Ask a Physio: Why don’t painkillers work?

03 December 2018

Why don't painkillers work?

Good question!

We don’t get much benefit from our painkillers because of two main reasons:

1.Taking the wrong type

Broadly speaking, painkillers fall into two types:

• Pain blockers: these have the letters ‘-ol’ in their name, e.g. paracetamol, codydramol, tramadol

• Anti-inflammatories: these have the letters ‘-fen’ in their name, e.g. ibuprofen, neurofen, diclofenac sodium

Pain blockers work best when there is no inflammation associated with the pain and anti-inflammatories, also known as NSAIDs, work best when there is inflammation. Signs of inflammation can be night pain, early morning stiffness, heat and swelling, but you don’t have to have all of these to have inflammation. So make sure you are taking the right type of painkillers for your pain.

2. Taking them at the wrong time

What I mean by this is leaving it too late before you take them. Most people don’t like to take painkillers and that’s not a bad thing. However, a common scenario would be:

You’ve had mild pain for a while, perhaps at around 2-3 on a scale of 0-10, 0 = no pain and 10 = worst pain ever, and you can function normally with no pain killers necessary.

However, it starts getting worse, going up to a 5-6, and you chose to ignore it but try to carry on; tasks are a bit trickier and take a bit longer to achieve. Then your pain reaches a 7 and you finally submit to taking a couple of painkillers.

Half an hour later there’s no significant change. Now you’re worried, it’s 4-6 hours before you can take some more tablets. You don’t sleep well and the pain is getting a grip.

Why didn’t they work?

Waiting for your pain to become unbearable, and then taking painkillers, is like trying to put a fire out with a cup of water. You are better off taking your medication when the pain gets to 4-5, so that it never reaches 6,7,8… Ultimately you will take less medication.

Of course there will always be exceptions to this, but if you want to give your pain medication the best chance of working, take the right type at the right time. And remember, always talk to your pharmacist before taking a new medication.

Alison Hodges - Physiotherapy Manager, Spire London East

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