DEAR DOCTOR,

Is it okay to take painkillers for cramps? My sister does so and I feel like this is something she can cope with without medication. How do I get her to stop medicating herself? JUSTINE

DEAR JUSTINE,

Does your sister get cramps in the legs while walking or is it cramps in lower part of tummy during her menstrual periods? What painkillers does she take for relief?

Pain is a highly subjective sensation. What is severe pain for one person, may be tolerated very well by another person. It depends on underlying cause of pain, a person’s mind-set and overall health.

Any painkiller does cause some side effects as well. More the frequency of intake, more is the risk of side effects. The commonly used NSAIDS (non-steroidal anti-inflammatory drugs) for pain relief cause burning pain in chest and abdomen and if taken frequently, can cause peptic ulcer in the stomach or small intestine. NSAIDS can damage the kidneys as well, they are a known risk factor for hypertension, as well as heart problems and known to induce and aggravate attack of asthma. Paracetamol can cause liver toxicity, aspirin can cause bleeding from any site in the body.

Opiods is another group of painkillers used for severe pain, as after surgery or in cancer patients. They cause constipation and blurred vision as side effects. If taken regularly, one develops dependence on them, i.e., same dose taken will become ineffective, thus the need for increasing the dose. Gradually, these cause addiction, i.e. the person feels uncomfortable without them, compelling him/her to take it regularly, thus augmenting the side effects. 

People consider that using a pain relieving drug in ointment form makes it safe, but this is not true. Anything applied over the skin is absorbed in the body via the skin and then its action begins. Thus painkillers are also absorbed and if used regularly, side effects can occur.

Considering these side effects of painkiller medicines, it is best to avoid taking them, unless pain is severe. It is better to identify and treat the underlying cause of pain.  

If pain is mild and tolerable, it is advisable to avoid taking a painkiller. If severe, then painkillers can be taken for a day or two, but stopped as soon as one feels comfortable.  If it is muscle cramps affecting the calf muscles, taking supplements of vitamin E would be helpful. She should avoid wearing high heeled shoes, as it is a common cause for painful muscle cramps in legs.  If it is cramps of menstrual cycles, taking an antispasmodic drug for one or two days would be sufficient.

Pain can be reduced by non-pharmacological measures as well, like cold or hot compression. Light massage is also beneficial. Pain relief by diathermy, wax therapy, are other non-pharmacological measures used for reducing pain by physiotherapists. In fact, in case of chronic long standing pain, it is advisable to focus on non-pharmacological measures. 

Dr. Rachna Pande,Specialist internal medicine E-mail rachna212002@yahoo.co.uk