EXTRA-STRENGTH EXCEDRIN: CAFFEINE WITH OTHER PAIN KILLERS
Caffeine is a potent pain killer. The relief it delivers to nociception, that is, pain perception, results from at least two distinct mechanisms: 1. Caffeine delivers pain relief by exerting so-called “peripheral action,” that is, relief at the site of an injury. In doing so, it acts directly on muscle tissue, relieving pain by repairing tissue damage and reducing inflammation; 2. Caffeine also has profound CNS effects that block the central processing of pain signals in the brain and that increase the effectiveness of the body’s natural pain killing mechanisms.
In addition to reducing pain on its own, caffeine in even low doses has been shown to magnify the pain killing power of aspirin and ibuprophen and even of narcotic analgesics.[i] That is the reason that caffeine is an active ingredient in over the counter pain killers like Excedrin Extra Strength, in prescription pain killers like Darvon Compound-65, and in narcotic pain killers like Percodan. Leading caffeine researchers Jan Snel and Monicque M. Lorist state that the studies of caffeine alone and in combination with other pain killers show that “different pain states can, to different degrees, be mediated by different mechanisms that may be caffeine-sensitive.”[ii] This means that there are several different mechanisms that enable caffeine to relieve pain of different kinds and differing intensities. Snel and Lorist add that caffeine’s power to alleviate intense pain suggests that the neural mechanisms that cause this pain are “directly sensitive to caffeine.”
One creative study, using a 200 mg caffeine pill, found that caffeine by itself was a potent pain reliever for muscle pain. Conducted by Daniel E. Myers, D.D.S., associate professor in the department of oral medicine and pathology at the University of Pittsburgh School of Dental Medicine, this experiment measured the effects of caffeine on “ischemic muscle contraction pain,” that is, the intense pain (such as that experienced during a heart attack) caused by blocking the flow of blood to an area of the body. Each participant in the study was given either a 200mg caffeine pill or a placebo. One hour later, subjects raised their arms to drain the blood and blood pressure cuffs were attached to prevent blood flow back into the arm. The participants then did wrist curls while holding a small weight, activity which would give rise to ischemic muscle pain. The subjects were then asked to rate pain levels after 15, 30, and 45 seconds of wrist curl exercises. At 15 seconds, the mean pain rating of those who had taken caffeine was half that of those who had taken a placebo! A similar profile but less pronounced pattern of effects was found at 30 seconds and 45 seconds. Myers attributes the pain killing power of caffeine in his study and in over-the-counter and prescription medications to its action in blocking adenosine receptors in muscles, concluding that caffeine alone delivers considerable analgesic efficiency and that the “implication is that there is a rationale for the use of caffeine in the treatment of muscle pain when blood flow is reduced.” [iii]
As we have noted, caffeine alone is a strong analgesic. But there have been relatively few studies of the effects of caffeine alone on pain in human beings. Most scientists have concentrated on examining caffeine’s use as an adjuvant, or added ingredient, in preparations of drugs like acetaminophen, acetaminophen and aspirin combinations, and ibuprophen. A thorough review of these studies was published in Pharmacological Reviews in 1993. It concluded that caffeine potentiated the pain relief of other analgesics, especially of ibuprophen, to a significant degree[BAW1] in postpartum pain, post-surgical pain following a dental extraction, and headache pain.[iv] Another metastudy reviewing 30 pain studies in which caffeine was used in combination with non-steroidal anti-inflammatory drugs (NSAIDs) to treat postpartum, dental, and headache pain, found that the addition of 65mg to 200 mg of caffeine (the amount in about 1/2 cup to about a 1 1/3 cups of filter drip coffee) resulted in a clear increase in the power of the NSAIDS to relieve pain.[v]
Caffeine has an especially powerful effect in relieving tension headaches. A landmark 2001 study, conducted by Dr. Seymour Diamond and Dr. Frederick G. Freitag of Chicago’s Diamond Headache clinic, tested hundreds of people who suffer from severe tension headaches at least three times a month.[vi] The researchers split participants into four groups, which were given either 400 mg of ibuprophen alone, 400 mg of ibuprophen combined with 200mg caffeine, 200 mg of caffeine alone, or a placebo. Amazingly, caffeine alone delivered as much pain relief as the ibuprophen, completely eliminating the headaches in nearly 2/3 of the participants! (In other studies, as little as 130mg of caffeine was effective at relieving headache pain. [vii]) Caffeine also worked faster, ending the headaches a half-hour quicker than the ibuprophen. However, the best results were achieved with the combination of caffeine and ibuprophen, which stopped the headaches in nearly ¾ of the participants. The combination of caffeine and ibuprophen also worked much longer, providing an extra four hours of pain relief as compared with ibuprophen alone. So, if your doctor is aware of these facts, perhaps he might be telling you, “Take 200mg of caffeine—and call me in the morning!”
How Caffeine Kills Pain
Scientists speculate that caffeine’s analgesic power arises from three different mechanisms:
- Blockade of “peripheral pronociceptive actions of adenosine,” which means that caffeine interferes with a neurotransmitter that is responsible for carrying pain signals from a specific area of the body to the brain (for example, caffeine could prevent adenosine’s ability to activate a nerve ending and block its ability to signal pain);[viii]
- Activation of “central noradrenergic [adrenalin] pathways that constitute an endogenous pain suppressing system,” which means that caffeine stimulates the body’s own pain killing mechanism; and
- Central nervous system (CNS) stimulation, which means that, caffeine’s overall stimulating effects somehow change the way pain signals are processed in a way that reduces pain.[ix],[x]
As has been known to physicians for nearly 500 years, caffeine also has a special power to relieve migraine headaches. Coffee was one of the earliest pharmacological remedies used against migraines, and caffeine has been a therapeutic ingredient in some modern migraine medicines for decades. In the 1970’s the theory arose that caffeine alleviates migraines by constricting cranial blood vessels. In the late 1990’s, it was discovered that, even though caffeine does constrict these blood vessels, its ability to relieve migraines is unrelated to this action and depends instead on its effects on the neurotransmitter serotonin. It turns out that migraines are not caused by vascular engorgement, but rather by a disorder of the serotonin system. This discovery helped explain why bad moods so often precede or accompany migraines. Caffeine has the power to help restore the balance of the serotonin system, and this is the key to its ability to relieve migraines. One lesson we can learn from this is that it is not always important to know why caffeine does what it does in order to get the benefits of using it. After all, people were using caffeine to treat migraines hundreds of years before anyone had ever heard of the serotonin system. You don’t have to know why it works—but you do have to know how to use it.
One additional statement that we found interesting was made by Jan Snel and Monique Lorist, leading caffeine researchers. They comment that “the positive effect of caffeine on lowering sensitivity to pain,” combined with the ways in which caffeine intensifies our sense perceptions, “may mean that caffeine…may form a major contribution to the enjoyment of life.”[xi]
Stopping Migraines in Their Tracks
Caffeine does more than mask the pain of migraines. It actually changes the course of the migraine headache. Left untreated, migraines typically progress into more intense headache pain and nausea. Many people find that by taking a 200mg caffeine pill at the first sign of migraine, followed by a 100mg supplement every few hours if necessary, they actually stop the migraine in its tracks and prevent it from developing into a full blown episode. The only way to find out if caffeine can do this for you is to try it for yourself.
PLEASE do address the dangers of caffeine in children, and specifically the dangers of so called “energy-drinks”, which are loaded with caffeine and are responsible for increasing numbers of E.R. visits and are even linked to fatalities in some situations.
Energy drinks are NOT loaded with caffeine. Ounce for ounce, they have only a small fraction of the caffeine that coffee has. Parents should monitor whatever their children eat and drink and especially any drugs they ingest. However, caffeine does not pose any special threat to children and most do very well with a moderate intake.
It would be best to put some numbers on the claims here. Please see http://www.caffeineinformer.com/the-caffeine-database which shows that there are 8 energy drinks with higher caffeine content per oz than “robust coffee”. The top energy drink has more than 10X the caffeine of “robust coffee”. (There are many energy drinks which are not worse than coffee, too.)
This is very misleading. All the leading so-called “energy drinks” contain less than half of the caffeine per ounce than Arabica coffee contains! And Robusta coffee has twice as much caffeine as Arabica coffee! The top energy drink certainly does not fit the description you give, which is grossly exaggerated and absurd. In fact all the top energy drinks contain about 10mg of caffeine per ounce, whereas Robusta coffees deliver about 30 mg. of caffeine per ounce or more!
Hi my name is Diane Sanabria I live in ocala fl. My number is 352 454-9559 if you want ask any questions. But I just want it known that it really helps I am a diabetic and live with severe neuropathy for over 5 years and to my amazement I found out that caffeine is helping relieve the pain in my feet.
I went to the E.R. last year for a severe pain in the back of my head. A CT scan showed nothing. The doctor called it nerve pain. I couldn’t sleep more than 2 hours a night with the pain until I was given a pain reliever with caffeine. I slept like a baby. I still get the same pain attacks in the same area, usually during sleep. By simply having an energy drink, I get relief within 20 minutes and lasts for hours. I try to space out the time it takes to drink the 160 mg. energy drink instead of downing it at once to prevent the dazed feeling after a crash.
I find this very interesting as I’ve always thought caffeine (coffee) was bad for the nerves but now that I have shoulder/arm pain that the doctor believes is a pinched nerve – I’m finding that when I quit drinking coffee, it got worse. Today, I had some (I only drink 2 oz.) and it relieved a lot of my pain! That is how I got to this post, by Googling to see why it was helping.
Thank you for your comment. As we explain, caffeine is the strongest non-prescription pain killer in the world. It’s too bad that doctors simply are ignorant of this proven fact.
I am experiencing the same thing- severe shoulder and arm pain due to foramina stenosis of C6 & C7 (i.e. pinched nerve at spinal cord). I was having severe pain this morning and non-stop spasming, and drinking a glass of coffee seemed to calm down my nerve and stop pain for the duration of the effect of caffeine (when I felt like the effects of the caffeine were wearing off, pain and spasming came back.) I’m not a regular coffee drinker and just had a glass because the pain was making me feel exhausted. A few days ago I thought I felt the same effect when drinking a coffee.
Thanks for your comment. If I understand you, your pain has been relieved at least in part by coffee. Let me suggest that you try caffeine pills. They work even better!
I to just found out that caffeine has help my pain almost all gone in the morning soon as I drink a cup of coffee. One day I was on the way back from the doctor and was in so much pain i couldn’t stand to drive any more. I stopped at a coffee shop and all of a sudden the pain was going away. So the next time I stopped same coffee shop it went away again. I thought it was their coffee, she said just strong coffee… I stopped at the store and bought coffee and went home and made some strong coffee, sure enough the pain started to go away some. So I am back to drinking coffee again. I to googled the same and came to this post. I am going to try caffeine pills next.
I just read last night in one of my old dietary books that caffeine also elevates the mood, is used occasionally for bronchial troubles, including asthma, and on rare occasions for some people [such as myself] actually causes sleep. It reduces the risk of benign tumours in found in the breasts. I am using it now for treating cold symptoms. But I would always suggest taking only small amounts at a time, ie, a small cup of coffee, not very strong! I’m so pleased to see more evidence of what I already knew.
I began having pain over my whole body about 6 years ago. It came on suddenly but would never go away. I was always fine during the day after I had coffee, but at night when I stopped working and tried to relax, the pain would get intense. The doctors could not find anything wrong, so they said it must be fibromyalgia. I took pain medication for years but recently nothing I tried worked and I was not getting any sleep. One night last week, I had been tossing and turning all night until I just couldn’t take it and decided to just get up for the day and make coffee. After only a half cup, I could feel the pain leaving my body. Within 30 minutes, I was asleep. No pain at all. Last night I had a cup before bed when I noticed the pain coming back and it worked. I slept all night with no pain.
This is totally cool to read this. I’ve been experiencing headaches and muscle pain at my job. I began taking strong aspirin, but it was only partially effective. On breaks, I started drinking coffee simply because I love coffee and my pain was suddenly and significantly reduced. I wondered if the caffeine in the coffee had something to do with it, which is the very reason I researched this subject. I am surprised and delighted with the information I have found here.
Good for you!
I have severe nerve pain (sciatic nerve) it has been going on and on up and down with the amount of pain for 2 months, I was in an amazing amount of pain and nothing was helping. Then all of a sudden i noticed i was not in much pain at all and the only thing I had done was have a cup of coffee. Since then whenever the pain gets really bad I have a coffee and it nearly goes completely. Why was I not told about this sooner, especially as I am tacking Ibruprofen and it works best with this. I can actually do some things at home now with out being in terrible pain.
Yes!!! Caffeine and ibuprophen provide equal pain relief, but combining them provides the BEST non-narcotic pain relief available!
I have arthritis, herniated discs and degenerated joints. I discovered quite by accident that coffee actually relieves much of my pain. I am a very occasional coffee drinker, so it became very apparent to me that when I do drink coffe my pain is less!
I’ve been suffering with sciatic nerve pain in one leg (butt to heel) for 6 weeks. This is my second such episode, a year apart. When I get up in the morning, which can be any time from 2am till 6am, usually the earlier, and always in severe pain, I make a pot of coffee and drink a mug or two. Within an hour or so, the pain is gone. Nothing else works like this, though there aren’t many things to try. I’m able to go back to sleep after about two hours. I am also taking gabapentin and Tramadol (low dose) but they alone do not relieve the pain, though I think the latter helps me sleep, and the gabapentin may reduce the pain level (from 8s and 9s) down to 6s and 7s. I’m not sure.
I’d like to know if anyone else has experienced similar sciatic nerve episodes from a pinched nerve, how frequently these episodes recur. My first one lasted about 7 weeks, and I’m about to enter week 6 in this second episode, exactly one year later.
Hi..I have had the same issues with severe sciatic pain. The worst pain ever and was laid up for weeks. I was taking diclofenac for inflamation and tylenol for pain….when I added a couple cups of coffee it worked very well for the pain .
Thank you, Peter. You know, I finally got an Rx for diclofenac gel, which relieves my foot pain. I did not know it came in an oral form. I do take 50 mg of Tramadol, usually just once a day, and 2700 mgs of Gabapentin three times. It’s wonderful. But I also have my coffee throughout the day. May your pain diminish. I’m getting up and out these days, but still hurt a lot, sometimes all day long. This sciatic pain is awful!
thanks for your reply elaine….I have heard of the diclofenac gel…but have not tried it yet….things are getting better…physio does help…gentle stretches…and walking will help…good luck
I too have been suffering from same issues as the above comments…. I tried to do a cleanse and just go off coffee… but my pain increased and I felt I was going insane from pain.. I was at the pool for my first physio and I was in such pain.. the hot tub helped a bit… on the way home I thought I am going to just give into my trying to go off coffee..so I grab a coffee and within 20 minutes the pain was much more tolerable.. I have in the past gone on a kick to eliminate caffeine due to studies of women after 50 should quit, as well as trying to better my health and do I could to help myself to recover from back pain ect. I had a recent work injury that flared up my lumbar and sciatica and I felt I was on the mend and possible go back to work… the physio did the dry needling 4 day prior to my pool physio and during that time I also been of coffee for 3 days.. man I could not sleep last on the 2 day the pain made me feel like dying.. if this is what I have to look forward to is pain.. and I can not enjoy life , just want to cry , I so want to be back at work.. so like I said I gave into coffee and my back pain totally subsided within 20 minutes.. It is crazy how that made such a difference… I recall I had increased back pain when I tried to go off coffee or caffeine before and so is a reason I thought I’d just try a coffee and see if it is actually a cause for all to be so much worse without the coffee, and yes.. it seems to be a factor.. is interesting…I am totally trying to stay off strong medication, and do the natural thing such as Ice, heat, and eating pineapple which is suppose to be great for inflammation ect… which is also a good read for natural painkiller… any how I cam home to day and wanted to read about the caffeine and pain related issues and found this site… and all the comments… and want to say I feel so bad for us all that are suffering from pain… and dealing with doctors and professionals.. and really not getting much help other that just pills.. or a 20 minute appointment at physio and nothing really helps.. not one but no one understands such unless ya have had unending pain.. so little help that is long lasting… but the coffee does help a lot for me anyways in just making life a little more enjoyable.. Please for give me I’m not a gifted writer.. but I just wanted to share as maybe it can help anyone.. we have to help each other and be a support system..
the problem is with pain at night interfering with sleep, caffeine at night is likely to make sleeping even worse.
Sometimes, the relief caffeine gives to pain can actually enable you to sleep. Once, when I had a very high fever, I ached everywhere. Advil didn’t help. I took caffeine and amazingly, because my pain was gone, I fell asleep right away. But of course your experience might be different.
Like other commentators on this page I am currently suffering from severe sciatica with a non-stop high level pain running from my right-side Glute muscles down the back of my leg and into my foot. It’s like having a giant tooth-ache with each heart beat bringing a cold, merciless throbbing. Last week, after having an MRI (showed 2 ruptured lumbar discs) I went back to the pain doctor for a follow up. When I told him the only temporary relief I get from this 9 to 10 level pain is after drinking some strong coffee, he rolled his eyes at me and acted as if I had just reported seeing a UFO convention in his parking lot. It’s just amazing to me that even doctors who specialize in treating pain can be so completely oblivious to the one-and-only effective ingredient for easing Sciatica pain; caffine. That same pain doctor has me on Methadone for this condition and before adding coffee to the mix, even that strong narcotic did nothing to ease the pain enough to sleep. Seriously, if you ever end up with this sort of pain, drink some strong coffee as your first line of defense in fighting the pain. Even when taking a narcotic pain killer, the caffine enhances its effectiveness and will give you a 4 hour window of time to get some much needed sleep.
I am sorry to learn of your trouble, but very happy indeed that you have followed our advice and used caffeine to combat pain!
Doctors not only do not know about this benefit. They do not know about most or even any of the dozens and dozens of therapeutic and performance benefits of caffeine. For example, caffeine extends your life, primarily by protecting your heart, reduces the chances of getting a stroke, enables you to exercise more and also to relax, combats Alzheimer’s and a dozen cancers, etc., etc. etc. It is truly a panacea — and largely unrecognized!
Hi Douglas, How are you now? I have been suffering from the exactly same problem for months now and couldn’t find any cure, Can you please help me by telling me as to how you cured this issue?
Ok, I don’t want to jump the gun here, but I might have stumbled across this caffeine phenomenon as well. I haven’t been able to work in 10 years. Degenerative disc disease, Hyper-kyphosis, spinal stenosis, bone spurs, I think last count was 9 bulging discs, sciatica, compression fractures, scoliosis, the horrible lumbar ache that everyone describes and the absolutely positively hellish un-Godly non-stop burning pain that comes along with the muscles spasms that run along each side of the spine from L5-S1 all the way up to the middle of my shoulder blades-I’m guessing that’s near the top of the thoracic vertebrae. Physical therapy, acupuncture, massage, dry needling, TENS units, corticosteroid injections, hydrocodone, oxycodone, methadone, tylenol, muscle relaxers, a bunch of meds that were used off label to try to get ahold of this pain etc, etc, etc, etc, etc, etc, etc, etc.Oh and the cocktail of Tramadol mixed with a bunch of other crap threw me into a seizure and in one second I fell and broke 4 vertebrae, my right shoulder, my nose, and smashed my eyebrow open so much I needed 10 stitches. Was in the hospital for 3 days. As if I needed more pain right? Never broke a bone in my body until that day. A couple fractures wouldn’t heal so they injected cement into them. Vertoplasty or something? That was a year ago. No doctor ordered any physical therapy for my back or my shoulder. Was dealing with the aftermath of the seizure for months now take pills for that everyday. A month and a half ago I started physical therapy after complaining to my new doctor for 3 years about the pain. I think he thought by stuffing pills down my throat I’d shut up. I’m all for the exercise, I do think it will help and I definitely need to build a strong core because literally laying down for 5 out of 10 years has pretty much depleted me of any strength. I’ve been reading alot and I can see how and do understand to a degree how much a strong core is important to back health. However, there are no doctors or physical therapists, or pain psychologists or whomever out there that have any kind of idea the amount of pain that myself or anyone who has commented or anyone who is reading this goes through on a daily basis. The pain has completely sucked the life out of me and I’m sure some, if not most of you, know exactly what I’m talking about. Which leads me to my point. Trying to drag myself out of bed in the morning to face yet another endless day of hell. No energy. No motivation. Damn near no will power left. I call a friend to ask him if he knows of any supplements I could take that might give me a little “get up and go” energy so that daily life isn’t so damn brutal. Now I mentioned I’m not working, I’m just trying to make it through the day and 90% of that day is spent laying down to avoid pain. So he mentioned a popular fitness/workout supplement that you’d see at a supplement store and I look it up and it’s loaded with caffeine. I can’t tell you when the last time I had caffeine was. I don’t drink caffeine. I’ve tried coffee and things like that before but never really understood the fascination. Anyway, concerned I might have a heart attack if I ingested the amount of caffeine that came in a serving size of this particular supplement I just went to the local fast food joint and picked up a small coffee. I drank it at about 2pm. Laid down until about 6pm because that’s what I do, I lay down to avoid pain. So at 6 I get up to grab some water, throw a bag of trash out, some other small “task” and I immediately notice the pain reduction. I was taken back. I was like “holy crap, what the heck is going on and why is there less pain and why don’t I want to shuffle back to bed and lay down right this second”? It was really weird. The lumbar ache was alleviated. Still present but at a much lower pain level. And the muscle spams, the burning pain that torments me the most, was turned down quite a few notches. I walked around the house for a few minutes. I did a couple stretches and got my back to crack a little bit indicating the muscles were in fact relaxed a bit. I just had physical therapy yesterday and this morning I felt like I got hit by a bus. THE ONLY THING THAT CHANGED WAS THE ADDITION OF COFFEE—PERIOD. I can’t explain it. I can’t wait to try it again in the morning either. I still can’t believe the amount of relief it gave me. I just absolutely can not wrap my head around this whole situation. Years and years and years and years of non stop absolutely horrible pain that has all but sucked the entire life out of me has been partially alleviated by a cup of coffee? Are you kidding me? All the pills, the money spent on massage and acupuncture, the chiropractic work, physical therapy, getting electrocuted with TENS devices and most importantly all the hell I’ve been through can be scratched out a little bit, or a lot if I was able to notice it that fast, with a cup of coffee? I still can’t believe it. Like I said I don’t want to jump the gun but my pain level dropped significantly and dramatically today within only a few hours and the ONLY THING THAT CHANGED was drinking a cup of coffee. For the first time in more than 10 years I can actually say that I’m looking forward to getting out of bed tomorrow to see if it works again. I found this website somehow and if you’re reading this you stumbled upon it too. If you’re in pain, If the meds you take don’t work or don’t work as well as you’d like them to, If you’ve tried other treatments and nothing has helped, Try some coffee. Just give some coffee a shot. I never drink caffeine. Ever. I drink water. That’s it. Water water water. Today I had coffee and my pain level dropped drastically. I noticed it almost immediately when I stood up. I avoid standing because laying down helps the horrible lumbar pain and the nasty burning muscle spasms. When I noticed the drop in pain I was actually confused because it was, and still is, abnormal. I walked around scratching my head asking myself why I didn’t hurt so bad. And this was 2.5 hours after I should have taken another round of pain pills. I still can’t even wrap my head around this. If this is the key, If this is the answer to my prayers, then this is going to be the first step of many in an entirely brand new direction. I absolutely can not believe it. If you’re in pain and your doctors can’t get a handle on it or if you’ve been suffering like me for years on end please please please please please do yourself a favor and just give coffee a chance and see what happens. What have you got to lose? In my experience, you might have a little pain to lose. It’s not a miracle “pain off button”, but I’ll tell you that in order for me to notice such a dramatic reduction in pain in regards to the constant horrible pain I’m always in, coffee and/or caffeine has to interfere with signal processing of pain/nerve signals or something to that effect. There’s no other explanation. I’m still trying to wrap my head around this. I’m actually looking forward to the morning to see if it works again and I can’t even believe I’m saying I’m looking forward to the morning. The amount of pain, the level of pain, the constant pain, and the dramatic drop in the level of pain all of the sudden because of a single cup of coffee? Unbelievable. Un-Fricken-Believable.