Gerard Francis D.

Santos

Pain Reliever: Facts and Fallacies

A Medical Students Perspective

Ang heartache kakayanin mo. Sa sakit na di mo kaya. . . Mefenamic Acid

(Dolfenal) These were the last words in the 1-minute commercial by Unilab aired on
2012. The TV ad featured a broken-hearted man who caught his girlfriend cheating. As
the memories came flashing back, his emotional pain caused him to almost end his life.
Eventually, he learned to overcome his agony by finding another partner.
I would like to point out three points from the video. First, can Mefenamic Acid
(Dolfenal) truly relieve severe painone with a pain scale of 10 over 10 or simply sakit
na di mo kaya as the TV ad claims?
According to Guyton, physical pain starts with the transduction of noxius stimuli
into nociceptive impulses such as bradykinin, and histamine among others.
Prostaglandins enhance sensitivity of the nociceptors, which are responsible for the
transmission of impulses from the peripheral nervous system to the dorsal horn, where
modulation can take place. Impulses will then be sent to the thalamus and cortex where
pain is perceived. This is where Mefenamic Acid comes into play. It works by blocking
the effect of cyclo-oxygenase (COX) enzymes, which are necessary for prostaglandin
production. Hence, stopping the chain of events at its very onset. However, this
medication is not able to target the higher center but only a minute part of the process.
This makes it a weak medication only suitable for mild to moderate pain, unlike
medications like opiods, which target alpha, delta and kappa receptors, both in the spinal
and supraspinal level and are, thus, able to relieve severe pain. This makes the statement
in the TV advertisement a mere fallacy.
Secondly, however, the statement Sa sakit na di mo kaya also has good
implications. Come to think of it, the commercial does not promote the use of the
analgesic negligently if the pain is still tolerable. While Mefenamic Acid is indeed
effective in controlling pain, it has drawbacks when used in long term. Such
disadvantages include increased tolerance to such medications and decreased pain
threshold. Put simply, while individuals perception of pain vary, the longer time you use
an analgesic, the sooner and faster you will feel the pain even at a minimal stimulus
(decreased pain threshold). This will then result in a need for higher dosage of the

medication to decrease the pain (drug tolerance). And the vicious cycle continues. The
TV ad, then, gives us a reminder that a moment of satisfaction may cause a lifetime of
regrets.
Last is the comparison between emotional and physical pain. Ang heartache,
kakayanin mo. Sa sakit na di mo kaya. . . Mefenamic Acid (Dolfenal), he said. But is
emotional pain more easily dealt with than the physical one? Physical pain passes. It feels
terrible at the time, but when the stimulus is gone, then it's done. When enkephalins and
serotonins are released, that pain is but a history. You survive. It fades. Emotional pain,
on the other hand, can often be so intense that it causes physical pain and other
symptoms. Your body freezes; your knees tremble; your heart hurts. Like in the TV
commercial, the pain lingers and remains. Even if you feel like its over, the memories
will haunt you. It shows up in your nightmares. It cripples you and takes away the little
hope you have left. Ang heartache, kakayanin mo, he said. But can you simply take a
Mefenamic Acid and expect your heartaches to go away? Come to think of it.