When you get a headache or suffer joint pain, perhaps ibuprofen works to relieve your pain. Or maybe you take acetaminophen. Or aspirin. Researchers now confirm what many pain specialists and patients already knew: Pain relief differs from person to person.
It's all in the biology, says Fine. "Human beings, person to person to person, are very different in the way they respond to drugs, and one size does not fit all." In large part, that results from genetic differences in our pain receptors — the cells in our nervous system that recognize pain and transmit that message to the brain.
Just slight differences in the chemical nature of the drugs we use affect people differently, depending on their genetic makeup, says Fine.
In a massive review of current studies and research published earlier this month, scientists at Oxford University in England examined 350 different studies involving about 45,000 patients. They looked at doses of single painkillers as well as combinations of drugs, totaling 38 different pain medications — everything from acetaminophen, aspirin and ibuprofen to more powerful opiate derivatives.
Biochemist Andrew Moore headed the study, which aimed to explore whether one medication worked "best" for most people. Their conclusion: No. Certain pain medications which worked to relieve pain for certain individuals were barely noticeable for others.
It's a simple message for physicians, says Moore. "If the first painkiller a patient tries doesn't seem to be working, then a doctor should look to find an alternative reliable drug and see if it is more effective in that individual patient," he says.
Moore also found that combinations of medications often worked best, providing potent, long-lasting pain relief. Pain specialist Perry Fine says that coming up with effective pain treatment for patients is often a matter of trial and error. In the absence of genetic testing to predict a patient's response to a certain painkiller, the best option, he says, is to figure out a pain relief combination based on the patient's past experience in coping with pain.
But Fine offers this note of caution: More is not necessarily better, and certain high doses of individual medications as well as certain combinations of pain drugs can be toxic to the liver and kidneys. That's reason enough to check with your doctor first about safe doses and safe combinations of pain medications.
STEVE INSKEEP, Host:
So, sugar might help relieve pain for babies, but when adults get a bad headache or have joint pain, they usually head for that bottle of aspirin or Tylenol or Motrin. A recent analysis of lots of different pain studies tried to find out whether there's on single pain medication that seems to work better than others for most people. As NPR's Patti Neighmond reports, the research confirmed what pain specialists already know: Relieving pain is different for each person.
PATTI NEIGHMOND: Ask any group of people when they head for the medicine cabinet. That's what we asked Megan Levi, Dave Price and Joan Turman at a metro stop in Washington, D.C.
MEGAN LEVI: Only when I have a really bad headache.
DAVE PRICE: I'm actually taking some aspirin today, because I have a cold.
JOAN TURMAN: Pain medication? When I just really can't take it anymore.
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NEIGHMOND: And when it comes to pain relief, these people pretty much reflect what researchers found. They're all different when it comes to which medication works best for them.
TURMAN: Aleve, Tylenol.
LEVI: I usually use ibuprofen, or an Advil once in a while.
NEIGHMOND: Why so different? It's all in the biology, says Dr. Perry Fine, president of the American Academy of Pain Medicine.
PERRY FINE: Human beings, person to a person to a person, are very different in the way they respond to drugs, and one size does not fit all.
NEIGHMOND: That's because of genetic differences in pain receptors. These are the cells in their nervous system that recognize pain and transmit that message to the brain.
FINE: And so slight differences in the chemical nature of the drugs we use affect individuals differently depending upon their genetic makeup.
NEIGHMOND: Researchers at Oxford University in England reviewed dozens of studies involving tens of thousands of patients. They looked at 38 different pain medications, everything from Tylenol, Aspirin and Ibuprofen, to more powerful medications like Oxycontin and Vicodin. Biochemist Andrew Moore headed the study, with one question in mind.
ANDREW MOORE: How well do they work? How well do they work compared with anything else I might take?
NEIGHMOND: The answer was as mixed as the people on the street we just heard from. Different medications worked for different people. But one of the more striking findings, it was combinations of pain medications that worked best.
MOORE: Each of them works a little bit. Then what happens if you put several little bits together is you get a lot. And it's interesting thing to see, that combinations of relatively simple and old analgesics like acetaminophen and ibuprofen can be helpful and really very potent when you put them together.
NEIGHMOND: In fact, when Tylenol was combined with Advil, effectiveness more than doubled. But then again, not for everyone.
FINE: How are the medications working? Are they causing you bad side effects?
LEVI: At the University of Utah Pain Management Center, Dr. Fine counsels his patient, Kimberly Ball, who suffers chronic back pain from arthritis.
KIMBERLY BALL: And in the winter time it seems, you know, gets a little worse, but now that I'm back on the other medication, I can deal with it a lot better.
NEIGHMOND: Coming up with effective pain treatment, says Fine, is often a matter of trial and error.
FINE: In the absence of genetic testing, to know exactly what somebody's predictable response is going to be, which we don't have yet, then we give our first best shot at trying to match the patient with a drug that we think will be most helpful to them based upon our past experience and their experience. And if it doesn't work, then we got to go to another choice.
NEIGHMOND: Fine says he often uses combinations of pain medication, but only with caution.
FINE: These are not drugs that are benign. That is, even though people can buy them by the bucket load for almost no cost at all at big-box stores, one of the problems we see is that people think these are safe drugs, their pain's not well controlled, so if a little's good, maybe more is better.
NEIGHMOND: But more can be toxic to the liver and kidneys, which is why it's so important, Fine says, to check with your doctor about safe doses and safe combinations of pain medication. Patti Neighmond, NPR News.
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