4

votes

Where do painkillers fall along the "optimal" spectrum?

Answered on September 12, 2014
Created June 05, 2011 at 7:27 PM

I'm not asking if they're Paleo - I know they definitely are not.

As others have said here, "paleo" doesn't necessarily mean "what our ancestors ate." It can mean what's optimal for us.

That said, I'm currently trussed up in a figure of 8 brace for a fractured clavicle. Believe me, the brace hurts. A broken bone is usually immobilized by a cast. You can't do that with your collarbone.

I was given a ton of prescription-strength painkillers (500-mg generic Vicodin [hydrocodone but mostly acetaminophen] to be taken no more than eight times a day) and NSAIDs (800mg of generic Motrin, to be taken three times a day).

I originally declined the Motrin but was told by my earnest, wide-eyed doctor that I needed to take it to help with the shoulder and arm inflammation that came along with the broken bone as a result of a bike crash. I didn't search for information on inflammation here until today and it seems that the consensus (here, http://paleohacks.com/questions/1667/what-is-a-paleo-anti-inflammatory-for-acute-inflammation#axzz1OQkTAllQ) is that inflammation is good in cases of acute injuries. Oops. I'm going to stop taking the Motrin.

That said, I'm wondering about the Vicodin. The side effects look nasty and it seems like the body takes a beating in processing all the chemicals. However, I can't sleep without taking one of the Vicodin a little before bedtime. It hurts too much. No sleep=prolonged recovery, and sufficient sleep IS paleo.

Again, I think the eight pills a day is too much. However, are there cases in which taking painkillers might do more good than harm, just to let the body recover more comfortably? I'm not referring only to my situation - I'm not looking for rationalizations or permission to take the hydrocodone. I can imagine there are many people who are in awful pain due to far worse injuries or chronic conditions. Painkillers aren't Paleo and they may have a long-term negative effect on the body. But are they closer to the "optimal" end of the spectrum than "gritting your teeth and bearing it" is in some cases?

27e79ef3308bb5f2d7bd04ee7eea7b79

(2038)

on December 29, 2011
at 08:21 PM

Wow. I googled it as you said - http://www.physioroom.com/research/reviews/200502_review_nsaids.php I wish I'd seen this several months ago. It may have changed my decision about taking the Motrin, or it may not - but it'd have been good to know. The bone has healed but it was a very long process.

6b59648a7e1a8499cb4947d1a883f764

(10)

on June 30, 2011
at 04:36 PM

@Kamal, I wont get deep into the neurology of Motion overrides pain, here is a link that makes it palatable, and it starts at the joint. http://health.howstuffworks.com/human-body/systems/nervous-system/pain4.htm . @ downvoting concerns, I would not downvote without an explanation it goes against my credo of never complain unless you have a "solution".

47a42b6be94caf700fce9509e38bb6a4

(9647)

on June 07, 2011
at 01:03 AM

@Akd, whoops, sorry, I wasn't criticizing, just clarifying. I also find the "downvote every answer in a thread" maneuver extremely irritating, and have also expressed frustration at downvotes given for no good reason.

47a42b6be94caf700fce9509e38bb6a4

(9647)

on June 07, 2011
at 01:02 AM

@Akd, whoops, I wasn't criticizing, just clarifying. I also find the "downvote every answer in a thread" maneuver extremely irritating, and have also expressed frustration at downvotes given for no good reason.

47a42b6be94caf700fce9509e38bb6a4

(9647)

on June 07, 2011
at 01:01 AM

@Akd, I wasn't criticizing, just clarifying. I also find the "downvote every answer in a thread" maneuver extremely irritating, and have also expressed frustration at downvotes given for no good reason.

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on June 06, 2011
at 08:36 PM

that said, i love my chiro and i turn to him before my PCP in most maters. he has done more for my general health and well being than almost anyone, and saved my husband from double knee surgery. in fact, my husband has two numbers programmed into his cell phone- me and our chiropractor. they have tools that are invaluable in the pain-fight.

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on June 06, 2011
at 08:34 PM

sorry paul. didnt mean to have a little tantrum. just irritating when everyone gets a down vote with no explanation. my bad.

21fd060d0796fdb8a4a990441e08eae7

(24543)

on June 06, 2011
at 06:28 PM

I have a suspicion that some things in this post are incorrect. Motion overrides pain? Topical cooling/heating/irritating often does not affect (deep) joint pain, although it can be great for (superficial) muscles. That being said, active release is great. And as a chiropractor who offers ART, I fully expect you to give me a discount because I'm paleo.

47a42b6be94caf700fce9509e38bb6a4

(9647)

on June 06, 2011
at 05:33 PM

@Akd: Couldn't be -- you can see on his user page that he has never voted anything down (or up).

1568416ef28477d1fa29046218d83ddd

(6235)

on June 06, 2011
at 04:52 PM

The worst is a slight "pinching" sort of feel, it doesn't feel like syringes from the doctors office. Sometimes it hurts when they twist or heat them, or even use electric current, but that isn't a "sticking" sort of pain, it feels more like the pain from when you have sat on your foot for a long time and get off of it-

27e79ef3308bb5f2d7bd04ee7eea7b79

(2038)

on June 06, 2011
at 03:19 PM

I know people say it doesn't but I gotta hurt anyway... don't those needles hurt?

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on June 06, 2011
at 01:33 PM

so then are you the one who went through and down-voted everyone?

1568416ef28477d1fa29046218d83ddd

(6235)

on June 06, 2011
at 01:16 PM

I have never considered giving up my sumatrypin type drugs for migraines. I just can't be non-functional for a few days whenever I get one.

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on June 06, 2011
at 11:06 AM

Wow. Really strange to downvote this answer with no comment. Someone really hates that I take motrin I guess.

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on June 06, 2011
at 02:26 AM

Shes a beast, kamal! She was on her best behavior for you today, but if you were in the car with us the way home, you would have begged me to leave you on the side of the road! I almst bit into my secret cyanide tooth.

21fd060d0796fdb8a4a990441e08eae7

(24543)

on June 05, 2011
at 11:42 PM

lil' miss akd is loud? i can see junior akd causing a ruckus.

8b982d4beccca9fcb85affe8d4bd4ff2

(1585)

on June 05, 2011
at 09:40 PM

You are one tough cookie!

  • 27e79ef3308bb5f2d7bd04ee7eea7b79

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10 Answers

best answer

2
Ed983a42344945b1ff70fd9597a23493

on June 05, 2011
at 07:40 PM

I think that severe pain can keep you from healing as quickly. That said, I also think we shy away from pain too much these days, and feeling some pain is a great indicator of the healing process' progress. I would take just enough pain killer to keep severe pain at bay, and try not to dull it completely. Be sure to do lots of other things to support your body's natural healing process, and remember to treat your injury like it hurts, even when the medication is dulling the pain! Good luck...

best answer

3
77877f762c40637911396daa19b53094

(78467)

on June 05, 2011
at 07:52 PM

Chronic pain yields chronically elevated cortisol levels. This can have a negative effect on a whole host of immune and other bodily functions. Painkillers in this context may be the example you are looking for.

I'm fine with the pain that comes with working out, but not the kind that comes from a broken body. Were I you, I'd take the Vicodin as needed, "paleo" be damned.

best answer

2
D5096ff5baffc0ba5d20b21346414a7a

(1112)

on June 05, 2011
at 08:01 PM

I also hate to take pain killers if I can tolerate the pain. What I have found out over the last 6 months is that I probably need to be taking 2 Aleve twice a day just as the orthopedic specialist said (broken heel). When I don't take them, the ankle swelling is terrible as well and obviously there is inflammation involved whether there is excruciating pain or not. So I am taking them and start therapy tomorrow to see if I the PTs can work their magic. It is really a hard question to answer since so many people abuse pain medication.

8b982d4beccca9fcb85affe8d4bd4ff2

(1585)

on June 05, 2011
at 09:40 PM

You are one tough cookie!

best answer

4
Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on June 05, 2011
at 10:56 PM

i get migraines, so i take 800mg of motrin as the first sign. i have two loud kids, and cant afford to spend the day in bed nursing a headache when they happen. i used to take them a lot more frequently, but once or sometimes twice a month for me i have found to be great. its not frequent enough to cause rebound headaches or develop a tolerance, but it is enough to stop a migraine in its tracks or reduce the duration and severity at the least.

i think that youre the best judge of whats best for you and what your body can handle, but its hard to be honest with yourself as to the point it becomes a physiological or emotional crutch.

21fd060d0796fdb8a4a990441e08eae7

(24543)

on June 05, 2011
at 11:42 PM

lil' miss akd is loud? i can see junior akd causing a ruckus.

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on June 06, 2011
at 02:26 AM

Shes a beast, kamal! She was on her best behavior for you today, but if you were in the car with us the way home, you would have begged me to leave you on the side of the road! I almst bit into my secret cyanide tooth.

1568416ef28477d1fa29046218d83ddd

(6235)

on June 06, 2011
at 01:16 PM

I have never considered giving up my sumatrypin type drugs for migraines. I just can't be non-functional for a few days whenever I get one.

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on June 06, 2011
at 11:06 AM

Wow. Really strange to downvote this answer with no comment. Someone really hates that I take motrin I guess.

best answer

11
21fd060d0796fdb8a4a990441e08eae7

(24543)

on June 05, 2011
at 11:38 PM

Painkillers are paleo. And here is why. (I'm only half-joking)

First, a minor definition issue. Painkillers are things that stop the pain signal from propagating somewhere along its path or target receptors that counteract pain signals (e.g. Vicodin, Oxycontin, etc). NSAIDs and other drugs can stop things associated with pain or causative of pain. The distinction between these two categories is important when putting pain-stopping drugs in the context of evolution.

Now here is why painkillers are paleo, given the right context. Opioid medication is very very similar to endogenous painkillers (endorphins). That similarity is responsible for all that is bad with opioids as well as all that is good. Because they are so specific for opioid receptors, and mirror chemicals in the body, they work awesomely and have very few systemic side effects compared to other drugs. The poppy plant was perhaps the most important medicinal plant for our great-great-great...grandparents.

But...they they provide a fertile ground for recreational usage. On the flip side, "addiction" to painkillers by someone with bad chronic pain issues is a terribly wrong misnomer that is propogated by evil doctors, insurance, and the federal government. If you need painkillers, you need them. Cavemen would not face similar pain stimuli as we do. They would have fewer repetitive motion injuries to small joints. Acute pain from falls and such would (probably) go away either from rest or from, well, dying.

I've actually got a way-too-long answer to this question, but will address it in my blog on pain issues (to be launched in around 2-3 weeks). The conclusion to that future post is going to be that the issue is complex, and painkillers are both really good and really bad. In some cases, painkillers can actually be curative, to a degree, and not just symptom-reducers. In my opinion, most physicians don't understand painkiller issues enough, and it's good for random internet dudes (i.e. me) to take a second look at them and tie their usage to diet and lifestyle changes.

1
Cf4576cbcc44fc7f2294135609bce9e5

on December 29, 2011
at 05:29 AM

Google the scientific experiments titled ASPRIN DELAYED HEALING and discover why you would have to be crazy to take an NSAID.

27e79ef3308bb5f2d7bd04ee7eea7b79

(2038)

on December 29, 2011
at 08:21 PM

Wow. I googled it as you said - http://www.physioroom.com/research/reviews/200502_review_nsaids.php I wish I'd seen this several months ago. It may have changed my decision about taking the Motrin, or it may not - but it'd have been good to know. The bone has healed but it was a very long process.

1
1568416ef28477d1fa29046218d83ddd

(6235)

on June 06, 2011
at 01:25 PM

Another option to consider is an acupuncture session. Not knocking opiods, but I have found that for me they just make me not care that I hurt, they don't make me not hurt. Acupuncture can actually make it not hurt or "tun down the volume" on that actual pain, not the caring about the pain for me.

I broke my clavicle and pelvis in a car wreck about a decade ago. I remember the pain. As soon as I was out of the hospital I went to see the needle guy. It helped SOOO much more. And as a bonus he is a TCM doctor so he gave be these awesome bruise balls that got rid of so much of my bruising.

1568416ef28477d1fa29046218d83ddd

(6235)

on June 06, 2011
at 04:52 PM

The worst is a slight "pinching" sort of feel, it doesn't feel like syringes from the doctors office. Sometimes it hurts when they twist or heat them, or even use electric current, but that isn't a "sticking" sort of pain, it feels more like the pain from when you have sat on your foot for a long time and get off of it-

27e79ef3308bb5f2d7bd04ee7eea7b79

(2038)

on June 06, 2011
at 03:19 PM

I know people say it doesn't but I gotta hurt anyway... don't those needles hurt?

1
6b59648a7e1a8499cb4947d1a883f764

(10)

on June 06, 2011
at 03:45 AM

I would have to disagree with the majority and so no, painkillers & nsaids are not paleo. I understand you are injured (those things happened attacking your dinner with a spear & rock), however tapping into chemical and pharmaceuticals, and yes there are better options than "grinning and bear it".

You should address the issue on 3 levels 1)inflammation 2) Pain, and 3)long term function.

1) Inflammation ties the following 2 levels together. Managing inflammation will help the pain and immobilization of the injury. The paleo approach would be RICE, rest, ice, compression, elevation. Rest is obvious, yet an innate demand that we often ignore. Ice-as ice, or cooling in a body of water (ocean, river, lake), compression=wrap it! and eleveation (goes hand in hand with rest). Dietary sources that were available for Palea such as increasing omega 3 fatty acids, tumeric, and arnica will also help, as well as avoiding inflammatory foods (stay paleo!)

Few studies on Prescription and OTC painkillers, as well as fish oils http://articles.mercola.com/sites/articles/archive/2006/07/20/taking-tylenol-even-at-a-recommended-dose-can-harm-your-liver.aspx

Prescription Drug abuse http://www.nytimes.com/2011/01/06/health/06drugs.html?_r=2&src=un&feedurl=http%3A%2F%2Fjson8.nytimes.com%2Fpages%2Fhealth%2Findex.jsonp

Great article on Cortisone Shots & disrupting the bodies inflammation & healing http://well.blogs.nytimes.com/2010/10/27/do-cortisone-shots-actually-make-things-worse/

2) Pain: Don't pull the batteries for the fire detector. Sensation neurologically travels faster than pain, it overrides the signal (pain-gait theory for those curious). So, I believe paleo approach is to introduce sensation (carpacin oil (Sombra is a great product), tiger balms, bio freeze, and other topical stimulants may help. Ice and heat packs as well, and compression. As soon as the injury is stable, get motion in it. Motion overrides pain (why do you think you shake your thumb when he hit it with a hammer, or rub your shin when you bang it on the door)

3) Long term function: Our innate defense is to brace/cast the injured area with inflammation and soft tissue adhesions to limit the damage and infection to the injured area. Better to lose a finger, than your entire life. Utilize body work and soft tissue treatment to restore function. Manipulative therapies date as far back as the roman and chinese dynasties. I am a proponent of Active Release Technique, a great therapy to help regain optimal long term function within the realm of the body healing itself.

47a42b6be94caf700fce9509e38bb6a4

(9647)

on June 07, 2011
at 01:03 AM

@Akd, whoops, sorry, I wasn't criticizing, just clarifying. I also find the "downvote every answer in a thread" maneuver extremely irritating, and have also expressed frustration at downvotes given for no good reason.

47a42b6be94caf700fce9509e38bb6a4

(9647)

on June 07, 2011
at 01:02 AM

@Akd, whoops, I wasn't criticizing, just clarifying. I also find the "downvote every answer in a thread" maneuver extremely irritating, and have also expressed frustration at downvotes given for no good reason.

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on June 06, 2011
at 01:33 PM

so then are you the one who went through and down-voted everyone?

21fd060d0796fdb8a4a990441e08eae7

(24543)

on June 06, 2011
at 06:28 PM

I have a suspicion that some things in this post are incorrect. Motion overrides pain? Topical cooling/heating/irritating often does not affect (deep) joint pain, although it can be great for (superficial) muscles. That being said, active release is great. And as a chiropractor who offers ART, I fully expect you to give me a discount because I'm paleo.

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on June 06, 2011
at 08:34 PM

sorry paul. didnt mean to have a little tantrum. just irritating when everyone gets a down vote with no explanation. my bad.

47a42b6be94caf700fce9509e38bb6a4

(9647)

on June 06, 2011
at 05:33 PM

@Akd: Couldn't be -- you can see on his user page that he has never voted anything down (or up).

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on June 06, 2011
at 08:36 PM

that said, i love my chiro and i turn to him before my PCP in most maters. he has done more for my general health and well being than almost anyone, and saved my husband from double knee surgery. in fact, my husband has two numbers programmed into his cell phone- me and our chiropractor. they have tools that are invaluable in the pain-fight.

47a42b6be94caf700fce9509e38bb6a4

(9647)

on June 07, 2011
at 01:01 AM

@Akd, I wasn't criticizing, just clarifying. I also find the "downvote every answer in a thread" maneuver extremely irritating, and have also expressed frustration at downvotes given for no good reason.

6b59648a7e1a8499cb4947d1a883f764

(10)

on June 30, 2011
at 04:36 PM

@Kamal, I wont get deep into the neurology of Motion overrides pain, here is a link that makes it palatable, and it starts at the joint. http://health.howstuffworks.com/human-body/systems/nervous-system/pain4.htm . @ downvoting concerns, I would not downvote without an explanation it goes against my credo of never complain unless you have a "solution".

1
8b982d4beccca9fcb85affe8d4bd4ff2

(1585)

on June 05, 2011
at 09:40 PM

I think they are over used but necessary in some cases or course.

There are so many natural herbal solutions out there.

-2
332d9f75d1077abafff6887681f6b130

on June 06, 2011
at 07:28 PM

Inflammation is good for acute injuries, but once the injury lasts more than a day or so, such as a broken bone, the inflammation can actually hinder the healing process. Since you're broken bone is likely to still be broken in a week, you should try to reduce inflammation so it can heal better. You could soak your whole body in cold water, use an ice pack, or take the meds that your doctor gave you. The difference being that those meds will also make you stop hurting and let you have some quality of life while you heal.

True, they have side effects, but unless your very unlucky you wont get all of those side effects. I've never had a side effect from anything (except Benadryl, and that just makes me sleepy some of the time.) And its true that your body has to process all of those compounds out of your blood, but that's why the liver and kidneys are able to repair themselves: they're a filter -- that's what they do.

Its ridiculous to sit at home and suffer, or feel bad about taking medicine to help you while you heal a broken bone. Grok wouldn't have used those meds, but that???s because he couldn't. If he had the choice, I bet he'd have been all about them. Doctors aren't evil, they're actually there to try to help you. Their thinking may not be 100% inline with the paleo / primal schools of thought, but they do know how to treat injuries such as broken bones. If he gave you some meds to help with the healing process and your comfort then take them.

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