It depends on the painkiller.
Some of them stop the processes that send pain-inducing chemicals, like aspirin. In this case, yes, the pain is actually “gone” because those pain signals stop sending.
In stronger things like opioids, the pain receptors are blocked. The pain is still “there” but you can’t even receive those pain signals.
So for example, you can’t take something like aspirin and feel no pain if you suddenly cut your hand, because aspirin doesn’t stop that type of of pain process. While someone high on opioids may not even notice they cut their hand.
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