Why pain medications often do f**k all.
If pain meds don't work for you, you'll want to read this.
This is a pretty important blog because of the sheer number of people in pain that are affected by this. It is so common for me to hear from a new client that the pain medications that the GP/MD has prescribed haven’t helped with their symptoms.
It’s that common that I can almost predict what my clients are about to say from the expression on their face as soon as I ask about any pain medications they are using!
I also frequently hear that clients have been unable to stay on the medications that they have been prescribed because the side effects of the meds have been really problematic. From feeling like a zombie in a stupor to feeling nauseous and dizzy or struggling to focus at work.
So if it is so common that pain medications don’t work for a lot of the people that they are prescribed for - why is this the case?
This blog has been inspired by this research study1 and I believe that it is important for a person with pain to understand. So rather than asking you to read scientific research which can be jargon-heavy, I’ve simplified it into (hopefully) a much easier read!
The nociceptive system
I promise not to bore the pants off you with complex technical language here. A little bit of an introduction to neuroanatomy is required to give you the context necessary to understand why pain meds won’t always work very well.
The diagram below shows a basic model of the sensory nervous system. I’d like you to think of it like taking a train journey.
In this model, stimulation of the nerve endings in the hand create a nerve impulse that travels from the hand via the nerve into the spinal cord. This is the first leg of your journey - you buy your ticket and board the train
(stimulation of the hand) and then you travel to your destination (spinal cord).
The impulse is then able to travel up into the brain to a brain centre called the thalamus. (From here you can continue onto the central train station via the same train or an interconnecting train on a different track.)
From there on, it has the possibility to travel to many other brain regions. (Just like landing in Grand Central Station, NY or Euston Station, London - you have many options to choose from for onward travel.
GEEK FACT: No matter where you touch the skin of a human, you are only 3 neuronal connections away from the most sophisticated part of the brain. Your skin could therefore be considered to be the outermost covering of your brain!
The nociceptive system is that part of the nervous system that informs the brain about the potential for tissue harm. It encompasses many different types of stimuli such as heat, cold, sharp stabbing sensations and more.
This system is widely thought of as a significant contribution to the experience of pain. It is not pain itself - rather it is a stream of input that is important when the brain is processing what is happening in your body and what its response to that “happening” might be.
As such, blocking or reducing the input from the nociceptive system is often targeted via the prescription of pain medications. This seems to make sense right?
So how might that work?
Pain meds block the action of neurotransmitters.
Neurotransmitters are the little chemicals that help neurons and nerves to send signals to other neurons and nerves.
Pain meds usually only block one or two types of neurotransmitter at a time.
The unfortunate reality is that there are multiple distributed pathways by which nociceptive input may reach the brain - multiple neurotransmitters may be involved for this to happen and at the moment there are no available medications that can safely target many neurotransmitters and pathways at once.
And this is a very good thing for us, even if it means that sometimes pain medications fail to help our symptoms.
We have multiple routes available for nociceptive input to travel to the brain which means that the brain will likely always be informed if something injurious happens. We definitely do want that to happen even if it means that pain will be part of the experience.
There are people who are unable to feel pain and despite how appealing that might seem to be at first read - those people unfortunately do not live long and healthy lives. They often end up with significant health problems and injuries as a result of not feeling pain - after all, pain is apart of an alarm or alert system for a reason.
So if these danger detecting nerve endings have many routes to reach the brain, I guess it is pretty unrealistic to assume that pain medications should be able to affect and minimise most pain experiences.
There are too many ways by which the resilient nociceptive system can transmit its input into the brain.
I’m writing this to help you understand why medications often don't reduce your pain. This is usually a source of distress for a person in pain - it makes them think that their symptoms and pain must represent an even bigger problem than they thought they had - if even the strongest medications don't help their symptoms.
The reality is that it's normal for this to happen.
It's certainly not ideal for you to find yourself in the midst of a very strong pain experience (acute or chronic). Hopefully this blog helps you to avoid the addition of increased levels fear and worry into the equation when medications aren’t effective for you.
The Dark Side of Pain Medications
The darker side to this is that some pain medications are highly addictive.
Some have very strong side effects. In my opinion, pain medications are highly over-prescribed.
I get that the medical system is part of the problem because the average GP/MD is overworked and is asked to fit in ridiculous numbers of patients in a regular work day. I’m not blaming doctors at all here, often the most straight forward option that they have is to prescribe pain medications and muscle relaxants.
Considering that these options might not be that effective - it is kinda surprising that they are still offered as a primary option within the medical model. (Actually, I’m not that surprised by this - Big Pharma highly fund medical doctors education and seem to have much more influence than they should over models of care - another blog for another day perhaps!)
For the people who do get good relief from pain medication - happy days! They are a legitimate tool to use from the toolbox of options available for you to help manage your symptoms. My hope for you is that they are not the only option that you have.
For those that they don’t seem to work for - hopefully you now have a better understanding as to why those medications haven’t helped you.
And if this blog has helped you reframe the failure of those medications into something that is more normal than abnormal - then it has had its desired effect.
David
The Distributed Nociceptive System - A Framework for Understanding Pain
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7530033/
Hi David
I’ve an article or two that may interest you.
Pain is a very useful sensation because it asks us to remedy something.
You pointed this out as a negative for those who feel no pain. Eg People with a paralysis and no sensations must inspect their body for injury so it can be looked after in a timely manner.
So why would looking to a pill be a good idea? I have a pain. Oh that’s an indication for a pill.
Simply not sound thinking.
I suggest there is always a good reason for pain and to suppress it is folly. The body will simply try and increase the siren call. We have an emergency and someone keeps turning off the alarm!
The body’s physiology runs on hydration. If there is an area deficient in hydration there will be problems.
Eg a headache is a sign of dehydration not a message to pop a Panadol.
Hydration equals salt plus water.
Click on my icon and read my three articles. I bust a few paradigms with logical thinking. You will need to ponder and experiment with hydration.
The darkest side of pain medications is that they're all toxic af. No exception.
I haven't taken an Ibuprofen or Paracetamol in over 10 years, I use CBD oil and it works. If I'm in severe pain due to a more severe injury, I use on old fashioned Indica. No side effects, non-toxic, non-addictive, almost free when you grow it yourself. Most of the time I just suck it up though.