Understanding Pain

Pain is a complex biological response triggered by the nervous system, signalling potential harm and requiring attention. It is broadly categorised into acute and chronic types, each with distinct causes and treatment approaches. Understanding these mechanisms can greatly enhance the quality of life for those experiencing persistent discomfort.

Acute pain typically results from injury, surgery, or illness. It acts as a direct, short-lived response to tissue damage, serving a protective role by prompting individuals to seek relief and avoid further harm. Acute pain generally subsides as the underlying cause heals. Chronic pain persists beyond the expected period of healing and may develop into a chronic condition. This type of pain might originate from initial injuries or conditions like arthritis, but is perpetuated by changes in the nervous system that maintain pain independently. Chronic pain can stem from multiple factors, including inflammatory conditions, neuropathic pain, cancer, and functional pain syndromes.

Treatment involves various medications, each targeting different points in the pain pathway:

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

• • Mechanism of Action (MOA): These medications work by blocking certain enzymes in your body that create inflammation-causing chemicals. This reduces swelling and pain.
  • Pros: Effective for inflammation-induced pain; widely available
  • Cons: Risks include gastrointestinal issues and kidney damage with long-term use
  • Examples: Common brands include Voltaren (diclofenac), Brufen (ibuprofen), Myprodol (ibuprofen combined with an opioid), and Disprin (aspirin).
• Opioids:
  • Opioids work by attaching to specific proteins called opioid receptors in your brain and body, changing how you feel and respond to pain.
  • Pros: Effective for severe, acute pain or end-stage illness
  • Cons: Requires monthly prescription due to high addiction potential; side effects include nausea, constipation, and respiratory depression
  • Examples: Brands such as Morphgesic (morphine) and Gen-Payne (codeine)
• Antidepressants & Anticonvulsants
  • MOA: These medications adjust the levels of chemical messengers in the brain and spinal cord, influencing how you perceive pain or calming overly sensitive nerves.
  • Pros: Useful for neuropathic and nerve-related pain and accompanying mood disorders
  • Cons: Not available over the counter. Side effects include dry mouth, weight gain, and dizziness. Ineffective in fever and inflammation
  • Example: Antidepressants include Aropax (paroxetine) and Zoloft (sertraline), whereas anticonvulsants include Neurontin (gabapentin) and Lyrica (pregabalin)
• Analgesics
  • MOA: work primarily in the central nervous system to block pain signals and reduce fever
  • Pros: Available over the counter. Effective at managing fever and providing pain relief, making them ideal for symptomatic relief in infective diseases
  • Cons: Offer no anti-inflammatory effects
  • Examples: Panado (Acetaminofen)
• Palmitoylethanolamide (PEA)
  • MOA: Multiple unique mechanisms reduce inflammation and pain by influencing several pain-related pathways. Ccts by down-regulating the expression of pro-inflammatory genes and modulating the activity of neurons (nerves) and immune cells involved in pain signalling
  • Pros: Non-prescription (natural origin). Non-addictive, with minimal side effects; suitable for long-term use. Provides a broad mechanism of action that could offer a comprehensive approach to managing chronic pain, potentially without the complications associated with more traditional pain medications
  • Cons: Despite numerous clinical trials, PEA is not a registered essential medicine, largely because it is derived naturally and is thus categorised as a supplement. This classification limits its recognition and availability, restricting its accessibility compared to traditional pharmaceuticals.
  • Example: Payne-less (micronised PEA)

Each class of pain medication offers unique benefits and risks, making individualised treatment plans essential. Some alternative options like PEA have amassed extensive clinical and scientific evidence supporting their efficacy and safety in pain management. This underscores the need for further recognition and potential inclusion in essential medicines lists to broaden treatment options.

ABOUT THE AUTHOR

Carmi Wilmans (BSc Hons Pharmacology) is the COO at Neogenesis Health.