How do painkillers kill pain? It's about meeting the pain where it is
Expand / A variety of pain relievers are available over-the-counter and by prescription.
Select Stock/Getty
Without the ability to feel pain, life is more dangerous. To avoid injury, pain tells us to use a hammer more gently, to wait for the soup to cool, or to put on gloves in a snowball fight. People with rare inherited diseases that leave them unable to feel pain are unable to protect themselves from environmental threats, leading to fractures, skin damage, infections and ultimately a shorter lifespan.
In these contexts, pain is much more than a sensation: it is a protective call to action. But pain that is too intense or long lasting can be debilitating. So how does modern medicine lessen the appeal?
As neurobiologists and anesthesiologists who study pain, this is a question we and other researchers have tried to answer. Scientific understanding of how the body detects tissue damage and perceives it as pain has advanced tremendously in recent years. It has become clear that there are multiple pathways that signal tissue damage to the brain and set off the pain alarm bells.
Interestingly, while the brain uses different pain signaling pathways depending on the type of damage, there is also redundancy in these pathways. Even more intriguingly, these neural pathways transform and amplify signals in chronic pain and pain caused by conditions affecting the nerves themselves, even though the protective function of pain is no longer needed.
>Analgesics work by attacking different parts of these pathways. However, not all pain relievers work for all types of pain. Due to the multitude and redundancy of pain pathways, a perfect pain reliever is elusive. But until then, understanding how existing pain relievers work helps medical providers and patients use them for the best results.
Anti-inflammatory painkillersA bruise, sprain or broken bone due to injury all lead to tissue inflammation, an immune response that can lead to swelling and redness as the body attempts to heal. Specialized nerve cells in the area of injury, called nociceptors, detect inflammatory chemicals the body produces and send pain signals to the brain.
Common over-the-counter anti-inflammatory pain relievers work by decreasing inflammation in the injured area. These are particularly useful for musculoskeletal injuries or other pain problems caused by inflammation such as arthritis.
Nonsteroidal anti-inflammatory drugs like ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin do this by blocking an enzyme called COX that plays a key role in a biochemical cascade that produces chemicals inflammatory. Blocking the cascade decreases the amount of inflammatory chemicals and thus reduces pain signals sent to the brain. While acetaminophen (Tylenol), also known as paracetamol, does not reduce inflammation like NSAIDs do, it also inhibits COX enzymes and has similar pain reducing effects.
>Prescription anti-inflammatory pain relievers include other COX inhibitors, corticosteroids, and more recently drugs that target and inactivate the inflammatory chemicals themselves.
[embedded content]
Because inflammatory chemicals are involved in other important physiological functions...
Expand / A variety of pain relievers are available over-the-counter and by prescription.
Select Stock/Getty
Without the ability to feel pain, life is more dangerous. To avoid injury, pain tells us to use a hammer more gently, to wait for the soup to cool, or to put on gloves in a snowball fight. People with rare inherited diseases that leave them unable to feel pain are unable to protect themselves from environmental threats, leading to fractures, skin damage, infections and ultimately a shorter lifespan.
In these contexts, pain is much more than a sensation: it is a protective call to action. But pain that is too intense or long lasting can be debilitating. So how does modern medicine lessen the appeal?
As neurobiologists and anesthesiologists who study pain, this is a question we and other researchers have tried to answer. Scientific understanding of how the body detects tissue damage and perceives it as pain has advanced tremendously in recent years. It has become clear that there are multiple pathways that signal tissue damage to the brain and set off the pain alarm bells.
Interestingly, while the brain uses different pain signaling pathways depending on the type of damage, there is also redundancy in these pathways. Even more intriguingly, these neural pathways transform and amplify signals in chronic pain and pain caused by conditions affecting the nerves themselves, even though the protective function of pain is no longer needed.
>Analgesics work by attacking different parts of these pathways. However, not all pain relievers work for all types of pain. Due to the multitude and redundancy of pain pathways, a perfect pain reliever is elusive. But until then, understanding how existing pain relievers work helps medical providers and patients use them for the best results.
Anti-inflammatory painkillersA bruise, sprain or broken bone due to injury all lead to tissue inflammation, an immune response that can lead to swelling and redness as the body attempts to heal. Specialized nerve cells in the area of injury, called nociceptors, detect inflammatory chemicals the body produces and send pain signals to the brain.
Common over-the-counter anti-inflammatory pain relievers work by decreasing inflammation in the injured area. These are particularly useful for musculoskeletal injuries or other pain problems caused by inflammation such as arthritis.
Nonsteroidal anti-inflammatory drugs like ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin do this by blocking an enzyme called COX that plays a key role in a biochemical cascade that produces chemicals inflammatory. Blocking the cascade decreases the amount of inflammatory chemicals and thus reduces pain signals sent to the brain. While acetaminophen (Tylenol), also known as paracetamol, does not reduce inflammation like NSAIDs do, it also inhibits COX enzymes and has similar pain reducing effects.
>Prescription anti-inflammatory pain relievers include other COX inhibitors, corticosteroids, and more recently drugs that target and inactivate the inflammatory chemicals themselves.
[embedded content]
Because inflammatory chemicals are involved in other important physiological functions...
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