Dr Sean Ng is the consultant orthopaedic
surgeon at Ardmore Orthopaedic Clinic.
How do I know what type of painkiller
to take?
There are many types of medicine available for pain
management. It depends on the severity of the pain, the patient's
underlying medical conditions and sensitivity to certain drugs or
conditions.
For mild pain: Simple non-opioid analgesia such as
paracetamol, which is safe for those who are pregnant or
breast-feeding. It is the safest drug, but the dosage should be
limited for those with kidney or liver problems.
For moderate pain: Non-steroidal anti-inflammatory
drugs (NSAIDS) such as ibuprofen, diclofenac or aspirin. For
patients with gastritis, gastric, duodenal ulcers and asthma,
beware.
Another option is cyclo-oxygenase (COX)-II inhibitors
such as celebrex. It reduces gastric side effects by targeting
COX-II, an enzyme that deals with inflammation and pain.
For severe pain: Opioids such as morphine, codeine and
tramadol. These can cause many side effects - nausea, constipation,
drowsiness, confusion and breathing difficulties.
Many arthritis patients who have chronic pain do benefit from
painkillers such as NSAIDs (nonsteroidal anti inflammatory drugs),
but there has to be caution in prescribing such
medicine.Dr Sean Ng
Can one become overly reliant on
painkillers?
Yes, people can become over-dependent on painkillers
and should seek further medical advice. Either titrate (adjust the
dosage) or change the medicine, or treat the underlying
pathology.
When should I start taking medicine
for pain management?
The easiest scale to use is the visual analogue scale
(VAS), where patients are asked to score their pain on a scale from
zero to 10. Pain is subjective, and different people have different
thresholds of pain. The point where one will need medicine also
varies from person to person.
For mild pain (VAS 2 to 4), paracetamol usually
suffices. Those in moderate pain (VAS 5 to 7) can take NSAIDs or
COX-II inhibitors.
Opioids can be added on for those in severe pain (VAS 8
to 10).
Some studies have linked a certain
brand of painkiller to cardiovascular risks. Is it safe for
cardiovascular patients to take painkillers?
Studies have shown that some painkillers had clinically
significant higher risks of cardiovascular side effects.
An example is Vioxx, which has been withdrawn from the
market.
Many arthritis patients who have chronic pain do
benefit from painkillers such as NSAIDs, but there has to be
caution in prescribing such medicine.
One commonly-held view was that classical NSAIDs were
safer in terms of cardiovascular risk profiles, compared to COX-II
inhibitors. But a recent study has shown that celebrex is actually
just as safe as ibuprofen and has a much safer gastrointestinal
risk profile with fewer adverse side effects.
TNP