Download Pain Relief in the 21st Century

Pain Relief in the 21st Century
Pain killers have been around since the 4th century when people chewed willow bark, but aspirin
became the first marketed formulation of it when a german chemist isolated the active ingredient in
the willow and gave it to his father for his stomach ache. Since then aspirin has been linked
beneficially to reducing heart attacks, bowel cancer, strokes and a great many other positive news
stories. It also, though, has dangers for children and causes a serious disease called Reye’s syndrome
if given for some viral illnesses.
Opium was around even earlier and has been popular since about 300 BC. Initially it was used to
help people sleep, but in the Renaissance it became popular as a painkiller. The Victorians mixed it
with sherry to make laudanum – named from the latin laudare meaning to praise. The advantage
over opium was that it was cheap (cheaper than a bottle of gin) and respectable middle class
Victorians could now drink their opium in private, away from the public opium dens where you
smoked it and which had underworld links to vice and crime. The active ingredient (morphine) was
isolated in about 1803, but it took until 1843 until the Scottish started injecting it! This led it to
become so popular that it became the painkiller of choice and also a way of curing alcohol and
opium addiction. Indeed, its use in the American Civil War led to nearly half a million soldiers
developing the ‘soldiers’ disease’; otherwise known as morphine addiction. In 1874 an English
scientist purified it and modified it further to produce diamorphine. It was sold by Bayer who called
it Heroin because the people who took it reported that it made them feel heroic. Doctors then used
it to cure morphine addicts and turned them into heroin addicts. It became outlawed in 1914 unless
obtained by prescription from a doctor.
Paracetamol hit the market through a different route. Pharmaceutical companies were
experimenting with different compounds to reduce fever. The cinchona bark (otherwise known as
Jesuit’s bark) had long been used to produce quinine to reduce malarial fevers. Willow was
producing aspirin, but supplies of these two substances were inadequate for mass production. In
1883, in Strasburg, Professor Kussmaul was investigating the treatment of intestinal worms and his
assistant gave a patient the wrong medication. Instead of killing the worms, it reduced the patient’s
fever. Bayer, who by now marketed aspirin and heroin, started modifying the new fever pill from
Strasburg and found that it was a good painkiller as well. They called it paracetamol but thought it
was too dangerous to use so production ceased in 1893.
In 1943, a different drug company decided to re-look at it and discovered that the original research
was flawed and that, in fact, it was a very good painkiller and only caused liver damage in high dose,
but was safe in low dose, particularly in people who had stomach ulcers. Paracetamol is now the
best selling fever medicine and painkiller in the world.
Indometacin was the first non steroidal anti inflammatory drug to hit the scene, and that was in
1963. Others followed and the most popular is now ibuprofen. They were initially introduced as a
treatment for rheumatoid arthritis, (and hangovers) but are now used for all sorts of types of pain.
Recent versions are more specific in their actions and cause less stomach ulceration than the earlier
versions. These are called COX2 drugs but possibly cause an increased risk of heart attacks and
strokes.
We are now in the fortunate position of understanding a great deal more about pain, its effects and
how to treat it. Not all treatments have to involve medication. Soldiers in battle will sometimes not
notice appalling injuries until they reach base. There own adrenaline and endorphins (the body’s
own pain killer) stop the pain sensation being recognised by the brain until later. Excitement and
fear produce the same effect. But fear can also worsen pain, so medication to relax anxiety is also
useful in reducing pain. Heat and cold can reduce the pain of swollen joints or painful abdomens and
backs. TENS machines which produce a light vibration fool your brain into blocking pain sensation
but accepting vibration sense (called the gate theory of pain). Antidepressants, anti-epileptic drugs,
alcohol, cocaine and lots of chemicals that stimulate the brain also stop the brain from receiving pain
messages from the rest of the body, and so reduce the amount of pain you are aware of – or at least
you care less about it! Morphine works in the same way. If you ask a person who is taking morphine
whether they still have the pain, they will say yes. But if you ask them if it bothers them anymore,
they will say no.
The important medical advance in the treatment of pain is that you can mix all these painkillers up
together to get the maximum effect. A combination of low doses of a variety of painkillers is much
more effective than high doses of one type.
The ‘pain ladder’ was introduced by the World Health Organisation. It is based on the idea that pain
relief should be used in a logical way, and given regularly by the clock for as long as the pain persists.
Pain is easier to control once it is subdued, rather than waiting until it is bad again before treating.
Step One: Paracetamol and/or ibuprofen (or aspirin if over 16 yrs old).
Step Two: Add a mild non-prescription morphine type of drug, such as codeine. This is available with
paracetamol as co-codamol (so you need to stop the paracetamol of step one if you take this).
Step Three: Stop the codeine, restart the paracetamol, and have prescription-only morphine-type of
drug (such as tramadol, morphine, buprenorphine, fentanyl). Continue with the ibuprofen.
Any of the additional supportive medicines can be added at any stage to produce a feeling of well
being, calmness, confidence, happiness and relaxation if they are required. TENS ,hypnotism,
massage, psychotherapy, and acupuncture can also be used aswell.
So now you know everything you need to know to treat pain safely and easily. It is all in the mind.