While getting out, being active and playing sports mostly results in big smiles and a lot of fun, it can also have its downsides. Injuries unfortunately come with the territory…..and the more active you are, the greater the risk you have of developing an injury. With injury comes pain, and the need for pain relief……so I thought some information regarding the types of pain relievers out there may be useful!
Pain is the result of tissue damage within your body. This can be a caused by many things, such as sprains and strains to muscles, ligaments and tendons; skin tears; fractured or broken bones; internal organ damage or nerve damage. Prostaglandins are one of the major contributors to pain…..when the body is injured, it produces these hormones at the site of the injury. They result in pain, heat, redness and swelling, which alerts you to the injury, and helps in the healing process. Some injuries can also result in damage directly to the nerves, which can cause severe pain.
PARACETAMOL
Paracetamol (Panadol®, Panamax®) is one of the more commonly known and used pain relievers on the market. It has been commercially available since the 1950s, so it has a long history of being used for the relief of mild to moderate pain.
Although it has been around for a long time, the exact way that paracetamol works is still a bit of an unknown. It is believed to work by stopping the production of prostaglandins – chemicals produced by the body which are responsible for the sensation of pain. It acts as a good all round pain reliever (it is also great at reducing fever), but it does not specifically have any anti-inflammatory properties. Due to its general pain relieving properties, paracetamol is a good choice for pretty much any type of mild to moderate pain. Some people may find that it is not quite strong enough to relieve all types of pain, at which point a slightly stronger pain reliever may be required.
Paracetamol is readily available over the counter as a single ingredient, in combination with ibuprofen, or combined with codeine (see below for a bit more information on these medications). As paracetamol has been around for a while, its safety profile is well established….it has very few side effects, which are quite rare (experienced by less than 1 in 10,000 people), and most people can take it. Some asthmatics who are sensitive to NSAIDs may experience some worsening of their asthma, but this is very rare; and those with liver or kidney problems should avoid using paracetamol. It should also be avoided by those who are severely underweight or malnourished. Paracetamol can cause some liver damage, but only if taken in extremely large quantities.
For the athletes out there, paracetamol is not to be found on the WADA banned list, so it is a great choice for any pain relief!
NON-STEROIDAL ANTI-INFLAMMATORIES
Non-steroidal anti-inflammatories, or NSAIDs, are available both over the counter and on prescription. There are many different NSAIDs available, including aspirin (Disprin®), ibuprofen (Nurofen®), diclofenac (Voltaren®), celecoxib (Celebrex®) and meloxicam (Mobic®); quite a few other NSAIDs (specific molecules as well as brands) are available though. Some people will find that one works slightly better than another…..it all depends on the individual! Of course, for prescription NSAIDs, which are a bit stronger than the over the counter variety, it will depend on what the doctor is happy to prescribe. Ibuprofen is also available in combination with paracetamol, or with codeine.
NSAIDs are commonly found in oral form, but ibuprofen and diclofenac are also available as topical rubs. While these are nowhere near as effective as oral medications, they do provide some relief to mild sports injuries.
Like paracetamol, the exact mechanism of action of NSAIDs is not quite known; but in similar fashion, they are believed to inhibit the production of prostaglandins. They are slightly different from paracetamol in the fact that they are able to effectively reduce inflammation, as well as provide general pain relief.
NSAIDs are a good choice for any injuries that result in inflammation, as well as general relief of mild to moderate pain. Unfortunately, NSAIDs have a few side effects that people should be aware of. Stomach problems are common for those who take NSAIDs on a regular basis…..long term use can lead to stomach ulcers in some people! Hence they are best taken with food, and only used on a short term basis. NSAIDs can also trigger problems for some asthmatics…..if you are affected, its best to avoid them altogether. People with heart and kidney problems should also avoid using NSAIDs, as they can worsen these health conditions. Those with high blood pressure should speak to their GP or pharmacist before taking NSAIDs, as they can cause a few problems. In addition, if you are in a dehydrated state, NSAIDs may not be the best choice for your pain relief, as they could potentially cause some kidney damage. NSAIDs can also cause an attack in a small portion of individuals who suffer from asthma, so care must be taken if you are an asthmatic.
There is some debate as to whether NSAIDs should be taken immediately after injury, as they can cause an increase in bleeding and bruising. As a general rule, it is probably a good idea to wait about 48 hours before taking NSAIDs after an injury, as this will allow for any bleeding at the injury site to stop….but this depends on what damage you have actually done to yourself!
In similar fashion to paracetamol, NSAIDs are okay for use by athletes, as they are not registered on the WADA banned substances list.
OPIOID ANALGESICS
Opioid analgesics are strong pain relievers, which are designed to block nerve signals, to reduce your perception of pain. They are usually used for the treatment of chronic, or long term pain; or for severe pain as a result of major injuries, such as broken bones.
Codeine, in combination with paracetamol or ibuprofen, is available over the counter….but due to its potential for abuse, codeine containing products are usually kept behind the counter; and most pharmacies will ask for your drivers license to record the purchase on a national database. All other opioid medications require a prescription; and due to their nature, they are heavily restricted. These types of medications require a thorough assessment by a GP to ensure there is a genuine need for their use.
Commonly, these medications can cause constipation, dizziness and drowsiness, as well as nausea and vomiting. In higher doses, they can also cause breathing difficulties….. in higher doses, they can sometimes stopping breathing altogether.
With the exception of codeine, opioid analgesics are on the WADA banned substances list. So if you are an athlete, you will definitely need a Therapeutic Use Exemption with these types of medications. However, if you have an injury causing enough pain to require an opioid analgesic, you probably shouldn’t be out training or competing anyway….it may be best to rest up and let your body heal properly.
TRAMADOL
This is a synthetic analgesic, which works in a similar fashion to opioid analgesics. Tramadol is available only on prescription, after consultation and consideration of your GP. It is not quite as strong as most opioid analgesics, but it does produce similar side effects.
Tramadol is currently okay to use in sports, but its exclusion from the banned substances list is a hot topic; especially in the sport of cycling. Tramadol has been used by many athletes in the past as a pain reliever, but due to the fact it can cause a lack of concentration, dizziness and drowsiness, it has the potential to cause dangerous situations in a sporting environment. Like other opioids, I believe that if you are in enough pain to require a medication like this, it may be worth putting your feet up and letting your body heal properly before getting out there and training or competing.
HEAT RUBS AND GELS
The ingredients in these types of topical rubs, known as rubefacients, are designed to provide heat and increase blood flow to the area of application. However, there is very little evidence to suggest that they provide much benefit at all. Some people may find they give some relief from very mild injuries; but if you want to use a rub, you are much better off using something containing an NSAID.
COMBINATION PAIN RELIEF
As stated previously, there are some pain relievers available which contain a combination of medications. These are designed for use where one medication alone isn’t quite strong enough to relieve your pain. Codeine is available combined with either paracetamol or ibuprofen; while there is also a formulation containing paracetamol and ibuprofen together. These combination products are best used if you have already tried a single ingredient product, which doesn’t relieve your pain effectively.
WHAT SHOULD YOU USE????
Quite simply, it depends on the type of injury you have sustained. Most mild sprains and strains can be managed with either paracetamol or NSAIDs; while more severe injuries often require the addition of an opioid analgesic for extra pain relief….of course, you should speak to your GP if your pain is severe enough to need this type of medication.
Just remember…..pain is your body’s way of letting you know that something is wrong. If you sustain an injury that causes you pain, you really should allow enough time for the injury to heal. Medications can help you to manage during this period of recovery….and can sometimes assist in the healing process. But using pain relief as a way to mask pain while you continue to exercise or play sports is not the best idea…..you will just be delaying your recovery time, and potentially causing further damage!
Of course, any painful sporting injury should be assessed by a health care professional, to ensure you haven’t done any serious damage to yourself! While mild sprains and strains can be managed effectively with over the counter medications, if they are extremely painful, or take a long time to heal, you should probably seek medical advice just to be on the safe side.
The Sports Pharmacist 