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Aug 28, 2006

Review of 10 most used pain killers

by SirGan/Prescription & Over-The-Counter Drugs

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An analgesic, also known as a painkiller, is the term used for any member of the group of drugs used to relieve pain and to achieve analgesia - painless state. Analgesic drugs act in various ways on the peripheral and central nervous system. The pain relief induced by analgesics occurs either by blocking pain signals going to the brain or by interfering with the brain's interpretation of the signals. There are several groups of pain killers and they include:

paracetamol (acetaminophen)
the nonsteroidal anti-inflammatory drugs (NSAIDs) such as the salicylates
narcotic drugs such as morphine
synthetic drugs with narcotic properties such as Tramadol …

Some other classes of drugs, which normally don’t belong to the group of pain killers, are used to treat some pain syndromes and these include tricyclic antidepressants and anticonvulsants.

It should be pointed out that some experts include aspirin and other non-steroidal anti-inflammatory drugs in the class of analgesics, because they have some analgesic properties but they primarily have an anti-inflammatory effect.

Groups of pain killers

Simply put, analgesics are a class of drugs used to relieve pain. There are basically two kinds of analgesics:

non-narcotics
narcotics

Non-Narcotic Analgesics

Paracetamol

Most people already know that Paracetamol or Acetaminophen is the most commonly used over-the-counter, non-narcotic analgesic. It is extremely popular pain-reliever because it is both effective for mild to moderate pain relief. It is also relatively inexpensive. Although not too many people take this drug seriously- it is proven that, if acetaminophen is not used according to the directions, serious side effects can occur. The most common side effect is increase the risk of liver damage. The risk of liver damage with acetaminophen use is also increased by ingesting alcohol. This medication can be found in combination with other active ingredients in many cold, sinus, and cough medications.

Narcotic Analgesics

Everyone should know that there are two types of narcotic analgesics: the opiates and the opioids. What exactly are opiates? Well, they are the alkaloids found in opium. Opioids are any medication which bind to opioid receptors in the central nervous system or gastrointestinal tract.

They are used in medicine as strong analgesics, for relief of severe or chronic pain. What's interesting- there is no upper limit for the dosage of opioids used to achieve pain relief, but the dose must be increased gradually to allow for the development of tolerance to adverse effects.

There are four broad classes of opioids:

Endogenous opioid peptides- they are normally produced in the body and include endorphins, dynorphins, enkephalins…
Opium alkaloids – the most commons are morphine, codeine, thebaine
Semi-synthetic opioids – most common are heroin, oxycodone, hydrocodone, dihydrocodeine, hydromorphone, oxymorphone, nicomorphine
Fully synthetic opioids – the most common are Demerol, Methadone, Fentanyl, propoxyphene, pentazocine, buprenorphine, butorphanol, Tramadol…

Oxycodone

It is important to point out that Oxycodone is a potent and addictive opioid analgesic medication. It is synthesized from thebaine. Its name is derived from codeine because the chemical structures are very similar. Oxycodone is one of the most powerful medications for pain control that can be taken orally and it is also used in treatment of moderate to severe chronic pain. OxyContin is available in 5, 10, 20, 40, 80, and 160 mg tablets, and it is effective for 8 to 12 hours. What's most important- In the United States, oxycodone is a type II controlled substance.

Morphine

Probably everyone knows that Morphine is one extremely powerful opiate analgesic drug. It represents an active ingredient of opium. It should be pointed out that, like other opiates, morphine acts directly on the central nervous system to relieve pain. Target tissue are synapses of the arcuate nucleus, in brain. There are several side effects that could occur and the most common are:

impairment of mental performance
euphoria
drowsiness
lethargy
blurred vision
constipation

The most important thing there is to know about this drug is that it is highly addictive when compared to other substances. Tolerance and physical and psychological dependence develop extremely quickly.

Tramadol

Tramadol is an atypical opioid which is a centrally acting analgesic, used for treating moderate to severe pain. What makes it so special? Well, beside the fact that it is a synthetic agent, it also appears to have actions on the GABAergic, noradrenergic and serotonergic systems. This isn't case with other pain killers! Tramadol is available in both injectable and oral preparations. Dosages vary depending on the degree of pain experienced by the patient but it is useful to know that Tramadol is approximately 10% as potent as morphine. Oral doses range from 50–400 mg daily, with up to 600 mg daily when given IV/IM.

Codeine

Everyone should know that Codeine is a narcotic analgesic painkiller used for pain relief. The drug codeine is also used in combination medications with the drug acetaminophen, in brand names such as Tylenol, Tylenol with Codeine, Empirin and Phenaphen with Codeine, or in drug combination with aspirin. It is extremely useful for treating moderate to mild pain!

Darvocet

Darvocet is a combination narcotic analgesic painkiller used for pain relief. Other brand name drugs which contain propoxy and acetaminophen include: Propacet, and Wygesic. It is very useful for treting all kind of pains, but the problem is that there are several possible side effects related to the use of this medication!

Propoxyphene

Two medications: Darvon and PP-Cap (generic drug name propoxyphene) are narcotic analgesic painkillers used for pain relief. It is important to point out that the medication propoxyphene comes as a tablet, capsule, and liquid to take by mouth. Darvocet contains the drugs propoxyphene and acetaminophen.

Duragesic

Duragesic is a narcotic analgesic painkiller used for severe pain relief. It is important to know that Duragesic comes only as a skin patch, which contains the generic drug Fentanyl. The medication is absorbed directly from the patch when applied to the skin.

Marijuana

The debate over the use of marijuana for medical purposes has been ongoing for years. Marijuana has been hailed as a prescription for many ills and physicians once used it to stimulate appetite, relieve chronic pain, and treat asthma and migraines. Most common indications for use of Marijuana are:

chronic pain
migraines
glaucoma
Multiple sclerosis…

Many young users are saying that the addiction with marijuana isn't possible. Of course, this isn't true! Addiction is highly possible! Long-term marijuana use can lead to addiction for some people, which means that they use the drug compulsively even though it interferes with family, school, work, and recreational activities. When a person is chemically dependent on marijuana, it means that it needs to use more and more to get the same effect. Most common withdrawal symptoms are: depressed feelings, trouble sleeping and nausea.

Salicylic acid

Not too many people know that Salicylic acid is a colorless, crystalline organic carboxylic acid. Salicylic acid functions as a plant hormone because. It is important to point out that salicylic acid is toxic if ingested in large quantities. In small quantities is used as a food preservative and antiseptic in toothpaste. The medicinal properties of salicylates have been known since ancient times and everyone should know that the substance occurs in the bark of willow trees.
Aspirin can be prepared by the esterification of the phenol hydroxyl group of salicylic acid. It is often combined with bismuth and when combined the two key ingredients help control diarrhea, nausea, heartburn, and even gas. It is also very mildly anti-biotic.

Side Effects and Adverse Reactions of Opioids:

Common side effects and adverse reactions:

nausea
of the pupil)
orthostatic hypotension
urinary retention
vomiting
drowsiness
dry mouth
miosis

Less common side effects and adverse reactions:

bradycardia (slow heart rate)
tachycardia (rapid heart rate)
raised intracranial pressure
confusion
hallucinations
delirium
hives
itch
hypothermia ureteric or biliary spasm
muscle rigidity
flushing
respiratory depression
fatal overdose

Pros and cons for use of pain killers

There have been debates over the addictive potential of opioids vs. the benefit of their analgesic properties, especially for treating non-malignant chronic pain, such as chronic arthritis. Although they can be extremely helpful- there are several possible lethal side effects that can occur! Some experts believe opioids can be taken safely for years with minimal risk of addiction or toxic side effects. This could happen only if taken under close supervision of doctor!

Important notification about information and brand names used in this article!

Author's biography

SirGan is doing his specialization in neurosurgery at Portugal. He is interested in expertise for radiosurgery, as well as treatment of brain tumors, and currently he is studying interventional radiology. He gained significant operative experience that is done under the supervision and guidance of senior residents.

Article sources

http://www.vaughns-1-pagers.com/medicine/painkiller-comparison.htm
www.arthritis.about.com
image:www.associatedcontent.com

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Comments

The following content represents the opinions of SteadyHealth.com users. It is not editorially reviewed for medical or factual accuracy. It does not constitute medical advice. See your doctor for medical advice.

Posted 7/09/09 - 01:31 by bluedog

Guest wrote:

I would just like to clarify something:

People in an amazing amount of pain generally will not take the medication to receive euphoria. I, personally, have been on methadone for 2 years, and since then, was moved to morphine. I have been on the same dosage, 15 mg as needed for breakthrough and 2 12 hour 20 mg tablets, for over 2 years now. I have not had to increase my dosage, and I still feel relief from the same amount I had before. Eventually the euphoria goes away, but the pain relief does NOT. Yes it is possible to get addicted to the euphoria, I suppose; But this is possible with ANY drug you use that might offer a "high".

One last thing-

People need to understand that there is a BIG difference between being ADDICTED to a drug and being DEPENDANT on the drug. I am dependant on morphine; this means that I will suffer withdrawals if I were to stop cold turkey. I am not an addict, as I use the medication as prescribed. There is a BIG difference and the people who compare chronic pain sufferers with "heroin" or street users/drugs are VERY MUCH MISINFORMED. It is thought patterns like that that make it harder for legitimate people to receive the pain relief that is needed.

Can you explain a little more about the difference between addiction and dependance? I don't think I fully understand and it would help me to understand the difference if you explained it. Thanks!

Posted 31/08/09 - 04:55 by Guest

... see all comments ...

Posted 3/07/09 - 20:38 by bluedog

I was very surprised to see that you had posted marijuana on here but yes it is very effective as a painkiller so I suppose I'm not that surprised. I know that not all opoids are totally addictive. When I had my teeth pulled, I was put on codeine and I didn't really suffer any withdrawal symptoms so I think it's important to realize that everyone has a different experience. Does anyone else have any thoughts?

Posted 2/07/09 - 17:38 by Guest

This is pure crap. Opioids always get you hooked. Even mild ones such as codeine. Sure, they take the pain away, but they also are very pleasure to take drugs, and in short time you create tolerance and need to increase the dosage to "feel" good again, and that leads to heavy addiction, that when you are not on the opioids, you cant function as you normally used too. And the withdraw sindrome is bad, and after you start on this road, even after recovery, you never be the same, you will always crave it.

Doctors should be more direct to patients when prescribing this kinds of drugs (opiates such as codeine or hydrrocodone)

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