How painkillers work

I've often wondered how prescription painkillers really work, so I asked an expert.

Dr. Stevan Walkowski is an osteopathic physician and acupuncturist. He works with people in pain every day. His Columbus, Ohio clinic, Wellcare Center for Health, offers services in osteopathy, acupuncture, massage therapy, reiki and the Feldenkrais Method.

Here is my interview with him, exclusive to That's Fit.


That's Fit: How do prescription painkillers really work?

Dr. Walkowski: Well Daryl, that's a very complex question. There are many different types of painkillers on the market today and each category treats pain with a slightly different mechanism of action. For simplicity, let's consider the most common over-the-counter medications. These are non-opiate, non-steroidal anti-inflammatory medications, and this category of drugs includes aspirin, acetominophen (Tylenol) and ibuprofen (Motrin).
Dr. Walkowski: These drugs (aspirin, acetominophen and ibuprofen) are anti-inflammatory. That is, they work to control inflammation - redness, swelling, pain, tenderness.

Aspirin and ibuprofen block a chemical called prostaglandins that carries the pain signals from the point of inflammation to the nerve. If the message doesn't get to the nerve, our brain won't receive the pain signals anymore.

Tylenol, however, is a bit of a mystery. It does seem to work well to reduce pain and fever, but it tests out as a very weak anti-inflammatory. We're not exactly sure what the mechanism is with that drug.


That's Fit: So with aspirin and acetominophen, they are just stopping the pain signals from ever reaching the brain?


Dr. Walkowski: Yes, that's true. There is also another type of pain medicine called opiates that mimics the body's own pain control chemicals, which are called endorphins. This is a different way of killing pain, but the result is the same. This includes drugs like morphine.


That's Fit: But if these drugs are just "fooling us" into thinking there's no pain, then why do some pains go away permanently with a painkiller? For instance, I had some back pain a while back, and I took a Tylenol and the pain went away for good.


Dr. Walkowski: This is where it gets interesting. I don't think anybody knows the answer to that question exactly. In order to understand back pain, we have to look at the process of muscle tightness and how it occurs. One of the theories around muscle pain suggests that there is a reinforcing loop of information that runs from the affected muscle back to the spinal cord and out to the muscle again. The tight muscle sends a pain signal to the spinal cord and the spinal cord then sends a signal back to the muscle tightening it up to protect it from more pain. So it becomes a bit of a vicious cycle of pain-spasm-pain. If you block that cycle, there is the possibility that it can release and your body can do the rest of the work of letting the muscle relax, stopping the cycle, and regulating the normal tension in the muscle again. So in your case, you were able to get in the middle of that cycle with the pain medicine you took, and your normal level of activity while the pain was less was able to help re-establish the normal tone and balance in the muscles that were affected.


That's Fit: I understand that you've eliminated drugs from your medical practice completely. Is that true?


Dr. Walkowski: Not entirely. I just try to get as much accomplished as possible without phamaceuticals. I do use medications with patients when it's necessary. Since I am not a primary care physician, when I see that a drug is needed, I'm more likely just to send the patient back to their primary doctor so they are getting their medication all from one practitioner. Then I can concentrate on other ways of helping them, like using acupuncture.


That's Fit: Thanks for your insights, Dr. Walkowski.


Dr. Walkowski: My pleasure.



-------------------------------------------------------------------------------

You can find out more about Dr. Stevan Walkowski at his Website. He practices in Columbus, Ohio, in the Clintonville area. He is also featured in a book that I wrote in 2004 called "Doctors of the Future - Central Ohio MDs and DOs Who Use Alternative Medicine."