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Can you really beat pain without drugs?

10/08/2020

Can you really beat pain without drugs? After new official advice warns GPs not to prescribe pills for chronic pain, check out our expert guide to the alternative options

Some pills should no longer be routinely prescribed to patients with chronic pain
Advice came from the National Institute for Health and Care Excellence (NICE)
Nice suggests exercise, therapy and alternative remedies such as acupuncture

Taking painkillers too often may be doing more harm than good. That was the advice last week from the National Institute for Health and Care Excellence (NICE), which warned that pills including paracetamol, aspirin, ibuprofen and opioids such as codeine should no longer be routinely prescribed to patients with chronic pain — defined as pain that lasts three months or longer — with no obvious cause.

This follows a Good Health campaign that highlighted the risk of addiction from opioids. But if you’re in chronic pain, what will help? Nice suggests exercise, therapy and alternative remedies such as acupuncture should be offered.

PAT HAGAN asked experts to assess over-the-counter drug-free fixes (we then rated them).

Cooling gel to soothe aches 7/10

LloydsPharmacy Freeze Gel, 100ml, £3.99, lloydspharmacy.com

CLAIM: This gel is designed to be massaged into ‘mild aches’ from muscles or joints. It contains menthol and camphor, which have a cooling effect that is said to temporarily soothe away pain.

EXPERT VERDICT: ‘Menthol triggers a cold- sensitive receptor [called TRPM8] in the skin, which then sends a message to the brain that the area is being chilled, although how this eases pain remains unclear,’ says Professor Robert Moots, a consultant in rheumatology at Aintree University Hospital, Liverpool.

‘It’s possible it constricts blood vessels, which might reduce inflammation, but it’s most likely to just distract the brain from the pain. This makes it potentially useful for minor strains, but not for long-term conditions such as osteoarthritis.’

Pain-busting zapper pen 4/10

Paingone Pen, £34.99, boots.com

CLAIM: This battery-powered device is said to provide relief from everything from sciatica to migraine and muscle aches using transcutaneous electrical nerve stimulation (TENS) — where an electric current is generated to interrupt the pain signals from the area of pain along the spinal cord to the brain.

The pen is held against the skin, as often as needed, for 60 seconds, generating a mild tingling sensation.

EXPERT VERDICT: ‘Traditional TENS machines that use electrodes to deliver an electric current are used in childbirth to ease labour pain, although the evidence as to how effective they are is mixed,’ says Professor Moots.

‘There is a lack of evidence for how effective this approach is in muscle or joint pain, which can be chronic and with different causes. This pen will only provide short-term relief.’

Migraine forehead strips 2/10

Kool ‘n’ Soothe Migraine, pack of four, £2.33, most pharmacies

CLAIM: These soft gel sheets are meant to provide immediate relief from migraines, headaches and hot flushes by cooling down the fore- head — or back of the neck — for up to eight hours. The main cooling ingredient is water.

EXPERT VERDICT: ‘This is not something I would recommend for anyone with a severe headache or migraine,’ says Dr Andrew Dowson, a headache specialist at King’s College Hospital, London.

‘These strips might help take the edge off for those with mild pain or while waiting for the painkillers to take effect but, on their own, they are very unlikely to get rid of the pain. Using a damp flannel would have the same effect.’

‘Electric’ bandage for knee 6/10

ActiPatch Knee Pain Therapy Device, £22.39, amazon.co.uk

CLAIM: The device is a cross between a bandage and a knee support made from elasticated material with a ‘generator’ inside that fires electromagnetic pulses straight into the knee.

These pulses are said to stimulate nerves in the joint, which dampen down pain signals transmitted to the brain. Other versions are available to soothe sciatica or lower back pain. Wear until you get an effect, the maker says.

EXPERT VERDICT: ‘A review of electromagnetic pulse therapy this year concluded that it was ‘safe and effective’ in the treatment of both acute and chronic muscle pain, even at the low intensity found in this patch,’ says Tim Allardyce, a physiotherapist specialising in pain control at Surrey Physio clinic in Mitcham.

‘Whether it would be able to tackle very painful conditions such as sciatica is doubtful.’

Pain relief in a roll on 1/10

Puressentiel Muscles and Joints Roller, 75ml, £14.99, hollandandbarrett.com

CLAIM: This roll-on contains a mixture of 14 essential oils, including nutmeg, eucalyptus and peppermint, in a ‘natural’ pain-relieving formula.

Rub on sore joints and muscles three times a day to suppress pain.

EXPERT VERDICT: ‘Any benefit from this is almost certainly due to the effects of massaging the painful area with the roller ball,’ says Professor Moots.

‘We know that any form of massage can provide an element of relief by simply helping muscles relax, which can impede pain messages from reaching the brain.

‘There’s no evidence that any of the ingredients have an active effect on painful muscles or joints and, even if they did, the amounts that would reach the damaged areas by rubbing them on the skin with a roller would be absolutely tiny.’

‘Hot’ spray for sprains 4/10

Boots Pharmaceuticals Pain Relief Heat Spray, 125ml, £2.99, boots.com

CLAIM: The main active ingredient is ethyl nicotinate, a chemical that dilates blood vessels near the skin’s surface to improve blood flow, allowing more oxygen and nutrients to reach the site, which is said to reduce inflammation and pain. Use two or three short bursts on aches, sprains and strains.

EXPERT VERDICT: ‘This mechanism could be effective for mild pain relief,’ says Tim Allardyce.

‘There is no doubt that heat can help joints, especially degenerative or arthritic joints, which is why people often find warm weather makes their joints feel better [this is possibly due to changes in atmospheric pressure].

The effects will probably be short-lived because it won’t penetrate deep into the joint. For a similar benefit, apply a hot water bottle for ten minutes once a day.’

DIY ultrasound treatment 4/10

Revitive Ultralieve Ultrasound Therapy, £149.99, lloydspharmacy.com

CLAIM: This hand-held, portable gadget generates sound waves that are said to penetrate soft tissue and relieve aches and pains.

The high frequency sound, it is claimed, can make cell walls more permeable — allowing more proteins from the blood to get inside to kick-start healing and dampen down inflammation. Use for five to 15 minutes a day.

EXPERT VERDICT: ‘There is limited evidence supporting the use of ultrasound therapy for tissue repair and pain relief,’ says Tim Allardyce.

‘We know from research that ultrasound can improve localised blood flow and create heat in the area, which is good for painful conditions because heat dilates blood vessels, allowing more blood to flow to the area that contains the oxygen and nutrients needed to reduce inflammation.

But these hand-held machines are not as powerful as professional grade ones.’

Painkiller in a plaster 6/10

Voltarol Pain Relief Medicated Plaster 140mg, pack of two, £9.99, boots.com

CLAIM: This stick-on bandage for one-off use on strains and sprains contains 140mg of diclofenac sodium, a drug normally prescribed in tablet form to ease pain and swelling by reducing inflammation.

By placing on to the damaged area, the drug seeps through the skin. Wear for 12 hours and do not use these plasters for more than a week. Suitable for over 16s.

EXPERT VERDICT: ‘Diclofenac is a good painkiller and anti-inflammatory drug,’ says Professor Moots.

‘But there is considerable doubt over whether topical application is as effective as taking it orally — there is no evidence that, when it is applied to the skin, it is able to reach the area that needs treating.

It belongs to a class of medicines called non-steroidal anti-inflammatory drugs, which can cause severe allergic reactions in some patients with asthma, potentially even when used topically.’

Needle-free acupuncture 2/10

Laser Acupuncture Pen, £8, wish.com

CLAIM: The battery-powered, pen-sized gadget provides a needle-free alternative to acupuncture using laser beams to generate pain relief, the maker says. It has a dome-shaped end, which is pressed against the painful area.

At the push of a button, invisible laser light passes through this dome and into the tissue beneath the skin.

The manufacturer claims it’s capable of soothing pain caused by arthritis, osteoporosis, sciatica, migraine, back pain and sports injuries — as well as muscle, joint and back pain. Use as often as required.

EXPERT VERDICT: ‘I think a pen that claims to do acupuncture without the needles is a little far-fetched,’ says Tim Allardyce.

‘I doubt that there would be any significant pain relief using this product.’

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