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Painkiller use in Chronic Pain

Note, this article is written for the UK and things may differ in other countries

What is chronic pain

Chronic pain is pain that is not helpful for the sufferer. Acute pain is usually helpful as it tells the body something is wrong. For example, you put your hand on a hot surface, the pain quickly tells you to remove it. Afterwards you may have pain because you have a burn and you will do the right thing i.e. put cold water over it. Not so in chronic pain. Chronic pain often represents a pain stamp in the brain when the acute pain has long gone.

“but my pain is real, I know I have back pain, it is always there”

In some cases this is the case i.e. if you have a disk prolapse and therefore severe back pain. But this is not typical chronic pain. In typical chronic pain you have been investigated and little or no cause has been found and you still suffer the pain.

If chronic pain is not caused by a pain stamp in the brain it is often caused by the following

  • Physical inactivity (who doesn’t get back pain when they sit in a chair for 12 hours?)
  • Obesity (if you put 80 tons of the axles of a 40 ton lorry the axles wear out quicker)
  • Lack of exercise (classic example: Patients with dementia in a nursing home sitting in a chair all day. Studies have shown taking them out of the chair a few times a day is better than giving regular painkillers)
  • Other poor lifestyle choices (i.e. diet, smoking, alcohol etc – a classic example are osteoporotic fractures of the spine and elsewhere, terribly painful and often caused by smoking, alcohol and lack of core strength)
  • Aging (with all of the above – yes, sorry, but our joints degenerate and pain becomes more common in older age – I always say weaker joints need stronger muscles)

The classic example “Phantom Pain”.

There is no better example than a sufferer of so called phantom pain. This is for example a patient, who has had their leg amputated and still has severe ankle pain. This ankle pain may even get worse in cold weather etc, just there is no ankle. This usually represents a “pain stamp” in the brain

“So if I have pain, I’ll take painkillers – Right?”

Correct, in acute pain painkillers are a great relief and there is usually no problem with taking painkillers for a short time (unless you are allergic etc). However, again a good example on what not to do is my own son: He had shoulder pain when playing too much table tennis in training and we gave him painkillers instead of telling him to rest or sending him for physio. He continued heavy training sessions. This causes a lot more serious shoulder problems. So if your child has injured themselves on the trampolin, don’t give them more Nurofen just to go back onto the trampolin.

However, in chronic pain painkillers are better avoided. Why – 3 reasons:

  1. Tachyphylaxis.
    Tachyphylaxis means you are getting used to them and need more and more. Simple example. Today you take a Paracetamol for a stomache ache. You never take painkillers, it works perfectly. Over the next month you take it a lot more. Everytime you take more your brain feels cheated. They work less and less. You contact your doctor for more painkillers
  2. Hyperalgesia
    Hyperalgesia is another concept, which affects particularly Opioid Painkillers, for example Morphine, Tramadol, Pain patches of all sorts including Buprenorphine, Codein, Dyhydrocodein and more. This means the brain feels even more cheated and instead of reducing the pain the pain gets worse and worse and you need more and more painkillers yet have more and more pain.
  3. Side effects and long term effects. See example of a list below
Type of Painkillers Main issues
Paracetamol (US: Acetaminophen) Most commonly used painkiller, very toxic in overdose, can cause liver damage.
Ibuprofen and other anti-inflammatories Increases blood pressure, damages kidneys, reduces kidney function, can cause stomache ulcers and serious stomache bleeds.
Codein, (Co-Codamol (UK) Severe constipation, tachyphylaxis, hyperalgesia, nausea and sickness, addiction
Dihydrocodein, Co-dydramol (UK) Severe constipation, tachyphylaxis, hyperalgesia, nausea and sickness, addiction, driving offense*
Pain patches – usually opioid containing with few exceptions Constipation, tachyphylaxis, hyperalgesiia, driving offense*
Morphine Constipation, tachyphylaxis, hyperalgesiia, driving offense*
Gabapentin Tiredness, mood changes, tachyphylaxis,
Pregabalin Addiction, weight gain, memory problems, headaches, sleepiness, driving offense*
Amitriptyline Constipation, Dry mouth, heart problems, falls in the elderly, must not drink alcohol

*In the UK driving when on controlled drugs (most prescription painkillers) is not completely prohibited, but if you cause an accident while taking them you could be criminally prosecuted, particularly if others are involved.

So, in the table above you can see there is simply no painkiller that is good for you long term. They all have side effects to various degrees. When addressing chronic pain, alternative concepts should be applied.


Other methods, non-medical and non-pharmaceutical should be used and painkillers should be weaned as soon as possible. CBT (cognitive behavioural therapy) for example is a great way to train the brain to ignore pain


Viral Gastroenteritis Diet

Self-care for adults:

BRAT diet

For vomiting, follow these instructions in order:

  1. Do not eat or drink anything for several hours after vomiting.
  2. Sip small amounts of water or suck ice chips every 15 minutes for 3-4 hours.
  3. Next, sip clear liquids every 15 minutes for 3-4 hours. Examples include water, sports drinks, flat soda, clear broth, gelatin, flavored ice, popsicles or apple juice. Do not drink citrus juices or milk. Increase fluids as tolerated.
  4. When you can tolerate clear liquids or diluted apple juice for several hours without vomiting and if you’re hungry, try eating small amounts of bland foods. Try foods such as bananas, rice, applesauce, dry toast, soda crackers (these foods are called BRAT diet). For 24-48 hours after the last episode of vomiting, avoid foods that can irritate or may be difficult to digest such alcohol, caffeine, fats/oils, spicy food, milk or cheese.
  5. When you can tolerate bland food, you can resume your normal diet.
  6. Kefir can help to re-populate the gut with good bowel bacteria, but use the sugar free versions.

Retake medications if vomiting occurs within 30 minutes of taking usual medication. If you vomited after taking oral contraceptive pills, use a back-up contraception method for the rest of the month.

If diarrhea is the only symptom, try Imodium, a non-prescription (over-the-counter) medication available at any pharmacy according to package directions. Follow a bland diet (see 4 above). After the passage of a soft, formed stool, you can resume a normal diet. Call for medical advice if you have no improvement within 48 hours after starting Imodium.


Warts and Verrucas

Topical treatment for warts and verrucas

Topical treatment includes wart paints containing salicylic acid or similar compounds, which work by removing the dead surface skin cells. I recommend Salactol Paint.
The paint is applied once daily. Treatment with wart paint usually makes the wart smaller and less uncomfortable; 70% of warts resolve within twelve weeks of daily applications.
• Soften the wart by soaking in a bath or bowl of hot soapy water.
• Rub the wart surface with a piece of pumice stone or emery board.
• Apply wart paint or gel accurately, allowing it to dry.
• Cover with plaster or duct tape.
If the wart paint makes the skin sore, stop treatment until the discomfort has settled, then recommence as above. Take care to keep the chemical off normal skin.

How about other methods?

Other methods have scientifically not proven more successful and are often not available on the NHS


  • Not trying for long enough
  • Not being persistent with the treatment


High Cholesterol – 8 Point Plan – What to do?

  1. Take it seriously. Cholsterol clogs up your blood vessels. It is a major cause of heart attacks, strokes and cancers including bowel cancer. And remember, having your Cholesterol tested every year and doing nothing about it is like weighing yourself every week. Absolutely no point.
  2. Adjust your diet: What is bad?
    1. Butter, Ghee
    2. Hard margarines
    3. Lard, dripping and goose fat
    4. Fatty meat and meat products such as sausages
    5. Full fat cheese, milk, cream and yogurt
    6. Coconut and palm oils and coconut cream
    7. Highly refined carbs i.e. lots of sugar and non-foods, cakes, sweets etc. If you get a lot of your energy from highly refined carbs this can also increase your cholesterol.
  3. Adjust your diet. What is good?
    1. Porridge, Oatbran, Oat breakfast cereals, Oatcakes, Bread made with 50% oat flour or oat bran
    2. Pearl barley, Adzuki beans, black beans, black-eyed peas, butter beans, cannellini beans, chickpeas, edamame beans, kidney beans, lima beans, mung beans, navy beans, pinto beans, split peas, white beans
    3. Red lentils, green lentils
    4. Vegetables rich in soluble fibre such as okra, aubergine, citrus fruits, turnip, sweet potato and mango
    5. Unsalted soya nuts (also called roasted edamame beans)
    6. Soya alternative to milk, yoghurt, Soya mince/chunks, Tofu
  4. Start exercising. Cardiovascular = sweat producing exercise. Three times a week for 45 minutes or 5 times a week for 30 minutes.
  5. Try to loose weight. Slimming reduces cholesterol.
  6. Cook from fresh. Don’t buy ready made products.
  7. Stop smoking and drink sensibly. Help is available for both.
  8. Inform yourself, be Cholesterol wise:
    1. Know your numbers!—know-your-number
    2. Ask your doctor for your Cholesterol Results
    3. Read more, inform yourself i.e.
    4. And read even more about what to do
    5. Calculate your risk on

Dr M Kittel, 2018


Toenail Cutting Service from Age UK

Letter to our surgery with the promotion of a new service

This letter was faxed to us, recently. Toenail cutting was not available locally for some time. I hope perhaps this new service may help some of the members of this website, their relatives or friends. I have not been able to confirm it is a free service, but would assume so with age UK being a charity.


Get Your Flu Jab early, this year

Why to get your Flu Jab early this year


Australia experienced the worst flu outbreak on record this summer (which is the Australian Winter). The observation was that flu hit them very hard and very early. Public Health England is now warning hospitals to clear wards for high levels of admissions with flu this winter.

Who is affected?

The main strain is H2N3 and children and old people are particularly vulnerable, but there are still significant amounts of H1N1 (Swine Flu) around and that affects young adults, particularly with chronic conditions like Asthma.

How can I protect myself?

  1. Get the flu jab early
  2. Isolation of patients with flu / keeping away from patients with flu (don’t see the doctor unless you are seriously ill)
  3. Wash your hands

Free & Subsidised Exercise Opportunities in Bracknell

We have received feedback from a number of participants, who have advised us on how much fun these classes are.

Sportivate (16-25 year olds – 8 week courses)

Get fit for FREE in a supported environment with people aged 16 – 25.

Bracknell College Sports Hall – Mondays 6-7pm from October 24th to December 12th

To sign up please click here. (You need to complete the survey to sign up)

Back to Fitness classes (Open to all – 8 week courses)

Get fit for FREE in a supported environment. Open to all and 100% beginner friendly.

The Parks Community Centre – Tuesdays 6pm – 7pm from 8th November to 13th December

New Priestwood Community Centre – Thursdays 9:30am – 10:30am from 10th November to 15th December

To sign up please click here. (You need to complete the survey to sign up)

Fit 4 All (Open to all – Ongoing)

Get fit in a supported and beginner friendly environment including tea & coffee, all for just £2 per session. Feel free to sign up here or turn up on the day.

Great Hollands Community Centre –  Fridays 10:30 – noon (inc half hour social/refreshments time)

Priestwood Community Centre – Mondays 10am -11:30am (inc half hour social/refreshments time)