and when it doesn’t!

In order to understand the effective use of pain medication with regards to chronic pain we need to understand the different types of pain.  You may have been prescribed medication for your pain and it hasn't worked. This article will explain why.

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In order to understand the effective use of medication in chronic pain we need to understand the different types of pain.  Pop over and read my blog on the difference between nociceptive pain and nociplastic pain. We also need to understand the difference between acute pain and chronic / persistent pain.  Acute pain is a natural response to tissue damage/injury.  During acute pain, nociception forms a large proportion of it.  Chronic pain is long lasting, well beyond the time it takes for tissue damage to heal.  During chronic pain there is little nociception and more nociplastic pain which is like the well trodden neural pathway, which incorporates things like memory, emotions, environment, thoughts and feelings.  Please remember that the amount of pain does not equate to the amount of tissue damage.

Pain killers do not kill pain, as pain is a perception formed in the brain, based on the input signals from a variety of sources. Pain medication works on dampening down the nociceptive signal into the brain and reducing nervous system activity, thus reducing the perception of pain.  This explains why you can get side effects such as headaches, light-headedness, feeling sick and more.  In this context, pain medication works well on nociceptive pain (acute pain) ad can therefore be good in the short term.  As mentioned earlier, chronic/persistent pain has little nociception, and given that pain medication tends to work on the nociceptive signals, this leads to it being less effective at reducing chronic/persistent pain. 

Chronic/persistent pain is often a result of an over-sensitive nervous system.  A little like a car alarm that goes off with the slightest of touches.  This is where pain medications are not going to be effective.  One would need to look at why the nervous system is on high alert and work out ways to calm it down.  Pain is a danger messenger, so you need to work out what the message is that Pain is trying to tell you.  This message might not always be physical which is why medications don’t always work.

Sadly, visits to the doctor are very quick and doctors don’t have time to unpick the root cause of pain. Therefore, prescribing pain medication has become the acceptable form of treatment.  Dr Tim Williams, a GP with an interest in pain suggests that GP appointments should be longer to allow more time to discuss persistent pain before prescribing medications (taken from Dr Deepak Ravindran’s book The Pain Free Mindset).

Some pain medication falls into the category of Opioids which are highly addictive.  Should these be prescribed to someone with persistent pain, you can see how one could start to become reliant and addicted to the drug.  Gabapentin and Pregabalin can have similar effects.  This has led to what is known as the opioid crisis.  Sadly the outcome of being addicted to opioids can lead to devastating results. 

Some medications such as Amitryptiline can often help patients get off to sleep, but please be aware that this sleep is a sedative sleep and not a healing restorative sleep.  In my opinion this is therefore a short term solution and a better long term solution would be to look deeper into the root cause of your pain and understand the bigger picture surrounding your pain.  

In summary, pain medications tend to only work when there is nociception which tends to be more acute pain.  Opioids and stronger pain medications don’t always lead to addiction. The risk factors for addiction include your social support network, family history and your emotional state.  There are alternative ways to manage pain without drugs and this is where the BEAT Pain methodology by Katie Rothwell works really well.  BEAT stands for Brain, Energy, Activity and Therapy. By educating clients about their pain they are much more likely to overcome it.  By learning ways to calm the nervous system, improving diet and including exercise, clients start to sleep better and heal from pain.  It might not be as quick as medicine and does involve commitment, but it’s a much better and longer lasting solution for chronic/persistent pain and doesn’t have any bad side effects.

I highly recommend reading the book by Dr Deepak Ravindran ‘The Pain-free Mindset’.  It’s broken up into 7 chapters; Medication, Interventions Neuroscience, Diet, Sleep, Exercise and Therapy (MINDSET).  

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