Thanks to excellent marketing by pharmaceutical companies, we have access to a great variety of pain medication which are available as "over the counter" (OTC) drugs i.e. you don't need a prescription to buy and use them. These range from mild Non-steroidal drugs like Paracetamol to more potent orally administered drugs like Tramadol, which contain opioid drugs.
It is common sense that as we progress along this spectrum, from milder to more powerful pain medication, the side-effects and dangerous adverse effects are more. There have been numerous cases of cardiac (heart-related), liver and Kidney toxicity when these drugs have been used inappropriately resulting in hospitalization and even death.
So, how do you choose and how do you manage pain responsibly? There are several guidelines available, published by many organizations like the World Health Organization (WHO), NICE guidelines in the UK, etc. We cannot follow everything so let me simplify it sufficiently for you to incorporate the RIGHT and RESPONSIBLE way to use pain-killers in your everyday life.
Welcome to the concept of the "PAIN LADDER" ! This is an important concept of pain management which was created by the WHO for the management of cancer pain, but later this was adapted to dictate the day to day use of pain-killers. The problem is, many doctors themselves do not follow this concept of management and start their patients on very powerful medication. If the treatment duration is short, there may not be any side-effects, not noticeable anyway. There is no guarantee that damage has not occurred at the cellular level!
The pain ladder concept involves starting off with mild pain-killers at low doses for the initial management of pain with gradual escalation of dose if the pain persists. Drugs with greater potency are prescribed if the pain does not subside, or if the initial pain is too severe to be treated by something as simple as a Tylenol (the USA equivalent of the Indian Crocin). Preferably, all medication should be taken after consultation with a doctor or a qualified nurse.
Let me show you a few images to give you a clearer picture of how this works:
Let's make that look like the ladder/steps that I mentioned!
Please note that the it is preferable that you take any medication ONLY after consultation with a doctor. This minimizes any risk and ensures success of the treatment. Opioid drugs eg. Pethidine, Tramadol etc are dangerous to self-medicate and should always be prescribed.
In cases of fevers with headache, injuries with a trivial mechanism (falls while playing, cycling, sprained ankles), always start with Paracetamol. Usually the dose is determined by the body weight of the individual, but it's not always easy to get that data. Paracetamol in India is USUALLY marketed as 500 mg tablets (please check the labels of the medication) and initial doses for adults and children more than 15 years of age should be ONE TABLET every 6 hours. If the pain is persistent or more intense, it can be taken every 4-6 hours. Stop taking any medication if you are relieved and you can bear it !!!!
In the above charts, there is a class of drugs mentioned with paracetamol called NSAID. This stands for Non-Steroidal Anti-Inflammatory Drugs. Common drugs you use which fall under this category are Combiflam (Ibuprofen + Paracetamol), Diclofenac, Aceclofenac. These should be used in musculo-skeletal injuries with moderate to severe pain, like in severe sprains and other sports-injuries. These drugs may be combined with Paracetamol and should be taken not more than ONE TABLET every 6 hours. If the pain is persistent, please see a doctor and get it revised.
Lessons for the day:
1) Avoid self-medication.
2) Always start with mild drugs like Paracetamol (marketed as Crocin, Calpol etc)
3) Use Ibuprofen (commonly Combiflam) or Diclofenac/ Aceclofenac only if pain is not subsiding or if it's severe enough to stop you from sleeping.
4) If the pain persists, please see your doctor
5) These drugs can have liver and kidney side-effects and the dose should be specified by a doctor.
For any medical students (like me) or Doctors: please follow the WHO Pain ladder while prescribing pain-killers.
NOTE: Some pain killers are banned but still available/ prescribed. Look out for these drugs and avoid them. If a doctor prescribes them to you, you have every right to question his judgement and ask for an alternative.
BANNED PAIN-KILLERS: NIMESULIDE (NIMULID) and ANALGIN. If I come across literature about any other dangerous but common medication, I will post about it.
No comments:
Post a Comment