Why unprescribed painkillers may only cause more pain

Cedric Noel Elagio

For every headache and minor pain, it has become Filipinos’ second-nature to respond with “Inom kang Biogesic.” In all fairness, the discomfort actually subsides as taking Biogesic scientifically increases the body’s pain threshold. However, one can not always rely on these medications to be “cure-all” remedies—as when painkillers become muscle memory, the cure ironically becomes the casualty.

Killing the Pain

Painkillers, as their name suggests, are medications designed to “kill” or relieve chronic and acute pain. The most common options are over-the-counter (OTC) drugs, readily available in pharmacies, given that they merely target mild to moderate pain. Known as Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), the largest group of OTC painkillers are namely aspirin, ibuprofen, and naproxen. These aid in inflammatory and pain-related conditions induced by migraines, menstruations, and body aches, among others. They work directly at the site of injury by blocking enzymes known as cyclooxygenases or simply COX enzymes, responsible for producing prostaglandins which act as messengers that trigger pain and swelling. By inhibiting COX enzymes, the body stops producing prostaglandins and thus stops the pain getting signaled to the brain, prompting bodily relief and reducing inflammation. 

Acetaminophen, another widely used OTC painkiller notably known as paracetamol or the brand Biogesic, works in a similar way but travels straight to the brain and spinal cord instead of the injury site, directly intercepting pain signals before the mind processes them. Hence, it alleviates pain but can not reduce inflammation or swelling, which is why it is not considered as an NSAID and is only widely used to target fevers and headaches.

On the other hand, painkillers known as opioids are taken to help with chronic pain from serious injuries or surgeries. Some common examples include codeine, morphine, fentanyl, and oxycodone. After intake, opioids bind to specific molecules in nerve cells throughout the body called opioid receptors, which regulate daily essential functions, such as breathing, stress response, and pain control. Once bound, opioid drugs alter these nerve cells to impede the transmission of pain signals to the brain and thus relieve the body from painful sensations.

Nevertheless, ingesting painkillers generally still leaves a bitter aftertaste. These COX enzymes and opioid receptors are not specifically pain-centric and are still shared across many organs. Hence, not only pain signals are killed but also crucial metabolic, respiratory, and cardiovascular processes.

Bitter Aftertaste

While OTC painkillers are dependable when used temporarily and in the right dosage, frequent and prolonged intake gradually damages vital organs. Once NSAIDs suppress COX enzymes, they also reduce the prostaglandins responsible for protecting one’s stomach lining and blood flow. Habitual use eventually increases risk of stomach ulcers, internal bleeding, kidney damage, and even heart complications, especially among individuals of higher age and with medical conditions.

Even paracetamol, often considered as the “safer” option, carries repercussions when misused, as it is primarily broken down by the liver. Taking doses beyond recommendation or mixing it with other medicines overwhelms the liver’s ability to process the drug. Toxic byproducts thus accumulate, eventually resulting in acute liver failure.

Opioid addiction, however, is a harder pill to swallow as the consequences increase tenfold. Unlike OTC painkillers, opioids act directly on the brain to block pain signals. With repeated use, the brain adapts to their continuous presence, making the same dose less effective over time. The patient’s body then demands increasingly higher doses over time, inevitably introducing unending dependence. Eventually, the body begins to rely on opioids simply to function normally. Yet, unfortunately, stopping intake can trigger withdrawal symptoms such as nausea, anxiety, and insomnia.

More ironically, opioids may eventually intensify the very pain they were prescribed to relieve. Opioid-Induced Hyperalgesia (OIH), a common side effect of opioid misuse, causes the nervous system to be more sensitive to pain, essentially lowering the patient’s pain tolerance. This traps the patient in a vicious cycle of increasing intake and dosage, where stopping may not be an option anymore. And in severe cases, such addiction leads to overdose, suppressing the body’s respiratory center, slowing or even stopping breathing altogether.

Dose and Don’ts

It is vital to note that pain itself is not the enemy, but rather the body’s alarm clock, signaling that something requires attention. Painkillers can snooze such an alarm, but can not always stop it from ringing again. These tablets may provide short-term relief, but can also mask symptoms of possible conditions, delaying proper diagnosis and treatment. Hence, taking painkillers also comes with a heavy responsibility. It is of bare minimum to follow the recommended dosage, dosing interval, and daily limit. Prescribed opioids should never be shared, saved for future use, or taken differently as prescribed by a health professional. Furthermore, recurring pain should never be self-treated indefinitely. When the clock does not stop ringing, it is time to wake up, face it, and stop ignoring it. Pain lasting for several days warrants a medical consultation to identify the root cause and treat it effectively.

After all, painkillers were never meant to silence pain forever—only to buy time until its root cause is addressed. While saying “Inom kang Biogesic” has become second nature, perhaps “Pa-check-up ka muna” should become the first. Otherwise, the medicine taken to kill the pain may only leave behind even more of it.