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Ways to relieve pain

In part one of this article, we established that 73 per cent of persons will choose OTC medications, before seeing their doctor, we also realised that of that number 37 per cent will make OTC choices without professional assistance. As promised we will look at some common errors and interactions that have occurred when using OTC’s. Please understand that the purpose of the article is not to present a horror show, or to instill fear but rather to impress upon the reader the need for informed assistance.

Pain is common to everyone, we have all experienced the discomfort associated with pain, and have realised that certain medicines can reduce pain, some effectively, others just barely. What is not realised is that certain painkillers take the pain away through different methods and by affecting different areas of the brain.

Paracetamol or acetaminophen is used to treat pain and fever. NSAIDs are non-steroidal anti-inflammatory medications. They include Advil and Voltaren. They do not block the pain but reduce the inflammation that is causing the pain signals.

Opioids are a stronger class of drug and only codeine is available over the counter however it must be combined with paracetamol or a NSAID in order to be sold as an OTC. They change the perception we have of the pain

Fear of adverse effects of pain medications often compromises the efficacy of treatments as sometimes we under medicate. Using doses lower than recommended is a waste of the treatment because the only effect you get is placebo and you can still suffer from side effects. That said, adverse effects are real and serious. If the medication is not indicated for your condition or if you have increased risk factors for side effects, do not use it.


Panadol does not help at the site of pain but works at the level of the nerve and brain. It can help with fevers but generally speaking does not have anti-inflammatory effects.

Paracetamol is effective only when used at maximal recommended doses.


Codeine acts on sensory nerves and the brain. Apart from reducing pain, codeine can also cause respiratory depression, sedation and constipation. Not just sometimes or in some people. Always. Just the amount of that effect varies from person to person.

Interestingly, the dose of codeine in many products you can get over the counter is limited by the amount of paracetemol or NSAID added so that the codeine is not actually in the therapeutic range. If you take the product as directed then you are not taking the right amount of codeine to get the effects you want. However, if you take more you will risk serious side effects of taking too much paracetemol or NSAID. If the pain is bad enough to need codeine then get the underlying cause treated or see a doctor for a prescription dose of codeine. In other words never make that choice on your own.

Of course codeine has a long list of side effects. Common side effects are nausea and vomiting, dyspepsia, drowsiness, dizziness, headache, orthostatic hypotension, itch, dry mouth, urinary retention and constipation.

The elderly have a much longer list of side effects because they often have reduced or impaired liver, gut and kidney function. That said, anyone with gut, liver and kidney problems and who drinks should not use any codeine unless under a doctor’s instructions.

Remarkably, if you take codeine more often you appear to be more likely to get a headache from it.

Respiratory depression from codeine is often sudden and quite unpredictably. The best way to judge the likelihood of this side effect is to monitor the sedation effects and whether you have difficulty in breathing.

The big warnings are not to use codeine if you have impaired kidney function or any sort of liver problem. Also not to use at any dose (unless prescribed by a doctor), if you have asthma or any other type of respiratory problem.

If you are pregnant or breast feeding then the baby will have the side effects also. This is important because respiratory distress is very dangerous in babies and can happen very quickly and at very low doses.

A couple of other points, be careful if you stand up quickly because it affects your blood pressure and you may get dizzy or pass out – this effect is much more marked if you are over 50-years old.

Some people say that panadeine (paracetamol and codeine) does not work for them. This is most often because the dose is incorrect (remember what was said before about the combination products) or because it is being used to relieve the wrong kind of pain.

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