Original Uses

Against Pain
aspirin was introduced as a painkiller. After 100 years it remains the "gold standard" remedy against which all new painkillers must be compared. In its usual tablet form it is used for aches and pains, for arthritis and "rheumatism", for headaches, period pains, toothache, the pain of bruises and other injuries, and after dental treatment. In fact, most forms of mild to moderate pain respond quickly to aspirin. It works best when taken early, before the pain has "taken hold".

Exactly how it works against pain is being unravelled by current research. In peripheral tissues, such as skin, muscles and joints, aspirin itself blocks the prostaglandins that are produced in inflamed, infected and injured tissues to cause the sensation of pain. However, aspirin also acts centrally: the salicylate and acetate parts of aspirin's chemical structure (aspirin is acetyl salicylic acid) cross separately into the brain and spinal cord - where they act on prostaglandins in sites in the central nervous system known to be involved in the perception and transmission of pain.

This new knowledge about the way, and where, aspirin works, has led to renewed interest in its use in severe pain - a field previously thought to be occupied only by opiates such as morphine and heroin and similar drugs. Dr Torsten Gordh, of Uppsala, Sweden, has reported that there are many forms of pain for which aspirin is much more effective than opiates - among them headache, post-operative orthopaedic or ENT surgery, superficial skin or mucosal ulcers, and the pain of secondary cancers in bone. aspirin also works in tandem with opiates. It is now being used successfully along with morphine or codeine to combat the pain of cancer. For example, it can allow doses of these narcotic agents to be reduced, so that patients are less sedated and can enjoy a better quality of life.

It is now being given as infusions of lysine-acetylsalicylic acid (lysine-aspirin) around the spinal cord ("intrathecally") to patients with intractable cancer pain and severe back pain. In the first study, in 1983 (Devogel et al) a single dose gave relief to 34 patients for between 2 and 27 days (mean 6 days): a second study in 1987 confirmed this benefit in 60 cancer patients (Pellerin).

aspirin has also been successfully used topically - on the skin - to relieve the pain of shingles. Future Uses of Aspirin may include a "patch" preparation, to deliver the drug through the skin.

Against fevers
Fevers caused by infections respond well to aspirin because it acts directly on the temperature regulation centre in the brain.

Against inflammation
Inflammation, with its classic signs of swelling, redness, local heat, loss of function and pain, is part of the body's reaction to infection or injury. It also occurs as an abnormal reaction in diseases such as rheumatoid arthritis and osteoarthritis.

aspirin was the first of the "non-steroidal anti-inflammatory drugs"(NSAIDs) now so widely used against arthritis. Although not a cure for arthritis, aspirin can relieve all the signs of inflammation, allowing sufferers to become more mobile and lead more active lives in relative comfort. However this needs medical supervision and higher doses to obtain an anti-inflammatory effect than would be taken for simple aches and pains or a headache.

This is particularly true for the management of childhood arthritis (Still's disease). In January 1996 Dr Jean-Louis Stephan of the University of St Etienne, France, reported that "The drugs preferred by the vast majority of paediatric rheumatologists for the initial treatment of Still's disease are salicylates. aspirin therapy has a good safety profile and it is cheap. The many formulations available allow accurate dosing in children. None of the other NSAIDs have been conclusively shown to be more effective and cannot be prescribed for children in France".

aspirin versus - and along with - paracetamol
aspirin and paracetamol are two of the main analgesics for mild and moderate pain. The preference for one or another varies from one country to another, and the decision may depend more on fashion than on the relative merits of the two drugs.

Two recent studies - one compared the two, and the other looked at their combination - have begun to clarify where they stand scientifically. In a general practice trial by Professor Jean Cabane, of St Antoine Hospital, Paris, involving 473 patients mainly with back pain and headache, but also with ENT pain and toothache, aspirin was the more effective painkiller of the two drugs.

Professor Harald Breivik, of Oslo, used a combination of the two drugs in patients with chronic pain. The combination allowed the drugs to be given in smaller doses with just as good an effect on pain.