Analgesics: Are these your key to being pain-free?
Posted 04-11-2008 at 07:31 AM by tinmuning
With the increasing number of analgesics in the market, many are wondering which is the best analgesic to choose. The answer: None. Analgesics have different types which are specific to each person, pain severity and origin. The more appropriate question should be: “What is the right analgesic for me with this particular pain I am feeling?” It is not right to decide to use the same drug that worked previously for migraine, this time for a nagging tooth ache. As one reads on, this article wishes that patients may be guided on choosing over-the-counter drugs and understanding the prescribed medications for them.
Analgesics are a wide array of drugs used to relieve pain. These drugs are classified in terms of their specific actions to the nervous system, other anti-pain related activities, structure and composition.
Acetaminophen/ Paracetamol (Tylenol)
This drug works by preventing prostaglandin (an enzyme responsible for pain perception) synthesis in the central nervous system, which explains its antipyretic and analgesic properties. They have but very little anti-inflammatory action. Acetaminophen/Paracetamol has very few side effects and is regarded as safe. In fact it is considered to be the analgesic/antipyretic drug of choice for children. However, overdose can still be harmful and may lead to liver and kidney failure.
NSAIDs: Ibuprofen (Midol, Advil), Mefenamic Acid (Ponstel, Ponstan), Diclofenac (Voltaren)
Like paracetamol, NSAIDs or Non Steroidal Anti-Inflammatory Drugs also inhibit prostaglandin synthesis, however its action starts by blocking its mother enzyme cyclooxygenase which accounts for both pain and inflammation. This is the main difference between paracetamol and NSAIDs. Paracetamol cannot be used for pain with or caused by inflammation since its anti-inflammatory action is negligible. Although NSAIDs are said to be one of the most widely used oral analgesics, some are becoming hesitant in choosing this drug due to its unwanted gastric side effects like hyperacidity and the risk of hemorrhage. (NSAIDs are said to affect platelet function)
Cox-2 Inhibitors: Celecoxib (Celebrex), Meloxicam (Mobicox), Rofecoxib (Vioxx)
These are drugs have been derived from NSAIDs and had been introduced before as the better and safer alternative to its predecessor. Cox-2 inhibitors have been famous during the time when they were launched since they seem to have more benefits than NSAIDs, one being less likely to cause gastric side effects. These drugs’ being “better and safer” are now being questioned based on recent findings which indicate that the danger associated with cox-2 inhibitors may outweigh it benefits over NSAIDs. Besides, experts argued that there is no particular study which shows that cox-2 inhibitors relieved pain better than NSAIDs. Recently, one type of cox-2 inhibitors have been taken out from the market due to its risks associated to heart attack and stroke.
Opioids
Opioids work on the central and peripheral nervous system, as well as on the gastrointestinal tract. This explains their wide range of effects; however, their primary use in medicine is still for the relief of intense pain and the anxiety that often accompanies it. Strong opioids include Morphine, Meperidine (Demerol), Methadone, Fentanyl, Codeine and Heroin.
Opioids are very effective analgesics against severe, acute pain; however, they also have several unpleasant side effects. Often, patients taking opioid drugs complain of nausea and vomiting. Constipation is also a problem among patients taking these drugs. The above-mentioned side effects are usually relieved by co-prescribing antiemetics and laxatives.
They are generally considered as safe when used properly. Yet because of they are often associated with addiction and respiratory depression, medical practitioners are quite hesitant to prescribe these drugs as readily as NSAIDs. Patients are also reluctant to follow prescriptions with opioids due to misconceptions and fear. It is important for the doctor to reassure the patient that risks associated with these drugs are minimized with familiarity of proper dosage.
Combination Drugs
Analgesics may be used in combination, whether patients are instructed to take 2 types at the same time or take a single drug with different analgesics as its component. Examples are the paracetamol - codeine (Dolviran) and codeine – dicolfenac (Voltaren Plus) preparations available in the market. Analgesics are often combined with another to have a synergistic effect, increasing the potency of that drug against moderate pain.
Adjuvant Analgesics: painkillers by accident?
Drugs having other primary therapeutic uses have been discovered to be helpful in controlling pain. Some of these drugs even act against the side effects of some analgesics. Take the case of a known anticholinergic/ antispasmodic drug, scopolamine, which is now being used potentiate the effect of opioids and at the same time acting on the latter’s unwanted side effects (nausea and vomiting). Some antiepileptic drugs are also currently prescribed against pain of neurogenic origin like gabapentin (Neurontin).
A lot of analgesics have been mentioned above and those mentioned are just few examples of analgesics available! It’s no surprise that more drugs will be discovered in the future to add to its roster but again, it should be emphasized that there’s no such thing as “one painkiller for all.” There are certain factors in choosing analgesics for a particular individual: co-existing illness, risks, side effects, etc. After all, the key to pain management really is education, not new drugs.
Analgesics are a wide array of drugs used to relieve pain. These drugs are classified in terms of their specific actions to the nervous system, other anti-pain related activities, structure and composition.
Acetaminophen/ Paracetamol (Tylenol)
This drug works by preventing prostaglandin (an enzyme responsible for pain perception) synthesis in the central nervous system, which explains its antipyretic and analgesic properties. They have but very little anti-inflammatory action. Acetaminophen/Paracetamol has very few side effects and is regarded as safe. In fact it is considered to be the analgesic/antipyretic drug of choice for children. However, overdose can still be harmful and may lead to liver and kidney failure.
NSAIDs: Ibuprofen (Midol, Advil), Mefenamic Acid (Ponstel, Ponstan), Diclofenac (Voltaren)
Like paracetamol, NSAIDs or Non Steroidal Anti-Inflammatory Drugs also inhibit prostaglandin synthesis, however its action starts by blocking its mother enzyme cyclooxygenase which accounts for both pain and inflammation. This is the main difference between paracetamol and NSAIDs. Paracetamol cannot be used for pain with or caused by inflammation since its anti-inflammatory action is negligible. Although NSAIDs are said to be one of the most widely used oral analgesics, some are becoming hesitant in choosing this drug due to its unwanted gastric side effects like hyperacidity and the risk of hemorrhage. (NSAIDs are said to affect platelet function)
Cox-2 Inhibitors: Celecoxib (Celebrex), Meloxicam (Mobicox), Rofecoxib (Vioxx)
These are drugs have been derived from NSAIDs and had been introduced before as the better and safer alternative to its predecessor. Cox-2 inhibitors have been famous during the time when they were launched since they seem to have more benefits than NSAIDs, one being less likely to cause gastric side effects. These drugs’ being “better and safer” are now being questioned based on recent findings which indicate that the danger associated with cox-2 inhibitors may outweigh it benefits over NSAIDs. Besides, experts argued that there is no particular study which shows that cox-2 inhibitors relieved pain better than NSAIDs. Recently, one type of cox-2 inhibitors have been taken out from the market due to its risks associated to heart attack and stroke.
Opioids
Opioids work on the central and peripheral nervous system, as well as on the gastrointestinal tract. This explains their wide range of effects; however, their primary use in medicine is still for the relief of intense pain and the anxiety that often accompanies it. Strong opioids include Morphine, Meperidine (Demerol), Methadone, Fentanyl, Codeine and Heroin.
Opioids are very effective analgesics against severe, acute pain; however, they also have several unpleasant side effects. Often, patients taking opioid drugs complain of nausea and vomiting. Constipation is also a problem among patients taking these drugs. The above-mentioned side effects are usually relieved by co-prescribing antiemetics and laxatives.
They are generally considered as safe when used properly. Yet because of they are often associated with addiction and respiratory depression, medical practitioners are quite hesitant to prescribe these drugs as readily as NSAIDs. Patients are also reluctant to follow prescriptions with opioids due to misconceptions and fear. It is important for the doctor to reassure the patient that risks associated with these drugs are minimized with familiarity of proper dosage.
Combination Drugs
Analgesics may be used in combination, whether patients are instructed to take 2 types at the same time or take a single drug with different analgesics as its component. Examples are the paracetamol - codeine (Dolviran) and codeine – dicolfenac (Voltaren Plus) preparations available in the market. Analgesics are often combined with another to have a synergistic effect, increasing the potency of that drug against moderate pain.
Adjuvant Analgesics: painkillers by accident?
Drugs having other primary therapeutic uses have been discovered to be helpful in controlling pain. Some of these drugs even act against the side effects of some analgesics. Take the case of a known anticholinergic/ antispasmodic drug, scopolamine, which is now being used potentiate the effect of opioids and at the same time acting on the latter’s unwanted side effects (nausea and vomiting). Some antiepileptic drugs are also currently prescribed against pain of neurogenic origin like gabapentin (Neurontin).
A lot of analgesics have been mentioned above and those mentioned are just few examples of analgesics available! It’s no surprise that more drugs will be discovered in the future to add to its roster but again, it should be emphasized that there’s no such thing as “one painkiller for all.” There are certain factors in choosing analgesics for a particular individual: co-existing illness, risks, side effects, etc. After all, the key to pain management really is education, not new drugs.
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