Nobody likes pain. This is why we invented painkillers. Are painkillers useful? Of course they are. People entering surgeries, just experiencing major trauma and and mothers about to deliver babies are just a few of many justified uses of painkillers. But how about in the field of rehabilitation and chronic pain?
Trauma and Painkillers
Recently I experienced grade 2 ankle sprain caused by my own carelessness. It was painful for me to simply put my feet down, let alone walk. What follows was a merry go round of 2 X-Rays and one MRI. Three ligaments were torn severely but not completely. Some foot tarsal bones were also severely bruised but none were broken. The orthopedic surgeon happily prescribed me a list of prescription medicine that includes strong painkillers up to the third week after the incident.
My case may not be typical. However, it cannot be denied that when a patient just experienced trauma, painkillers would be on the top list of drugs the doctor will prescribe.
Why This is Good and Bad
Traumas cause pain. Of course painkillers would be useful to help the patient get a decent rest that helps in recovery. However, every sane doctor will admit that painkillers have side effects. And painkiller dependency is not something any patient would want. In my case, the injured ankle was no longer causing any pain when it is in neutral position and not bearing any weight within 3 days after the incident. Continued dosage of painkillers in my bloodstream at that stage can cause more harm than good
Why Painkillers Could Interfere With Rehab
Believe it or not, pain actually has a function in our body. We even have specific tissues called pain receptors simply to perform this function. In the case of ankle and knee rehabilitation, it actually helps tells you which particular position, movement or loading that will worsen your injury. I was able to tell which particular ligaments were injured before the MRI result came in. Skilled physiotherapists can use pain as information to devise a training regimen that will best suit the situation. The training regiment can help improve your recovery and prevent repeated injury in the future. If you are on a heavy painkiller, your sense would simply get dulled, and it will interfere with your proprioception and rehab work. Proprioception is the muscle and ligament’s capability to sens its surrounding without the aid of vision.
In many cases such as mine, the general consensus by the American Orthopedic Association is that the patient should start basic physiotherapy once it becomes pain free to a certain range of motions. Keep in mind that rehab and gradual pain free motion and weight bearing is essential to your recovery. The keyword here is being gradual and pain free.
Chronic Pain and Painkillers
By definition, chronic pain is a type of pain that you experience either continuously, or on and off over an extended period of time. As Dr. McGill lamented in his book, Back Mechanics, the problem is that too many doctors are using painkillers to simply stop you complaining. If you are only getting painkillers without any treatment to address the underlying pain, then over time you will only become increasingly dependent on an ever increasing dosage of painkillers.
As Dr. McGill mentioned, whenever a doctor started prescribing you painkillers, you should ask the following questions:
- Why? What is the underlying problem that is causing the pain that needs to be addressed
- How long? What is the action plan to taper the usage of these painkillers.
Ultimately, pain in itself can be a gift even among elite athletes. You should not simply bury your pain in painkillers without understanding the cause and how to deal with the pain.
The next time you feel pain, don’t think of it as something bad. Your body is actually telling you what is wrong. Treat it as a gift.