Painkillers

A couple of months ago, we were given some “new” information about Tylenol. In actuality, there was nothing new about this information, it was just brought to our broader attention through “official” channels. (See, also: The Road Less Traveled, from 2022, where I brought a little light to the darker sides of over the counter (OTC) painkillers for headaches*.)

“But, popping a painkiller is so easy!”

I know. I truly do. There is a song called “The Sinking Feeling” by the band The The, which says, “The path of least resistance leads to the garbage heap of despair (air-air-aiiir), I think I’d better get back in bed.” I like the whole song, but that one line is what really sticks with me. Taking the easy route is not always the best choice.

I am confident in saying that when it comes to dealing with your pain, taking the road less traveled is well worth the time and energy required to figure it out. Using OTC painkillers don’t just block the pain, they block important healing messages to get the job done, doing what the body is meant to do — fixing what’s wrong.

“In all the cases, the immense advantage of homeopathy is that it cures in a gentle, quick and lasting manner, according to Hahnemann’s postulates. In this sense, there is no other therapeutic capable of being compared to it. Besides, it is never harmful, it is never dangerous, it never produces side effects because it lacks all chemical substance; thus, it is the best therapeutic ever invented by human beings.”
—Francisco Xavier Eizayaga, M.D.

For the sake of discussion, let’s assume we are dealing with a sprained ankle.

What exactly is a sprained ankle?
A sprain is a trauma to the ligaments by stretching it too far; this causes pain and difficulty with movement. “A mild sprain is really a pulled or strained ligament, with tenderness and mild swelling, but no tearing of tissue. A moderate strain** has partial tearing of the ligament, while a severe strain entails a complete tear, with corresponding degrees of swelling, bruising and inability to move the joint or bear weight” (Hershoff 2000). Conventional treatment involves applying ice to the area and wraps to compress the area. Taber’s also recommends “analgesics and NSAIDs.” As we’ll see below, not all sprains respond well to ice and wraps — another place where homeopathy shines. We can use those data points to help us find the best suited remedy.

Let’s get back to the simplicity of the over-the-counter pills… How do they work? If you ask an AI, it will tell you that the exact mechanism of acetaminophen (e.g., Tylenol) is not fully understood, but it is believed to work through the central nervous system to block pain signals. Ibuprofen (NSAIDS/Advil), on the other hand, blocks the production of prostaglandins.

What are prostaglandins again?
In simple terms, prostaglandins are the chemical messengers that cause pain, swelling, and fever — let’s call that the “alarm system”. In short, Advil turns off the alarm system at the source (blocks the prostaglandins). Tylenol turns the volume down on the alarm sounds in your brain — the alarm is still going, you just don’t “hear” it as loudly, so the pain feels less intense.

Sounds like a solid plan to me! What could be the problem with it?
Taber’s Medical Dictionary (Venes 2017) tells us that prostaglandins (PGs) “influence a broad range of biological effects, including vasodilation, vascular permeability, bronchoconstriction†, platelet aggregation, dysmenorrhea†, inhibition of gastric acid secretion, stimulation of neural receptors for pain during tissue damage, sleep inhibition†, and maintenance of patent ductus arteriosis†.” That sums it all up, doesn’t it?! Keep reading — we’ll see if we can sort some of this out.

• Vasodilation. If you sprain your ankle, vasodilation is what causes the ankle to swell up and become red, hot and painful. Blocking the vasodilation reduces swelling and makes the ankle less painful. The potential harm of blocking that vasodilation is the vasodilation is actually allowing for your body to call in the repair crew to come in and fix what needs fixing. The OTCs can slow down the healing process — the correct messages aren’t being sent to the fix-it crew.
• Vascular permeability. This is what causes the swelling (edema), another healing mechanism. As I understand the process, the swelling creates a nice liquid-y environment that allows the healing cells (neutrophils and macrophages) to move around quickly to get their jobs done. Think of it like a walled off watery construction site. If this mechanism is turned off, we risk messing with the essential building blocks (such as fibrinogen and fibronectin), making our imaginary construction site walls temporary, rather than permanent.
• Platelet aggregation. Kind of important stuff. Let’s assume that when you sprained your ankle, you also got a cut at the same time. Without platelet aggregation, bleeding would continue. Platelets job is to stop the bleeding. Ibuprofen keeps the platelets from doing their thing and is therefore considered a “blood thinner” — but it’s not actually thinning the blood, it’s slowing down the blood clotting mechanism.
  • This would be part of the reason Advil/Motrin has been known to cause gastrointestinal bleeding (especially with prolonged use or for those with a history of peptic ulcers or other bleeding disorders or who take blood thinning medication. If you require an OTC painkiller with any of these conditions, acetiminophen would be a better choice in this instance as it is “a weak inhibitor of platelet cyclooxygenase 1” (Munsterhjelm et al. 2005).
  • “NSAIDs induce clinically significant ulceration, bleeding, and/or obstruction in 1-4% of patients chronically taking these drugs. Even higher rates of ulceration are seen in patients with a history of peptic ulceration; in patients concurrently taking anticoagulants, low-dose aspirin, or glucocorticoids; and in the elderly” (Wallace 2008).
    • 1-4% doesn’t sound like a big deal, but there was a mom on the playground once upon a time who was “bleeding out” due to NSAID use (I was told later). Another mom, who happened to be a doctor, was nearby. If not for her, she probably wouldn’t have made it. This was my first wake up call to an OTC drug I used to use regularly. NSAIDs have also caused GI bleeding in family members - so two close encounters with this stated tiny minority.
  • Inhibition of gastric acid secretion. On the topic of the GI system, NSAIDs can increase gastric acid secretion and harm the stomach lining, too (Wallace 2008). So, the prostaglandins inhibit the gastric acid secretion and the NSAIDs can increase the acid secretion. Tylenol does not have this effect.
• Stimulation of neural receptors for pain during tissue damage. This is called nociception which is, according to Taber’s (Venes 2017): “The stimulus-response process involving the stimulation of peripheral pain-carrying nerve fibers and the transmission of impulses along peripheral nerves to the central nervous system, where the stimulus is perceived as pain.” By blocking these signals, you are blocking your body’s way of telling you to stop using an injured part so it can heal, potentially causing more damage before you have healed. Tylenol, on the other hand, could be even more harmful as it has not done anything to lessen the inflammation at the injury site, it has just turned down the pain volume.

OK. I get it, OTCs are not completely without risk. What do you suggest using for this fictitious sprained ankle?
Well, homeopathy, of course!

• Arnica is always a good place to start for any injury. Swelling, bruising, weakness; worse with movement, touch and jarring. Better for cold compresses.
• For a sprained ankled with redness that feels hot, painful, swollen and stiff and is worse when moving it (or, even incapable of moving it) but feels better from pressure (even tight bandaging) and local heat: Bryonia alba.
• Rhus tox for pain and stiffness that is worse with the starting of movement but it gets better with continued movement and feels better from applied heat. In other words, the stiffness and soreness are worse from staying in one position too long. Rhus works on ligaments and connective tissue as well as joints.
• If the affected area feels cold to the touch but also feels better from cold applications/worse for warmth: Ledum palustre. There may be a deep aching.
• Ruta if it feels tender or bruised and aching — especially good for sprains involving ligaments, tendons and connective tissues. Also good for repetitive strain injuries. May feel worse with cold, damp weather or pressure on the affected area; may feel better for warmth and rubbing.
• Symphytum is known to aid in healing ligaments and tendons, making it particularly useful in sprains where joint stability is compromised. Particularly good if there is a deep, aching sensation with significant bruising around the sprained area.
• Bellis perennis for sprains with more bruising and may feel cold (Bellis is sometimes called “the deeper Arnica) — deep-seated soreness; may feel better for warmth and gentle movement. There may be a feeling of constriction as if there were a band around the joint.

Another option… choose two well suited remedies and alternate them. There are a lot of different pieces to a sprain puzzle and these symptoms may change as the healing takes place — move to the next remedy as symptoms change or if the current remedy is no longer as effective.

Or, the combination of Arnica, Ruta and Rhus is an excellent injury go-to, covering many bases at once.

I encourage you to read up on the OTC painkillers. Drugs.com is a good place to start. (Hint: keep scrolling down the page on Drugs.com. There is a brief overview at the top of the page, but if you keep going, you’ll find further links for “side effects” that should be known but are a little hidden.)
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If you purchase/make a good household kit, you will be ready to deal with most common ailments that come your way and be able to skirt the OTCs.

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Julia Coyte, CHom
Classically Practical homeopath

#wellnessawaits


*Ibuprofen/Advil/Motrin/NSAIDS are used interchangeably throughout this article; likewise acetaminophen/Tylenol, too.
**Some sources say a strain is the injury to tendons while sprains are injuries to ligaments. Other sources use strain and sprain interchangeably.
†In keeping with the sprained ankle analogy, bronchoconstriction, dysmenorrhea, sleep inhibition and maintenance of patent ductus arteriosis do not pertain to this situation.

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Reference list
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