Author Nina Ebert, biologist
Why is there pain?
By medical definition, pain is an unpleasant sensation caused by actual or potential tissue damage. This means that pain serves a vital alarm and protective function in the event of danger of injury or even death.
Pain is triggered by certain stimuli such as injuries, cold, burns, pressure, or internal conditions such as inflammation or a disturbed nervous system. The nervous system transmits these stimuli to the brain. However, the brain does not have direct pain receptors and therefore cannot perceive pain itself.
Pain is based on a subjective perception that can vary greatly from person to person. The causes of pain are not always purely physical. The psyche has a significant influence on the perception of pain. Psychosomatic pain caused by intense emotional stress is not uncommon. The perception of pain can be intensified by grief, but reduced by joy. There is acute pain and chronic pain, the latter being a distinct disease. The original alarm function has lost its significance here.
Painkillers - anti-inflammatory, antipyretic, direct
The reason for the invention of painkillers is obvious - pain is no fun, neither acute nor chronic. The most common painkillers used in everyday life are NSAIDs, so-called non-steroidal anti-inflammatory drugs . These include common active ingredients such as acetylsalicylic acid, ibuprofen, paracetamol and diclofenac. The advantage is probably known to everyone from personal experience and immediate relief: immediate, direct, targeted and effective relief of pain. NSAIDs are absolutely right and important for quickly relieving acute inflammation of any kind, reducing fever or recovering after surgery. But what are the disadvantages and dangers of long-term use of NSAIDs? What are the consequences of long-term use of these medications and how can they have a lasting impact on the body's systems? To explain this in detail, here is a brief overview of the effects of NSAID painkillers.
NSAIDs - Pain relief through reduced prostaglandin synthesis
In contrast to "traditional" painkillers, opioids, which block pain receptors, NSAIDs inhibit prostaglandin synthesis. Prostaglandins are hormones that cause pain and also have important signaling properties. Reduced prostaglandin synthesis means less pain sensitivity in the nerve fibers and produces a decongestant effect. NSAIDs block the function of the two key enzymes involved in prostaglandin synthesis, the enzymes COX-I and COX-II, or simply COX-II.
What are the risks of taking NSAID painkillers?
Despite their beneficial effects for many people, NSAIDs sometimes carry high risks and serious long-term side effects. These painkillers are considered OTC (over-the-counter) medications, meaning they can be purchased without a prescription at pharmacies. The risks and side effects, especially when used long-term, should be carefully considered, as the consequences should not be underestimated.
- Damage to the gastrointestinal tract and microbiome
Painkillers from the NSAID class can irritate and damage the stomach lining in the medium to long term. Gastric juices are extremely acidic (pH 2-4), and if they come into prolonged contact with a stomach wall irritated by painkillers, this can cause gastritis, stomach ulcers, and gastric bleeding, and in the worst case, even perforation (a permeable stomach wall). The stomach acids then enter the abdominal cavity and attack organs that are not adapted to an acidic environment. Therefore, proton pump inhibitors (PPIs) or acid reducers are usually also given with chronic painkillers to block or reduce the secretion of stomach acid. However, this results in a stomach environment with an excessively high pH, which is detrimental to proper digestion. The digestion of proteins, in particular, depends on an extremely acidic environment.
In addition, some NSAIDs and acid reducers cause a shift in the gut microbiome. The consequences can include colonization imbalances, bloating, nausea, and diarrhea. The growth of unfavorable bacteria in the gut can also lead to allergies, immune deficiency, and susceptibility to infections, as well as psychological problems such as depression.
- Increased risk of cardiovascular disease
The American Food and Drug Association (FDA) warns that the risk of heart attack and stroke can increase significantly in the first week of taking NSAIDs and can worsen with longer use, even without a history of cardiovascular disease and at a young age. Numerous studies and experts warn of the risks of high blood pressure, bleeding due to blood thinning, as well as embolisms and thrombosis, which are significantly increased with medium-term and long-term use of NSAID painkillers. A study at Aarhus University Hospital in Denmark examined the risk of cardiovascular disease when taking NSAIDs among 6.3 million adults between 40 and 60 years of age. The study found that even a small amount of diclofenac caused a higher number of cardiovascular symptoms (heart attacks, strokes, heart failure) within the first 30 days than, for example, ibuprofen or paracetamol. According to lead researcher Morten Schmidt, “there is no reason to prescribe diclofenac.”
- Liver and kidney damage
According to Dr. Anton Gillessen of the Department of Internal Medicine at the Herz-Jesu Hospital in Münster, long-term use of NSAIDs and the combined use of several medications are particularly dangerous. When the active ingredients accumulate, critical levels are quickly reached, especially if the liver is already under stress. Furthermore, excessive use of NSAIDs is a risk factor for kidney failure, not only for people with kidney disease and fluid imbalance.
- Interactions with other medications
Painkillers like ibuprofen can interact with blood thinners, anticoagulants, and diuretics, as well as some blood pressure medications, when taken long-term, which can affect the effectiveness of both medications. In summary, alternatives to NSAIDs are urgently needed, especially for treating chronic pain. There are frequent warnings about NSAIDs and their high risks, yet they are still freely available. So, what life hacks are available for pain management?
The best natural painkillers
Instead of ibuprofen, ASA (acetylsalicylic acid), and the like, there are a whole range of effective natural methods for pain relief and alleviation - sustainable and free of side effects.
- Cryotherapy Cold shock produces so-called cold shock proteins (CSPs), a special class of proteins that reduce inflammation and promote tissue regeneration. Regular ice baths or a cryotherapy chamber for specifically designated cold therapy provide effective cold shock. In addition to reducing inflammation, cryotherapy also has other biological effects in the body, such as stimulating blood circulation, cell regeneration, and many more.
- Compresses - alternating hot and cold Especially for muscular injuries and discomfort, simple compresses, alternating hot and cold, can have a very simple and effective effect. The anti-inflammatory effect is created by the temperature change between hot and cold. Both cold shock and heat shock proteins are produced in greater quantities, while the pressure of the compress reduces blood flow to the wound. This, in turn, reduces swelling and inflammation.
- Acupuncture - Traditional Chinese Medicine (TCM)
The ancient technique of acupuncture involves inserting needles at specific points along the meridians. According to TCM, each point has a specific effect. Acupuncture can effectively relieve painful nerve pathways, stimulate the release of endorphins, and reactivate the flow of energy where it was blocked, thus promoting lasting healing.
- PEMF - Pulsed Magnetic Field Therapy
Physiotherapists and other body therapists offer PEMF (pulsating electromagnetic fields) sessions to accelerate the healing of bone fractures and injured cartilage, among other things. The electromagnetic pulses alter certain cellular functions and are used therapeutically in many areas to influence functional disorders or structural damage .
Many surgeons recommend PEMF as an effective post-operative method to minimize inflammation—inflammation is the source of pain. A double-blind, placebo-controlled clinical trial investigated the pain perception and recovery of 29 patients with tendinitis (tendon inflammation) in the shoulder. At the end of the study, 19 (65%) of the 29 patients were symptom-free, and five other patients improved significantly. PEMF therapy can therefore be very effective in treating persistent inflammation of the rotator cuff (upper arm/shoulder) and possibly other chronic tendon injuries. It is also used to accelerate recovery after workouts and to keep inflammation levels low. The technique uses electromagnetic pulses that oscillate through the tissue, gently stimulating anti-inflammatory and repair mechanisms. PEMF treatments are offered in physical therapy and chiropractic offices for those who don't want to purchase their own device, which costs around €1,000.
2. TENS - Transcutaneous electrical nerve stimulation
The TENS method can also help reduce pain, including menstrual pain, pelvic pain, sports injuries, and arthritis. The TENS device is smaller than a PEMF device and significantly less expensive. Two adhesive pads with electrical poles are applied to the corresponding area of the body. When switched on, mild electrical impulses are sent into the tissue of that area. A gentle tingling sensation is felt, and the low-frequency stimulation can reduce pain signals, which are then transmitted via the spinal cord to the brain. TENS thus contributes to muscle relaxation and pain relief and can also stimulate the production of pain-relieving endorphins.
- Massage therapy
A professional massage, such as a deep tissue massage or a soothing full-body massage with warm oil, can also work wonders. Massages relax the muscles and brain, contribute to improved blood and lymph circulation, stimulate detoxification, and thus also stimulate the body's anti-inflammatory mechanisms and self-healing powers. Relaxed tissue can help release tension and thus relieve pain.
Summary
Painkillers like ibuprofen, which belong to the NSAID class, undoubtedly have their place, but they can cause severe side effects if taken long-term. It's important to take the risks and side effects of long-term use seriously and to discuss possible alternatives such as manual therapy, traditional naturopathy, acupuncture, or targeted antioxidant supplementation with your doctor or therapist before taking any steps alone.
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