Pain Management

Painful conditions may be acute (short-term) or chronic (long-term). Chronic pain is one of the most common conditions general practitioners have to manage on a daily basis, affecting almost 1 in every 5 of their patients. Chronic pain can actually be considered a disease in its own right.^1,2

Musculoskeletal pain (affecting the bones, muscles or joints) is the most common source of serious long-term pain and physical disability. Chronic musculoskeletal pain is defined as pain that has been present or persists for longer than 90 days and beyond the expected time frame for normal healing.^2,3

Pain can also be divided into physiological pain (activation of pain receptors in the skin) which serves as a protective mechanism, when, for example, you automatically pull your arm back from a burning pan; and clinical pain, which is bodily and/or nerve injury and the associated inflammatory response (pain, swelling and inflammation).⁴

Poorly managed acute pain can result in the development of chronic pain, which can considerably affect a person’s normal function and wellbeing.⁴

In addition to the physical burden of pain, it can also be emotionally exhausting and isolating, and negatively impacts on social relationships, daily functioning, sleep and sense of self-worth.¹

Psychological factors can also influence the pain experience:⁴

• Anxiety and depression are associated with higher pain intensity.
• Anxiety before surgery has been shown to contribute to increased postoperative pain.

Not only is the aim of adequate pain management to provide pain relief, it is also aimed at minimising harmful effects caused by the body’s stress response, as well as preventing acute pain from becoming chronic.⁴

Medicines for the treatment of pain include paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids, as well as other therapies such as muscle relaxants, steroids and antidepressants, all of which can play an important role in pain management.²

Doctors usually use a treatment ladder, or stepwise approach to pain management, based on the severity of the pain. Treatment is gradually increased depending on the specific pain experienced by the individual patient.^2,4

Combining different medicines to treat pain may be recommended by your doctor in certain cases. The advantage of this is that it often means that lower amounts of each medicine are required, with consequently fewer potential side effects. When using opioids and NSAIDs, the combination of paracetamol with these agents is more effective than either agent alone, and it also reduces the dosage of the opioid, or NSAID, that is required to treat the pain.^4,2

Paracetamol is recommended by the World Health Organisation as the first-line treatment for mild to moderate pain.^6-8

Paracetamol is the main ingredient in Panado. The table below shows which products are most suitable for adults, and for children according to age.

Generally, adjunctive medications (for example, muscle relaxants) are defined as medications that do not contain painkillers, but which may play a role in the management of chronic pain, help reduce chronic musculoskeletal pain, and limit the need for painkillers.²

Your pharmacist or doctor will help you choose a suitable medication for your needs. Be sure to tell them about medical conditions you might have so that any contraindications can be checked. For example, people at risk of stomach ulcers (over age 65 or history of ulcer) or heart problems (risk factors include: high blood pressure, diabetes, high cholesterol) should be cautious about taking NSAIDs. There are other medication options available in these cases.²