Frequently Asked Questions About Pain Medications

Pain reliever or painkiller is a medication of natural, semi-synthetic and synthetic origin, designed to relieve pain which is called in medicine analgesia. The medicines are also named analgesics more professionally.
There are different groups of analgesics that act differently, have different potency of effect, can be used for the different amount of time, and so on. Thus, it is preferable that the painkiller is chosen by a medical specialist for every particular patient and case.

Formulations with painkiller action are used in the therapy of pain of various localizations. They include remedies for pain related to a change in pain threshold, damage (or dysfunction) of the nervous system. These medicines include flupirtine, antidepressants, and anticonvulsants. Also, frequently are used medicines that on their own have no painkiller effect, but enhance the analgesic effect of other formulations. These include muscle relaxants and antispasmodics.
The classification of painkillers is based on dividing them into opioid, non-opioid, and combination medicines. The rest medicines belong to the so-called supplementary and symptomatic agents, allowing achieving the desired effect with fewer adverse effects and in less time. Non-opioid medicines, all of which are non-narcotic, have received the highest spread. The majority of them are non-prescription medicines that can be bought OTC.

Non-narcotics painkillers include:
1. Salicylic acid derivatives: acetylsalicylic acid, and others;
2. Pyrazolone derivatives: Metamizole, butadione, amidopyrine;
3. Aniline derivatives: paracetamol;
4. Derivatives of alkanoic acids - ibuprofen, diclofenac;
5. Anthranilic acid derivatives (mefenamic and flufenamic acids);
6. Others - piroxicam, dimexide, chlotazol.

Narcotic analgesics are sold with Rx only and are used as the last resort, i.e. when the non-narcotic medicines do not provide sufficient pain-relief effect. They include:
1. Opioid receptor agonists (morphine, fentanyl);
2. Antagonist, agonists and partial opioid receptor agonists (pentazocine, butorphanol, buprenorphine).

Opioid formulations induce the closure of the calcium channel and the opening of the potassium channel in opioid receptors, which leads to a diminished conductivity of nerve cells in the posterior corners of the spinal cord. Most opioid receptors are found in the spinal cord and nervous system, but they can also be found in smooth muscles and cells of the immune system.

By the action, the painkillers are divided into:
– Biochemical action
1. Acting on the focus of pain.
2. Stopping the passing of pain signals to the brain.
– Narcotic action
1. Opioid (narcotic) painkillers are utilized for very intense pain management. They mainly affect the CNS and can provoke mental and physical addiction. The high dosages are lethal, so opioids are used in limited amounts and only under the control of medical stuff.
2. Non-opioid (non-narcotic) analgesics are utilized to lower body temperature.
– Anti-inflammatory effect
1. Nondepressing inflammatory processes (antipyretics).
2. Suppressing inflammatory processes (Non-steroidal anti-inflammatory drugs).

– For mild to moderate pain, it is advised to stick to aspirin or NSAIDs such paracetamol by Cipla, ibuprofen, and others that are available over-the-counter. They are effective for headaches, toothache, postoperative pain, osteochondrosis, and other joint and bones pains, as well as muscle traumas and spasms. Such medicines not only offer pain relief but also reduce inflammation. But if you have a stomach ulcer or history of gastrointestinal tract bleeding, you should stay away from them and consult your physician about what medicines you can use instead. For example, for joints aches, you can use Sulfasalazine;
– For the relief of severe pain, the optimal option is combined formulations, for instance, Nurofen plus. They usually contain caffeine, codeine, and Phenobarbital. These supplements enhance the action of the analgesic. Which component a tablet contains is easily found out from the package insert. Caffeine enhances the effect of analgesic, has a tonic effect on the body. Codeine has its own powerful analgesic effect. It belongs to narcotic medicines; therefore OTC combination pills contain codeine in very small doses. However, it is not recommended to give children any medicines with codeine;
– In severe pain associated with fracture, cancer, and other severe conditions, opioid analgesics are utilized but they are sold only with Rx because they cause dependence and are highly dangerous when taken uncontrollably.

Basically, although there are many brand names, the majority of OTC medications from the class of painkillers are based on four main substances: Aspirin, Paracetamol, Ibuprofen, Metamizole, and Nimesulide.

When deciding to use painkillers, it is important to keep in mind that you must identify and eliminate the causes of pain.

You can take painkillers for:
– Headache;
– Toothache;
– Pain in the spine;
– Post-surgery pain including after a dental procedure;
– In an inflammatory process (for instance, in flu when you have fever you can use some NSAIDs);
– In minor injuries or traumas.

In many pains, painkillers are not needed at all. For instance, in menstrual pains or intestinal colic, for pain relief, it’s sufficient to take spasmolytics/antispasmodics, for instance, Drotaverine. If the pains are intense, you can opt for combination medicines that contain an analgesic and spasmolytic, for instance, Metamizole or Ibuprofen with spasmolytic.

– For pains in the abdomen caused by bloating, Simeticone can be used as it effectively relieves the symptoms of excessive gas which can be accompanied by pain.
– In pains in the chest, it is advised to take vasodilators, for instance, nitroglycerin. If the pain is intense and doesn’t fade over 7-10 minutes, it is advised to take another pill and seek emergency help.
– In unpleasant sensations related to the diseases of the stomach and esophagus medications from the class of antacids, for instance, Maalox, Mylanta, Rolaids, and others are helpful.
– Headaches caused by elevated arterial pressure are relieved with antihypertensive medications.
There are certain disturbing symptoms in which taking analgesics is strictly prohibited. Their reception can confuse the picture of the disease and lead to erroneous treatment tactics. For instance, sharp and severe pain in the abdomen may be due to appendicitis, intestinal obstruction, and hemorrhage into the abdominal cavity in women with ectopic pregnancy. With such pains, you need to call an ambulance as soon as possible.
Another dangerous sign is a combination of headache with fainting, sleepiness, and vomiting. It can be caused by stroke or encephalitis. In this case, drinking analgesics without consulting a doctor is highly undesirable.

The prohibitions for NSAID painkillers are:
– Pregnancy;
– Increased sensitivity to the active substance or to any component of the formulation;
– Concurrent use with potentially hepatotoxic agents;
– Alcoholism, drug addiction;
– The active form of gastric ulcer or duodenal ulcer;
– The presence of recurrent peptic ulcer disease or gastrointestinal bleeding in history; history of perforation;
– Severe bleeding disorder;
– Severe heart failure;
– Severe renal failure;
– Liver failure;
– Suspicions of acute surgical pathology;
– A history of cerebrovascular bleeding or other hemorrhages.

Codeine-containing medicines are contraindicated in:
– Hypersensitivity;
– Toxic dyspepsia;
– Diarrhea on the background of pseudomembranous colitis caused by cephalosporins, lincosamides, penicillins;
– Acute failure of the respiratory system;
– The use is possible with caution in;
– Acute abdominal pain without the cause diagnosed;
– Asthma;
– COPD;
– Arrhythmia;
– Seizures;
– Medicine or illicit narcotics dependence;
– Alcoholism;
– Gallstone disease;
– After a surgery;
– Brain trauma;
– Intracranial hypertension;
– Liver or kidney failure;
– Hypothyroidism;
– Severe inflammatory bowel disease;
– Prostatitis;
– Urethral stricture;
– Seriously ill weak patients;
– Pregnancy, lactation;
– Use of MAO inhibitors;
– Old age;
– Infancy.

It is not recommended for pregnant women to use NSAIDs, especially in the third trimester as it is believed that the medications can cause premature labor and renal complications in the fetus.

Codeine-containing medicines can be used during pregnancy only if the doctor believes that the risk is lower than the potential benefit.

Yes, but the forms and dosages are different than for adults.

The first-line medications for kids are paracetamol-based medicines such as Panadol, Ibuprofen, Nurofen. Kids older than 12 can be administered Nimesulide. If you don’t have any of these medicines at hand, you can give your child Metamizole but in a very small dosage. Aspirin is highly contraindicated for children as it can cause life-threatening brain swelling.

Worth noting that there are different kinds of pain and in spasmodic belly pain or indigestion kids do not need analgesics but spasmolytics and enzymes for better digestion. In any case, it is better to consult a pediatrician and find out the reason of pain before giving your kid any medications.

There are different medications with painkiller effects. Here we list the most probable adverse reactions that can be caused by the most frequently used analgesics.
NSAIDs can cause:
– Diarrhea;
– Vomiting;
– Stomach ulcer;
– Skin rash;
– Itchiness;
– Dizziness;
– Bitterness in mouth.

Codeine-containing medicines can cause:
– Constipation;
– Dry mouth;
– Anorexia;
– Nausea, vomiting;
– Spasms in the digestive tract;
– Paralytic intestinal obstruction;
– Drowsiness;
– Lightheadedness,
– Headache;
– Fatigue;
– Nervousness;
– Confusion;
– Blurring vision;
– Excitation, restless sleep, nightmares;
– Convulsions;
– Depression;
– At high doses - muscle stiffness;
– Tremor;
– Muscle twitching, tinnitus;
– Worsening of the coordination of movements of the eyeballs with visual impairment, increasing the tone of smooth muscles (at doses above 60 mg).
– Arrhythmias (tachycardia or bradycardia);
– Low or elevated arterial tension;
– Depression of the respiratory system;
– Diuresis reduction;
– Spasms of the ureters;
– Atony of the bladder;
– Skin rash, urticaria, skin itching, facial edema, bronchospasm, laryngeal edema, laryngismus;
– Sweating;
– Raise or drop in body weight; with prolonged use they cause addiction and withdrawal syndrome.