Do you know what painkillers to take to manage your pain?

A toothache can range from mild discomfort to severe, debilitating pain that probably requires the use of drugs for pain relief. — Photos: Pexels

Pain is a profoundly personal experience, unique to each individual.

Yet, pain is also a part of life, whether it comes as the dull throb of a toothache, the sharp sting of a cut, the strain of a sports injury, or the lingering soreness after surgery.

Though it may differ in form and intensity, pain is something everyone will face at some point in their lives.

According to the Global Pain Index 2020 Report, one-third of the world’s population experiences pain every single day.

Since pain is inevitable, learning how to manage it effectively becomes not just important, but essential.

Pain and its classifications

In 2020, the International Association for the Study of Pain (IASP) defined pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”

This definition highlights that pain is not just physical, but also an emotional experience shaped by how the body and mind respond to injury or threat.

Pain can be identified and classified in several ways:

> By duration

Classification by duration looks at how long the pain lasts.

Acute pain appears suddenly, usually as a direct response to injury, infection or surgery.

It is short-term and typically fades once the underlying problem is treated or heals.

Chronic pain, on the other hand, lasts for more than three months and may persist long after the original injury has healed.

Unlike acute pain, it serves little protective purpose and can become a condition of its own, often disrupting daily life, sleep and emotional well-being.

Acute pain is pain that comes on suddenly and is usually sharp and intense, often resulting from injury, illness, surgery, or other causes.

> By causes

Classification by causes looks at the source of pain and it may arise from cancerous or from non-cancerous conditions.

Cancer-related pain often worsens over time and may involve both acute and chronic elements, making it more complex to manage.

Meanwhile, non-cancer pain usually comes from surgery, injury or progressive illnesses such as arthritis.

> By mechanism of pain

Classification by mechanism of pain focuses on how pain develops in the body.

Nociceptive pain, sometimes called physiological pain, happens when there is actual tissue damage, such as in muscles, joints or internal organs.

It is usually easier to identify and is often described as sharp, aching or throbbing.

Neuropathic pain, in contrast, arises from damage to the nerves themselves.

This type of pain is more difficult to pinpoint and is often described as burning, tingling or sharp shooting sensations.

Understanding your options

In 2008, our Health Ministry (MOH) introduced a nationwide policy that recognised pain as the fifth vital sign.

This initiative allows healthcare professionals to ensure pain is being addressed appropriately, leading to more effective management in both primary care and hospital settings.

Because of this, patients are encouraged to communicate clearly about their pain, including its location, how long it has been experienced and how it affects daily activities.

This information helps healthcare providers make a proper assessment, which leads to better, more personalised care.

Accurate pain assessment is essential because it guides the choice of treatment, particularly the selection of suitable pain relief medication.

Choosing the right medicine, tailored to the type and severity of pain, is key to ensuring effective and safe management.

Painkillers should be taken at the lowest effective dose and for the shortest possible duration.

However, in cases of persistent pain such as arthritis, chronic back pain or cancer-related pain, doctors need to carefully review the patient’s medical history and may conduct laboratory tests, including kidney function assessments, to determine the safest and most appropriate treatment option.

Types of painkillers

Medicines for pain management (analgesics) or simply known as painkillers are generally grouped into three categories: non-opioids, opioids and adjuvant analgesics.

Each group plays a different role in managing pain, depending on its type and severity.

> Non-opioid painkillers

These are usually the first choice for mild to moderate pain.

The most common example is paracetamol, which is safe and effective when used correctly.

Another group is the non-selective nonsteroidal anti-inflammatory drugs (NSAIDs), which include diclofenac, mefenamic acid, ibuprofen, naproxen, ketoprofen, indomethacin and meloxicam.

These medicines reduce pain and inflammation but must be used with care.

There are also selective cyclooxygenase-2 (COX-2) inhibitors, such as celecoxib and etoricoxib, which specifically target pain and inflammation while being gentler on the stomach.

However, all medicines in this group carry certain risks.

Allergic reactions are possible and cross-allergy is common between different NSAIDs and COX-2 inhibitors.

Stomach irritation, ulcers or bleeding may also occur, although this is less common with COX-2 inhibitors.

To reduce these risks, the medicines should always be taken after meals.

Without proper monitoring, long-term use may also harm kidney function.

In addition, COX-2 inhibitors carry a higher risk of cardiovascular problems such as stroke and heart attack, particularly in individuals with existing heart conditions, and therefore should be used with caution in this group of patients.

For mild to moderate pain, paracetemol is effective when used correctly. — dpa

> Opioid painkillers

These medicines are stronger pain relievers used to manage moderate to severe pain.

Weak opioids such as tramadol or dihydrocodeine, are commonly prescribed for managing moderate pain.

When the pain becomes more severe, stronger options like morphine, oxycodone or fentanyl are usually required.

In addition, partial agonist opioids such as nalbuphine may also be considered as alternatives within this group.

However, opioids can cause several adverse effects.

Common ones include gastrointestinal problems such as nausea, vomiting and constipation.

They may also lead to respiratory depression, a serious condition where breathing becomes slow, shallow or may even stop.

Other possible side effects are drowsiness, dizziness, confusion, excessive sweating, skin itching and urinary retention, where the bladder cannot be emptied properly.

> Adjuvant analgesics

This group of drugs are useful for managing nerve-related pain, which is often described as burning, tingling or electric shock-like sensations.

Among the commonly used options are certain antidepressants, such as tricyclic antidepressants (amitriptyline, nortriptyline) and serotonin-norepinephrine reuptake inhibitors (duloxetine).

Anticonvulsants, including carbamazepine, gabapentin and pregabalin, are also effective in relieving this type of pain.

Precautions to take

Some patients may develop stomach ulcers after taking NSAIDs.

To reduce this risk, they should take these medicines with food, preferably a full meal, rather than on an empty stomach.

Long-term use without medical supervision can also increase the risk of ulcers and stomach bleeding.

In such cases, COX-2 inhibitors may be a safer alternative, especially for patients with a history of gastrointestinal bleeding.

When it comes to opioids, frequent use can lead to tolerance, meaning the same dose may no longer provide relief and higher doses are needed.

Prolonged use or misuse may also cause both physical and psychological dependence.

To stay safe, patients prescribed opioids should follow the instructions given and avoid taking extra doses without a doctor’s advice.

If the pain is not well controlled, they should consult a doctor or pharmacist.

It is also important to avoid driving or operating machinery, as opioids can cause drowsiness.

All painkillers should be registered with MOH and patients are encouraged to get their medicines only from trusted and legitimate sources.

If pain persists or worsens, medical attention should be sought as soon as possible.

A proper check-up is needed to determine the underlying cause, since each type of pain may require a different approach.

Without supervision, painkillers can cause unwanted and sometimes harmful effects.

Pain is something everyone will face, but it does not have to control daily life.

With proper assessment and the right use of medicines, pain can be managed safely.

This not only provides relief but also helps patients preserve their quality of life.

For any inquiries regarding medicines, please call the National Pharmacy Call Centre (NPCC) at the toll-free number 1-800-88-6722 during weekdays from 8am to 5pm, except on public holidays.

Janice See Yoke Sim is a pharmacist at Hospital Teluk Intan in Perak. This article is courtesy of the Health Ministry’s Pharmacy Practice and Development Division. For more information, email [e-mail]. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.