Why should I advise you to really stop “bearing the pain”?

Whether it is a cold, fever, sprain or gum inflammation, we often experience pain. There are many different types of pain, no matter which type of pain is undesirable. But one clear fact is that almost everyone will experience pain every year.

Painkillers are the most direct way to solve pain, but many people, especially Chinese people, are very resistant to painkillers. They are worried about side effects and addiction, and always like to bear it. What does pain bring us? Are painkillers really that scary? How to use painkillers reasonably?

Today is World Pain Relief Day , let us talk about these topics together.

The Chinese who have been "enduring the pain"

Take migraine as an example. It is the most common type of headache and is a primary headache. The incidence of migraine among Chinese adults is as high as 10% , mostly concentrated in the age group of 20 to 40. The incidence of migraine in women is 2 to 8 times that of men, which is related to the hormone levels in women. In addition, 60% of migraine in women is related to the menstrual cycle.

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The bad news is that migraine is difficult to cure, and some patients do not experience attacks anymore until after the age of 60 to 70. But the good news is that migraine has a good prognosis, usually does not cause organic lesions, and most can be effectively relieved through drug and non-drug means.

Migraine affects the quality of life. There are many deficiencies in the actual diagnosis and treatment. The diagnosis accuracy of migraine is not high, and only about half of migraine patients in China seek medical treatment . Therefore, in fact, many migraine patients do not even know that their disease is called migraine, let alone receive standardized pain relief treatment.

Pain is not only a symptom, but also a disease. The WHO clearly states that when pain lasts for three months or longer, it is classified as chronic pain . In the 2018 International Classification of Diseases ICD-11, chronic pain was confirmed to be defined as a disease .

In the Global Pain Index Report (4th edition) released by GSK in 2020, based on the survey results of 19,000 people in 19 countries, one-third of the world's population experiences pain every day, and among people under 30, the number is one-fifth. These pains can occur in various parts of the body, including the most common headaches, sore throats, muscle pain, stomach pain, joint pain, and dysmenorrhea in women.

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Let’s look at the data from China:

1

Type of pain

60% of Chinese respondents suffer from osteoarthritis pain, which may be related to aging (the global average (19 countries participating in the study, the same below) is 50%);

2

Suffering more severe pain

36% of Chinese respondents described their pain as “severe” (global average 31%);

3

Pain lasts longer

41% of Chinese respondents described their pain as lasting several hours at a time (the global average was 36%);

4

The effect of pain is more significant

70% of Chinese respondents believe that pain affects their ability to enjoy life (global average: 65%).

Of course, this phenomenon is not unique to China. In neighboring Japan, people are not so timely in using painkillers. According to a survey conducted by Daiichi Sankyo, less than 40% of people in Japan use painkillers at the appropriate time to relieve headaches and dysmenorrhea.

Many people prefer to "endure" the pain, or take some physical methods (such as hot compresses) to relieve the pain, and are unwilling to take painkillers.

Are painkillers really addictive?

Most people are afraid to use painkillers because they don't understand the principles of painkillers and are worried about "addiction". In fact, the pain most people experience is mainly mild to moderate pain, and we should actively find the cause and take intervention measures. It is useless to bear it hard, and it may also cause anxiety, depression, sleep disorders and other problems .

The issue of addiction can actually be divided into two parts based on pharmacology: non-opioid analgesics and opioid analgesics.

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In the guidelines of various countries, non-opioid analgesics are usually used for mild to moderate pain, including the well-known acetaminophen, as well as non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, aspirin, indomethacin and loxoprofen. These are basic analgesics, which are safe to use according to the instructions and will not cause addiction .

Opioid analgesics include tramadol for moderate cancer pain, and fentanyl and oxycodone for severe pain. Long-term clinical practice shows that addiction to these opioids is still very rare when used in a regular dose , with only about 0.03% of people becoming addicted to them over a long period of time. In other words, the vast majority of patients with moderate to severe cancer pain can effectively relieve pain and improve their quality of life with these drugs.

How should we view painkillers rationally?

Let's take migraine as an example. The Chinese Guidelines for the Diagnosis and Treatment of Migraine say that when a migraine attacks, medication should be taken as soon as possible to improve the effectiveness. The first choice is still NSAIDs such as acetaminophen, ibuprofen, and aspirin. 70% to 80% of mild to moderate migraines can be completely relieved with these drugs during acute attacks.

Many people worry about overdose and taking painkillers for too long. In fact, the guidelines also define "long-term medication". It is usually recommended not to use NSAIDs for more than 15 days per month and not to use caffeinated combination preparations for more than 10 days.

Think about it yourself, how many times a month can you take painkillers? In fact, most people will not exceed this dosage.

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Another thing is the total daily dose. Usually one acetaminophen tablet is 500~650mg, and the maximum daily intake is no more than 2000mg, so if you have migraines or dysmenorrhea, 3 tablets a day is generally fine. In fact, 2000mg is the Chinese regulation, which is already quite conservative. For example, the recommended upper limit in the United States and Europe is 3000~4000mg.

Some middle-aged and elderly people have amazing endurance. They worry about "drug resistance" and "addiction" every day, and are unwilling to take painkillers even when they have splitting headaches.

One thing to note is that although these commonly used over-the-counter painkillers are not addictive, they have risks like other drugs. For example, NSAIDs such as aspirin and ibuprofen have a certain risk of causing peptic ulcers and bleeding (and ibuprofen is generally not recommended for pregnant women), and acetaminophen has an increased risk for people with impaired liver function . Therefore , before you use these painkillers, you must first understand your physical condition .

For migraine, it is not recommended to use sustained-release capsules, because the purpose of migraine treatment is to quickly relieve pain. In addition, as mentioned above, the sooner you take the medicine after a migraine attack, the better the effect. Don't take medicine when you can't bear it anymore, because then the control effect will be poor.

So there is no need to bear most of the pain in daily life. Life is not easy, you can choose to make it easier.

Planning and production

Author: Zhuang Shili and medical science blogger

Reviewer: Tang Qin, Director of the Science Popularization Department of the Chinese Medical Association, National Health Science Popularization Expert

Planning丨He Tong

Editor: He Tong

Proofread by Xu Lai and Lin Lin

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