Pain Meds

The Global pain medicine market is currently on the order of $100,000,000,000 annually. The amount of effort and material used is vast. The energies of production, packaging and distribution are also vast and all are growing. The pain industry is growing at 10% annually and can be likened to the rate of urbanisation of humans. There are likely very many other parallels worth exploring. 

Pain as a brain mediated sensation is very controllable by mental training. It is not easy. It is not quick. Not all types of pain are readily controlled and not everyone can readily train themselves or be trained. The biofeedback and re-current nature of pain are such that pain medicines are, especially with chronic pain, psychological considerations and the hunger for a quick fix, on target for ever increasing growth. 

It is worth examining some of the major use medicines. 

For the Future

The biofeedback, meditation and other therapies that can alleviate pain are also a growing industry. They are not likely to impact the pharmaceutical approach.  They will instead be of use to it as techniques and detailed insights develop as to the details of the context of situations and usefulness of mind pain control increase.

Packaging Pollution

Another aspect of enormous immediacy is the polluting and pollutative effects of pain medications and their packaging. The packaging of medications is chemically intensive and globally invasive. Just how much damage is daily done by the existing pain medication industry is hard to quantify other than to conclude that it is huge and long lasting. Pain medication wrappers are not yet generally designed to de-compose quickly.  What they next decompose into, and this is often with the medications still inside, is another matter altogether. The savings to be made by transitioning to decomposable packaging is significant.

Medication Pollution

There are many instances in water and in the human food chain of medications travelling through, both directly from the users and indirectly from passing through other organisms and also through the water system.

Aspirin, ASA, acetylsalicylic acid. 

[1.3gm/day = 4 tablets @325gms]

https://en.wikipedia.org/wiki/Aspirin

Use : Pain relief, reduce inflammation, reduce fever, reduce blood clots for heart patients, anti-thrombotic, anti-stroke.

Side effects : stomach bleeding, ulcers, indigestion, asthma, mild headaches, rash, tinnitus.

Actions : Irreversibly inhibits the enzyme family cyclooxygenase (Cox), which is needed for the production of Thromboxanes and Prostaglandins. 

Thromboxanes allow platelet aggregation that results in blot clots. 

Prostaglandins are involved in pain transmission, inflammation and regulation of the hypothalamic thermostat. https://en.wikipedia.org/wiki/Hypothalamus

Affects the energy production in some mitochondria.

Is a Non-Steroidal Anti-Inflammatory Drug (NSAID)

Paracetamol, Acetaminophen, Tylenol, Panadol, Apap. 

[3-4gms/day = 6-8 tablets @500gms]

https://en.wikipedia.org/wiki/Paracetamol

Use : Pain relief, migraine relief, reducing fever, nasal problems during a cold, anticonvulsant.

Side effects : liver damage, lowering of haemoglobin level, gastrointestinal bleeding.

Actions : Inhibits COX. The action of the paracetamol metabolite AM404, N-arachidonoylaminophenol localises the endogenous cannabinoid anandamide within the synaptic cleft, i.e. holds it there by inhibiting its transport out of the cleft. https://en.wikipedia.org/wiki/AM404

Weaker than Ibuprofen, but can be used for longer, not a NSAID, unlike Ibuprofen.

May be linked with autism and ADHD during pregnancy.

Ibuprofen, iso-butyl-phenyl-propionic acid

[1.2gms/day = 6 tablets @200gms]

https://en.wikipedia.org/wiki/Ibuprofen

Use : Pain relief, reducing fever, inflammation, migraines, rheumatoid arthritis.

Side effects : liver failure, gastrointestinal bleeding, kidney failure, heart failure, fluid retention, asthma.

Actions : Inhibits prostaglandins by decreasing the activity of COX.

May be neuroprotective and so aid against Parkinson's disease.

Is an NSAID.

The above drugs are often used in combinations and with the added inclusion of caffeine. 

They each work differently and have different side effects, both long and short term. Some of the mechanisms are interfered with, so, as one example, anti-platelet activity is knocked out in some combinations. Someone taking low dose aspirin as a blood thinner would have that "sought-for" side-effect stopped by taking a high dose combo intervention in a quick pain fix scenario.

Indometacin an NSAID

https://en.wikipedia.org/wiki/Indometacin

Diclofenac an NSAID

https://en.wikipedia.org/wiki/Diclofenac

Naproxen an NSAID

https://en.wikipedia.org/wiki/Naproxen

Grapefruit can can attach to and block the action of the small gut intestine CYP3A4. This enzyme is produced in a biorhythmic fashion and so follows a time course in its availability.

CYP3A4 metabolises many drugs thus preventing them from entering the blood stream. Grapefruit therefore acts so as to increase the amount of some drugs in the body. 

Furanocoumarins are a class of organic compound found in grapefruit, especially, citrus and other fruits. It is they that are the main agent.

Similarly Grapefruit can block the action of some drug transporters thus lowering the amount of drug action. Organo Anion Transporters, OATs, are a family of proteins in the bilipid layer of cell membranes that mediate cell entry and so effect the transport of drugs and body chemicals across cell membranes. 

https://en.wikipedia.org/wiki/Organo_anion_transporter_family

A list of commonly prescribed drugs affected by grapefruit

https://www.nhs.uk/common-health-questions/medicines/does-grapefruit-affect-my-medicine/

And another

https://www.health.harvard.edu/staying-healthy/grapefruit-and-medication-a-cautionary-note

And another

https://en.wikipedia.org/wiki/Grapefruit%E2%80%93drug_interactions