Although certain painkillers are available to buy over the counter, they should still be taken with caution and advice from a pharmacist or doctor, as they can have undesirable side effects. — dpa
Non-prescription pain relief tablets can be purchased online and in any pharmacy, with a packet often costing less than a bag of gummy bears.
The most commonly-used ones include ibuprofen, paracetamol and aspirin.
But just because they’re inexpensive and easily obtainable doesn’t mean you needn’t be careful when taking them.
One may work better for you than others, and some people should avoid certain painkillers altogether.
A pain medicine specialist and pharmacist provide some insights:
This depends on the person and their particular pain situation.
Generally speaking though, “the sooner you take action, the more effective small doses are,” says pain medicine specialist Dr Michael Überall.
The vice-president of the German Pain Association (DGS) and president of the chronic pain patients organisation German Pain League, recommends refraining from taking a pain reliever:
- If the pain is tolerable and doesn’t especially interfere with your daily life
- If the pain subsides after a short while, or
- If you haven’t tried other forms of relief, such as relaxation techniques.
If a pain reliever is necessary, you should follow the recommended dosage, frequency and duration to be safe.
“Otherwise, considerable side effects may occur,” he warns.
And you should always try to determine what’s causing the pain.
“Pain is a signal by the body, and not itself the cause,” remarks Ursula Funke, vice president of the German Federal Chamber of Pharmacists (BAK) and director of a pharmacy in Wiesbaden, Germany.
It may be a good idea to take a pain reliever for pain caused by a recent knee operation, for example, or by a tooth problem you’ve already made a dentist’s appointment for, she says.
As Funk explains it, pain is felt when certain chemical messengers dock onto the relevant nerve cell receptors, which then convey the pain signal to the brain.
Pain tablets block these receptors.
“It’s like a car going to a car park, but finding it to be fully occupied already,” she says.
If the pain messengers can’t dock, there’s no sensation of pain.
The type of pain doesn’t matter, since the painkiller doesn’t know, of course, whether it was taken to relieve a toothache, back pain, hangover headache or something else.
The desired effect always comes with possible unwanted side effects.
Ibuprofen and aspirin, which are anti-inflammatory, can disrupt kidney function and the production of protective gastric mucus, raise blood pressure, and deactivate blood platelets, which are instrumental in stopping bleeding, Dr Überall says.
Paracetamol, which isn’t anti-inflammatory, “doesn’t do any of this,” he adds, “but has a potentially toxic metabolite produced in the liver.”
The first choice, Dr Überall and Funke agree, is ibuprofen.
“It’s effective in most cases and has the best safety profile,” says Dr Überall.
Although aspirin works faster – as it’s mostly absorbed in the stomach, not the small intestine – its adverse effect on blood platelets lasts considerably longer, he says.
On the other hand, if taking ibuprofen leads to unwanted side effects such as stomach problems, you’d be better served with paracetamol.
The same goes if you have high blood pressure or take an anticoagulant.
Funke also recommends paracetamol for fever.
You’ve got to be careful about possible liver damage though.
“Consult your doctor or a pharmacist,” she says – common counsel that makes perfect sense when it comes to painkillers.
“Pregnant women should avoid all painkillers during the first trimester,” Funke says.
And during the third trimester, the only over-the-counter painkiller they should take is paracetamol, since it’s not anti-inflammatory.
“Anti-inflammatory medications can alter the unborn child’s circulatory system,” points out Dr Überall, which can result in premature birth or damage the child in the womb.
If it’s a hangover headache you’ve got, paracetamol isn’t the right choice.
“Alcohol puts strain on your liver, and paracetamol only adds to it,” notes Funke.
And she says that children under age 12 shouldn’t be given aspirin, because “it can trigger Reye’s syndrome, a dangerous disease” that causes swelling in the liver and brain.
Ibuprofen and paracetamol must be transported out of your stomach before taking effect.
So, if your stomach is empty, the tablet won’t have to lie a while in a mass of partially-digested food and can arrive more quickly in your small intestine, its main absorption site.
If you have a sensitive stomach, however, Funke says it might be a good idea to eat a little something with the tablet.
“The most important thing is to drink plenty of water when you take it.”
And it’s best that the water be lukewarm.
“The stomach doesn’t release food [and fluids] to the intestines until it’s at body temperature,” explains Dr Überall.
“So if you drink cold water, the tablet will lie in your stomach until your stomach warms it up and then sends it further on.”
Your body position can play a role as well.
“Most people’s stomach exit is on their right side,” Dr Überall says.
If you have the opportunity to lie on your right side after taking the pain tablet, “your stomach contents will press against the exit, which is a transport signal for the stomach.” – By Christina Bachmann/dpa
