Painkillers vs. Pain Relief: Are You Treating the Problem or Just Masking It?
- Dr Tommy-Lee McCafferty DC
- 6 days ago
- 4 min read
Painkillers can be helpful for short-term relief, but they do not address the underlying causes of musculoskeletal pain. National guidance from NICE recommends non-drug approaches such as manual therapy, exercise, and pain education for longer-term management. Chiropractic care may support improved movement and function as part of a personalised plan. When you are in pain, it is completely understandable to want quick relief. For many people, painkillers are the first step. They can ease discomfort and make daily life feel more manageable. But when it comes to painkillers vs pain relief, there is an important distinction. Are we addressing the cause of the pain, or simply dampening the signal? Understanding this difference can help you make informed, confident decisions about your health.
The Role of Painkillers in Short-Term Relief
Painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs), opioids and paracetamol are commonly used for musculoskeletal pain.
They work by reducing inflammation or altering how pain signals are processed in the nervous system. In the short term, this can:
Reduce acute pain and inflammation
Improve short-term function
Make movement more comfortable while tissues settle
For acute injuries or flare-ups, medication may play a supportive role. However, pain relief from medication does not necessarily mean the underlying dysfunction has resolved.
The Risks of Long-Term Painkiller Use
One of the challenges in the painkillers vs pain relief conversation is that medication can mask symptoms. If pain is reduced, it may feel as though the issue has been solved. In many cases, the mechanical, muscular or lifestyle factors contributing to pain remain unchanged.
Long-term use of certain medications is associated with recognised risks:
NSAIDs such as ibuprofen and naproxen have been linked to increased risk of gastrointestinal bleeding and cardiovascular events with prolonged use (Bally et al., 2017).
Opioids including codeine and tramadol carry risks of dependence, tolerance and misuse (Ballantyne and Sullivan, 2015).
Paracetamol, while widely used, has been associated with potential liver toxicity at high or prolonged doses (Roberts et al., 2016).
In response to emerging evidence, the National Institute for Health and Care Excellence (NICE) updated its guidance on chronic pain management in 2021 (NG193). NICE advises against routine long-term use of pain medication for chronic primary pain and instead recommends non-pharmacological approaches as first-line management.
This shift reflects growing recognition that long-term outcomes often improve when care focuses on restoring function rather than suppressing symptoms.
What Does NICE Recommend for Chronic Pain?
According to NICE NG193 (2021), effective chronic pain management should prioritise:
Manual Therapy
Manual therapies, including chiropractic care, may support improved joint mobility and short-term pain reduction in some musculoskeletal conditions.
Exercise and Movement-Based Rehabilitation
Exercise is consistently supported in research for improving function and reducing disability in conditions such as low back and neck pain.
Pain Education and Self-Management
Understanding how pain works can help reduce fear, improve confidence in movement and support long-term resilience.
Importantly, NICE emphasises shared decision-making and active participation in care. People who engage in movement, rehabilitation and self-management strategies often report improved function and quality of life.
What Does the Research Say About Manual Therapy?
Research has explored how manual therapy compares to medication for certain musculoskeletal conditions.
A large review published in The Lancet highlighted that non-pharmacological approaches, including manual therapy and exercise, should be prioritised in low back pain management (Foster et al., 2018).
A randomised clinical trial in Spine found that spinal manipulative therapy, when combined with usual medical care, led to greater improvements in pain and function compared to usual medical care alone in chronic low back pain (Goertz et al., 2018).
For neck pain, spinal manipulation combined with exercise has demonstrated favourable outcomes compared with medication alone in some patient groups (Bronfort et al., 2012).
It is important to note that individual responses vary. Manual therapy is not a universal solution, but it can form part of a broader, evidence-informed plan.
Chiropractic Care and Meaningful Pain Relief
When considering painkillers vs pain relief, chiropractic care aims to focus on improving function rather than masking symptoms.
Chiropractic assessment looks at:
Joint mobility
Muscle tension and coordination
Movement patterns
Postural and lifestyle factors
Care may include hands-on techniques, mobility work, strengthening exercises and tailored advice. The goal is to support the body’s ability to move more comfortably and efficiently.
This approach aligns with the biopsychosocial understanding of pain. Pain is influenced not only by tissues, but also by movement habits, stress, sleep and overall health.
At Connected Chiropractic, care plans are individualised and adapted based on your response, goals and preferences. We work collaboratively with you, and where appropriate, liaise with other healthcare professionals to ensure safe, coordinated care.
Final Thoughts: Looking Beyond the Quick Fix
Pain medication has a place, particularly in the short term. However, if you find yourself relying on tablets to get through daily life, it may be helpful to explore whether the underlying issue has been addressed.
The conversation around painkillers vs pain relief is not about judgement. It is about understanding options.
Evidence and national guidance increasingly support non-drug approaches for many types of musculoskeletal pain. Focusing on movement, function and education may offer more sustainable results for some individuals.
If you would like to discuss your symptoms and explore whether chiropractic care could form part of your management plan, our team is here to listen and guide you.
Written by Dr Tommy-Lee McCafferty, Doctor of Chiropractic.
References
Ballantyne, J. C., & Sullivan, M. D. (2015). Intensity of Chronic Pain—The Wrong Metric? New England Journal of Medicine.
Bally, M., et al. (2017). Risk of acute myocardial infarction with NSAIDs in real-world use: Bayesian meta-analysis. The BMJ.
Bronfort, G., et al. (2012). Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomised trial. Annals of Internal Medicine.
Foster, N. E., et al. (2018). Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet.
Goertz, C. M., et al. (2018). Effect of Spinal Manipulative Therapy vs. Standard Medical Care on Chronic Low Back Pain. Spine.
NICE (2021). Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain. NG193.
Roberts, E., et al. (2016). Paracetamol: not as safe as we thought? A systematic review of observational studies. The BMJ.
