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First, we need to make a distinction between the two main classes of painkillers, which are used for different situations and function via different mechanisms.
The first class is the narcotic opioid drugs. These are the heavy-duty drugs, like morphine and codeine, used to treat severe pain. They relieve pain in two ways: first by interfering with and blocking the transmission of pain signals to the brain, and then by working in the brain to alter the sensation of pain. These drugs neither find nor kill pain, but reduce and alter the user’s perception of the pain. They’re kind of like having an optimistic friend that says, “Hey man, everything will be cool. Nothing’s wrong. Here, look at this shiny, distracting thing!”
The other class is the aspirin drugs, like paracetamol and ibuprofen. These are the over the counter drugs we reach for whenever we’ve got a headache or a sore back. Throughout history, people all over the world were using botanical remedies for pain. The ancient Egyptians used leaves from the myrtle bush, Europeans chewed on hunks of willow bark and Native Americans did the same with birch bark. In the nineteenth century, scientists isolated the chemical in all these plants that gave them their pain relieving properties: salicin (which is metabolized to salicylic acid when consumed). They also discovered that these chemicals produced the side effect of horrendous digestive problems (which answers that other burning question, “Why is that Native American in that old commercial crying?”).
Eventually, a scientist at Bayer Pharmaceutical synthesized a less harmful derivative chemical, acetylsalicylic acid (ASA). Bayer dubbed it Aspirin and commercialized it. Hoffmann went on to develop a “non-addictive” substitute for morphine. The resulting product, heroin, was less successful than aspirin. [Bayer image courtesy of Wacky Packages.]
Despite its long history, we didn’t discover how aspirin works until the early 1970s. Unlike narcotics, aspirin drugs are real workhorses that actually go to the source of pain and stop it. When cells are damaged, they produce large quantities of an enzyme called cyclooxygenase-2. This enzyme, in turn, produces chemicals called prostaglandins, which send pain signals to the brain. They also cause the area that has been damaged to release fluid from the blood to create a cushion so the damaged cells don’t take any more of a beating. This cushion is the swelling and inflammation that goes along with our aches and pains. When we take aspirin, it dissolves in our stomachs and travels through the whole body via the bloodstream. Although it’s everywhere, it only works its magic at the site of cell damage by binding to the cylooxygenase-2 enzymes and stopping them from prostaglandins. No more prostaglandins means no more pain signals. The cells at the damage site, of course, are still damaged, but we’re left blissfully unaware.
This prostaglandin-stopping power is also why people take aspirin regularly to reduce the risk of heart attacks, since prostaglandins in the bloodstream can cause clotting. Additionally, aspirin reduces the production of thromboxane, a chemical that makes platelets, a type of blood cell, sticky. With aspirin in our systems, platelets make less thromboxane and are less likely to form a clot and block an artery.
Comments (18)
Comment
of course when aspirin works and stops the inflammation then the damaged cells do not get that extra cushioning, so this makes me wonder if aspirin and other NSAIDs Non Steroid Anti Inflammatory Drugs do harm as the cells have less protection. Does anyone know how much more damage cells get when you use aspirin?
posted by dHoward on 5-10-2008 at 12:35 pm
Actually, the old Native American in the commercial was Italian.
posted by Kathe on 5-10-2008 at 12:48 pm
that was fantastic. Thanks!
posted by ann on 5-10-2008 at 3:59 pm
I have always wondered this! Great article!
posted by Casey on 5-10-2008 at 4:07 pm
In the United States paracetamol is called Tylenol or acetaminophen. It works differently than Aspirin, and is not appropriate to put in the same group.
posted by Aaron on 5-10-2008 at 7:48 pm
Great article — thanks…. time for my Aleve … :)
posted by WizardBoy on 5-10-2008 at 10:04 pm
Posted this link in www.surfurls.com
posted by sharuk on 5-10-2008 at 10:11 pm
Small but important point, morphine, oxycodone, codeine etc belong to the opioid class of medications. Narcotics as a medical term is dated and not used among pain and palliative care professionals except when referring to legal issues about controlled substances. Continuing to use narcotics (which also include cocaine by legal definition) when referring to opioids for pain control furthers the stigma of opioids=addiction always. Addiction is possible but not an always event, especially when these meds are managed well.
And I also agree that tylenol and aspirin do not exactly belong in the same group. There is another broad class of pain medications usually lumped under ‘adjuvants’ like neurontin and elavil, and others.
posted by Christian Sinclair on 5-11-2008 at 1:07 am
@Aaron and Christian,
Thanks for the clarification.
I know morphine and codeine are both opioids, and there are other painkillers in that class. Are there non-opioid painkillers that fall under the narcotic label, or is “narcotic” a completely non-medical term?
Both these points have been edited. Thanks again.
@dHoward
That’s an interesting question, and one I hadn’t thought of in all my aspirin-using years. If I come across an answer, I’ll be sure to share.
posted by Matt Soniak on 5-11-2008 at 11:04 am
Panadol/paracetamol and Aspirin are not really in the same class.
I don’t agree that the synthetic forms of “asprin” are less harmfull than the natural
I believe the inspiration for aspirin came from Meadowsweet not as most believe Willow Bark.
The old botanic name for meadowsweet is Spirea ulmaria (?) hence the name of asprin.
posted by Michael Angel on 5-11-2008 at 1:20 pm
You’re also leaving out drugs like Neurontin, Tegretol, and other anti-neuroleptics that were originally developed for their anti-seizure properties but are used to control pain through action on the nerve’s ability to conduct impulses within itself via electrolyte channels.
posted by Jason on 5-11-2008 at 2:51 pm
First off, it’s cyclooxygenase.
Second off, Asprin works on both the COX-1 AND COX-2 enzymes. COX-1 is involved with maintaining stomach lining, which explains the risk stomach issues (ulcers) of most OTC NSAID’s.
There are COX-2-only inhibitors, but many of them have run into side effect issues (primarily cardio-vascular related, and most of these drugs have been removed from the market). These are usually only reserved for people who have stomach complications with traditional NSAID’s.
The swelling you usually get during inflammation is more of an effect than a protection. When your body recognizes damaged cells, the chemical signals will open up spaces between the cells in your capillaries to let white blood cells, platelets, and plasmids in (thus generating the swelling. This is called vasodilation). This is a secondary line of defense in our immune system (the first being the unbroken skin) designed to ward off infection. These WBC’s (mostly neutrophils) engulf and destroy bacteria and other foreign objects.
Also, interestingly enough, check out the role of Omega-3 fatty acids on the reduction of inflammation.
posted by Chris on 5-11-2008 at 3:54 pm
I have taken Aleve on several occasions for arthritic pain and found it completely ineffective! Ibuprofen works for mw, Aleve does not. Anyone else have that experience?
posted by peterg on 5-12-2008 at 8:32 am
FYI, codeine is over the counter where I live.
posted by BBrian on 5-12-2008 at 9:20 am
I find that Vikadin cures a hangover EVERY time!
posted by conrad on 5-12-2008 at 11:43 am
They don’t “kill pain”… they interact with the CNS and PNS and usually influence the transmission of pain signals.
posted by lucidguru on 5-13-2008 at 3:25 pm
Brilliant explained. Didn’t know how ibuprofen and paracetamol worked..
Only how morfine, codeine worked. So this was very interesting to me
Greetings from a 15-years old Dutch boy :)
posted by Ali on 5-15-2008 at 8:36 am
Hi, i have a huge problem, by means of stupidity I have accidentally became addicted to painkillers and want nothing more than to rid myself of this crippling addiction.
If anyone reads this I NEED UR HELP!
Others sites are so swamped with people asking this making it hard to find the right info. ALSO, I CANNOT just go to the DR. or rehab to ween off of this stuff in fear of my family finding out.
SO
Does anyone know an “at home” way of getting off of opoids? I get the worst aches and pains as well as diarrhea and deep depression. I heard you can rid yourself of the dependency after 5 days free of opoids.
i know this is off topic but i need your help and mental floss writers and readers seem like the wisest people to ask!
posted by Jason on 8-20-2008 at 6:05 pm