Painkillers in the Backcountry
There are a number of people today, some who write for reputable publications, who tend to be a bit reckless in dispensing advice on using painkillers. "When backpacking,” the advice goes, “if your joints start to hurt, simply pop a couple of over-the-counter pain relievers, and press on.”
Now there is a time and place for painkillers, and we’ll get to that shortly. But first, let’s briefly discuss three of the most popular types of over-the-counter painkillers and learn how they work.
Acetaminophen, Aspirin, Ibuprofen
Acetaminophen, aspirin, and ibuprofen are all well known painkillers and are sometimes called analgesics. Analgesic is just a medical term that means “painkiller.” These drugs are also known as NSAIDs (non steroidal anti-inflammatory drugs).
These three drugs tend to relieve pain, reduce inflammation, and lower fever. Each has a set of potential side effects that we won’t go into here but with which you should be familiar. So here’s how they work.
When you sustain an injury, the damaged tissue releases hormones called prostaglandins. Prostaglandins perform three very important functions. They send signals to your brain, letting it know that the body has sustained an injury. They cause the damaged tissue to swell and flood with blood. This is called inflammation and its purpose to begin the healing process. Finally, they amplify your nerves’ pain signals to tell you to stop whatever you were doing that caused the injury.1, 2
NSAIDs work by slowing down the body’s production of prostaglandins.3
So with all that being said, let’s look at the practical effects of using painkillers in the backcountry. Maybe you’re on a backpacking adventure. Or maybe you’re hiking an elk quarter back to your truck. Or maybe you’re a soldier rucking a 75 pound load on a reconnaissance patrol. After four hours of traversing rugged terrain, your back is aching, and sharp pains are shooting through your knees with every step. If you follow the advice that is all too common, you’ll simply toss back some ibuprofen, chug some water, and soldier on. But stop for a moment and realize what you are doing to your body.
Shutting Down Your Body’s Signals
Muscle pain due to lactic acid buildup during endurance activities is one thing. Joint pain is another thing entirely. Joint pain could be caused by several things, among them cartilage loss or torn tendons or ligaments. If this is the case, then prolonged repetition of the movement that caused the injury is going to increase the severity of the injury. If you don’t allow adequate time for the injury to heal, then you are going to destroy your joints.
When you ingest a painkiller, you are shutting down your body’s signals. By shutting down these signals and continuing the activity, you make it much more difficult to assess the extent of your injury, and you are almost guaranteed to make the injury worse.
Whether or not completing your mission is important enough to risk severe or even permanent injury is for you to decide. If your survival is at stake and you must complete your hike to get to safety, then maybe that’s a good time to use painkillers. The important thing is that you understand what the medicine is doing to your body and make an educated decision on when to take it.
Here are a few final thoughts for your consideration. One of the effects of aspirin is that it thins the blood and inhibits clotting. This may be good for heart health, but perhaps it’s not so good if one of your mission risks is traumatic injury—especially if you’re a good distance from a medical treatment facility.4, 5 And acetaminophen can cause serious damage to your liver if combined with alcohol.6
So again, if you choose to shut down your body’s signals, you should have a good reason for doing so. Understand how pain killers affect your body, and use them (or don’t use them) wisely.
1, 3, 5“Pain Relief: How NSAIDs Work.” WebMD. Accessed April 6, 2019. https://www.webmd.com/arthritis/features/pain-relief-how-nsaids-work#1.
2, 4Yolanda. “How Does Aspirin Work?” MedicineHow. Accessed April 6, 2019. https://www.medicinehow.com/aspirin/.
6“Tylenol (Acetaminophen) Liver Damage.” MedicineNet. Accessed April 6, 2019. https://www.medicinenet.com/tylenol_liver_damage/article.htm#is_it_safe_for_me_to_take_tylenol.
McNicol, Ewan. “Ask The Professor.” Tufts Journal. April 2008, accessed April 6, 2019. http://tuftsjournal.tufts.edu/2008/04/professor/01/.
Greenlaw, Ellen. “OTC Pain Relief: Understanding NSAIDs.” WebMD. Accessed April 6, 2019. https://www.webmd.com/pain-management/features/pain-relievers-nsaids#2.