“Popular painkillers useless for backache” declares a headline in the Daily Mail. The Science Correspondent explains that Australian researchers found the use of non-steroidal anti-inflammatory drugs (NSAID) for back pain (like Ibuprofen and Nurofen) is not effective and is dangerous due to side effects. The research was a review study, looking at and analysing data from many independent trials on the subject. This means its conclusion is much more reliable than an independent study and should be taken seriously.

I think the Daily Mail headline was exaggerated (what’s new?) –of course NSAID are not useless. They have their place and in some situations are needed and can be effective. I do, however, also think that they are colossally overused by GPs.

The basic problem with NSAID is similar to that of other modern medicines, they are:

a) Only treating the pain and not treating the problem that causes the pain. Therefore if the condition is chronic, the patient will need to continue taking the medicine for life, which leads us to:
b) These medicines can have unpleasant and even dangerous side effects. Around three thousand people die in the UK every year as a result of NSAID!

So, why are they so commonly prescribed by GPs? The simple but surprising answer is that in the NHS framework they don’t really have many other options available to them. At the current time, if a patient is going to present to a GP with chronic pain (this can be from a joint or a muscle, a tendon or a ligament, it can be from osteoarthritis, chronic inflammation, organ malfunctions or any other reason) he has to follow certain guidelines. He will start with simple painkillers like Paracetamol, then progress to NSAID. If needed then stronger pills will be prescribed like Codeine, then neurological agents like Amitriptyline and Gabapentin and eventually opiates like Tramadol and Morphine. The stronger the drugs the more dangerous the side effects and, as mentioned earlier, none of these actually treat the problem that causes the pain and will therefore need to be taken continuously. Another increasingly used treatment for chronic pain is the steroid injection- exactly the same problems apply here as well.

So what is the reason we feel pain? Physical pain is most probably a feeling we developed through evolution to warn us about impending or actual tissue damage. If we are in a situation where tissue damage is impending or occurring we need to know about it so we can hopefully do something to stop, or at least reduce, the damage. Just as in some other ancient evolutionary mechanisms (stress for example), this one is a double edged sword- on the one hand it can save us from great tissue damage. On the other hand, in some cases of chronic pain, it is pretty much useless and causes a great deal of suffering without really having much benefit to our health or to our survival prospects. It is a bit of a conundrum as to why this may be but the reality is we are kind of stuck with it. Therefore, when chronic pain strikes, we need to try and understand it and its cause in any given case, so we can treat the cause as well as the pain itself whenever possible.

There are many different causes of chronic pain, but in order to keep things simple I am going to focus on musculoskeletal pain and its causes, and possible effective and safe treatments! In Chinese medicine, pain is felt when there is disturbance in the free flow of the body energy (Qi) and /or blood. Blocked Qi or blood causes pain. Acupuncture is highly effective in freeing the flow of blocked Qi and blood and therefore in improving pain but that is not enough. In every individual case of pain we have to look at what is the cause of the blockage. Let’s take a painful joint like the knee. The cause of pain (blockage) can be heat in the joint. When inflammation is present the knee then will feel hot. It can be an accumulation of fluid in the knee- in this case the knee will be swollen and stiff. It can be due to cold invading the knee- in these cases the pain will increase when exposed to cold weather. Another common cause of knee pain is weakness of the joint and this is usually due to weak kidneys. In this case it is common to also be suffering from low back pain and possibly other joint aches and general symptoms like tiredness or bladder symptoms. In each of these cases it is not enough just to free the flow of Qi and blood in order to relieve the pain, we also have to deal with the cause of the blockage as well. A good Acupuncturist will do just that and by so doing will achieve effective and long-lasting improvement in the pain.

This was just an example of the way Acupuncture treats pain and it applies to all types of pain. Whether it originates in the digestive system, gynaecological system, headaches and so on, the principle stays the same: treat the cause of the pain as well as the pain itself. By applying this principle Chinese medicine is a very effective treatment for most cases where the main symptom is pain. There are other therapies that must be mentioned particularly in the context of musculoskeletal pain. When the pain originates from problems in the alignment of the spine or the pelvis then a Chiropractor or an Osteopath will be very helpful. If the problems arise from particular muscle weakness or stiffness then stretching and/or strengthening exercises given by an experienced physiotherapist are important. For general maintenance of a healthy musculoskeletal system I warmly recommend regular pilates classes.

Whichever of these ways you choose to deal with your pain problems it must be a more intelligent solution than taking painkillers long-term from the Doctor. These therapies are very effective, extremely safe, can save lives (by avoiding the dangers posed by chronic use of painkillers) and much suffering. In most cases there is really no need to put poisonous medicines into your body