Painkillers demystified

Pills.(AFP pic)

Pain in certain situations is considered a virtue. The phrase “no pain, no gain” is often used to motivate those struggling through rigorous workouts at the gym. It’s also the go-to phrase for Instagram captions and Tweets after one has experienced a particularly difficult situation.

But pain can be debilitating. A throbbing headache robs you of the ability to enjoy the company of others or focus on your work. A painful knee cripples your mobility and prevents you from moving around without wincing.

Not only is there absolutely nothing to gain from enduring severe pain in silence, it also significantly diminishes the quality of your life in the process.

There are painkillers one can take although these come with its usual side-effects, possibility of addiction and the potential to develop an immunity or drug tolerance towards the medication.

So, how do doctors pick the right painkiller?

The World Health Organisation’s analgesic (painkiller) ladder was originally intended to guide clinicians in the management of pain for cancer patients. However, it has since been widely adopted by doctors to treat other patients experiencing chronic pain due to its effectiveness and simplicity in implementation.

A doctor starts from the bottom of the ladder, prescribing the appropriate painkiller to answer the patient’s need. If pain persists, the doctor moves up one step. Simple, no? Let’s examine each step.

STEP 1: Non-opioid painkillers


Interchangeable with Panadol in many countries (Panadol is a brand name), this drug is very safe for use in the usual prescribed dose. Many discount this drug’s effectiveness simply because it is easy to obtain over the counter. However, Paracetamol has been found to be a very effective analgesic, even on its own. However, precautions with dosages must be observed for those who are extremely underweight or who have liver problems.

NSAIDs (non-steroidal anti-inflammatory drugs)

Examples include ibuprofen, aspirin, naproxen. This class of drugs reduces inflammation and therefore reduces pain. Ankle sprains and arthritis are common inflammatory conditions that benefit from the use of NSAIDs. For long-term use, consult your doctor as these drugs can have an effect on the stomach and kidneys. Same goes for those with asthma as these drugs can induce an attack.

STEP 2: Weak opioids

Codeine. Tramadol.

Opioid medications work a different way from the medications mentioned before. These are more potent but also come with other side effects such as constipation, nausea and dizziness.

STEP 3: Strong opioids

Morphine. Oxycodone. Fentanyl.

These drugs pack a punch when it comes to pain. But with more potency come more side effects. These medications can only be prescribed by a doctor and are considered heavily controlled drugs.


Adjuvants are medicines that do not specifically target pain but due to the way they function, they can help with pain relief. Examples include anxiolytics and anti-depressants.

Anxiolytics are medications that have a calming effect on a patient. These medications can also relieve muscle spasms that may be the cause of pain. They can be addictive so doctors are very careful about prescribing them. Mental health conditions can lead to physical symptoms. Therefore, if someone is depressed, dealing with the mental condition may be the solution to pain relief and that’s where anti-depressants come into play.

There you go. Painkillers demystified. Be sure not to suffer in silence but seek help when in pain.





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DISCLAIMER: The information in this article is not a substitute for professional medical advice. You are encouraged to confirm any information obtained here with other sources, and review all information with your physician. Please do not disregard professional medical advice or delay treatment because of something you have read here. FMT is not responsible and liable for any damage caused through information obtained here.