A B C D E F G H I J K L M N O P R S T U V W

ANALGESICS - PAINKILLERS

What are Analgesics for ?

Apart from pain relief, some painkillers (analgesics) have other effects that may be useful in particular conditions. Aspirin also reduces inflammation and fever. Paracetamol has similar painkilling qualities and can reduce fever. However, it does not reduce inflammation. Painkillers belong to different groups. Non-narcotic analgesics include aspirin, paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs – for example; ibuprofen, diclofenac, naproxen, indomethacin). They are useful for everyday aches and pains, such as headaches and joint and muscle pain. Other anti-inflammation drugs are discussed in another leaflet. Opioid analgesics are also called narcotic analgesics. They include codeine, morphine, dihydrocodeine and pethidine and tramadol. They are useful for moderately severe pain (e.g. after operations, serious injury or disease). A weak analgesic called dextropropoxyphene is also in this group, and is often combined with other analgesics. Compound or combined analgesics usually contain a small amount of a mild opioid, and a simple analgesic such as aspirin or paracetamol, all within one tablet or capsule. They are useful if the non-opioid painkillers are not enough. Anti-migraine drugs are discussed in the special section dealing with this disorder . Other painkillers include nefopam, which doesn't fit into any other group. Sometimes you might need to take other medication as well as your painkillers. Sleeping, anti-epileptic or anti-anxiety tablets may also be helpful if the pain is longstanding.

How do Analgesics work ?

It is not fully understood how painkillers work. Damaged or inflamed body tissues produce various chemicals which send signals through the nervous system to the brain. The brain produces the sensation of pain. Different painkillers act at different points in this process. For example, NSAIDS may act at the point of « injury », whereas others act on the nerves or brain.

How should Analgesics be used ?

The cause of a pain should always be discovered. Otherwise, painkillers may mask the underlying problem. Usually painkillers come as tablets or capsules, but sometimes as liquids, suppositories or injections. Paracetamol is one of the best and safest analgesics for routine pain relief. Aspirin is better for conditions where obvious inflammation and particularly fever is present, although side-effects are more likely. Compound tablets and capsules, for example aspirin with paracetamol or codeine, are sometimes useful when single drugs are not effective. NSAIDs like ibuprofen are particularly good for muscle and joint pains. Trial and error is sometimes the only way to proceed. Your doctor or pharmacist will advise you on choices and the doses, too. Sometimes it is appropriate to take painkillers when you know you are going to be in pain, rather than waiting for it to happen. Period pain or arthritis are common examples. Taking painkillers regularly rather than when required is often a better way of treating longstanding pain. Remember to check the label first! You must not take more than your doctor or pharmacist has advised.

During Treatment with Analgesics

Painkillers normally start to work within 30 to 60 minutes. They may work more quickly if they come as (soluble) tablets that you dissolve in water first. They may take longer to act if they are in a slow-release preparation (usually labelled SR, CR or MR); however, these have the advantage of working for a longer period of time. Aspirin and NSAIDs can irritate your stomach, causing indigestion, ulcers or bleeding. It is better to take these medicines nafter a meal. Shiny, so-called enteric-coated tablets may cause less stomach irritation. Speak to your doctor if you get frequent or severe indigestion-like symptoms. If, after taking aspirin or an NSAID you get a rash, become wheezy or short of breath, stop taking the medicine and tell your doctor. Ringing in the ears may suggest that you are taking too much aspirin. Paracetamol in the recommended dose rarely causes any side-effects : larger than recommended doses may damage your liver, and so should not be taken. Opioid painkillers can cause nausea and vomiting, constipation and drowsiness. Some of these symptoms may decrease as use of the painkiller continues.

Drug Interference

Alcohol or other drugs that makes you drowsy will worsen the drowsy feeling that you get with opioid painkillers. Antidepressants of a certain type taken with narcotic painkillers (especially pethidine) can make your blood pressure rise or fall. Anti-inflammatory drugs : In general, do not take two different types of painkiller (unless they are already in the same tablet or capsule). Stomach bleeding or ulcers may result. Blood thinners (anticoagulants) are made more active by anything more than the occasional dose of aspirin, dextropropoxyphene or paracetamol. You could develop bleeding. Cimetidine (an anti-ulcer drug) increases the amount of narcotic painkillers, which build up in the blood and can cause problems. Steroids (cortisone-like drugs) may increase the risk of stomach problems with aspirin. Epilepsy medication (phenytoin or valproate) doses may need to be reduced if you are having aspirin. Carbamazepine doses may need to be reduced if you are taking dextropropoxyphene. If you are taking methotrexate or lithium, do not take aspirin or NSAIDs before speaking to your doctor. NSAIDs may increase the effect of some antidiabetic drugs.This is not a full list , so check with your doctor or pharmacist if you take any other medication. It is best not to stop taking any medication your doctor has prescribed unless you have discussed it first.

What if Analgesics are not taken ?

If you take painkillers regularly and then stop them suddenly, your pain will probably come back if the underlying problem is still there. If you have been taking opioid painkillers for some time, your doctor will tell you how to reduce the dose gradually.

General advice about Analgesics

Before using over-the-counter painkillers, get advice from your doctor or pharmacist if you are pregnant. Always mention other medication that you are taking. Get advice also if you have liver, kidney or prostate problems, asthma or bronchitis, heart or blood circulation problems, an ulcer, glaucoma or epilepsy. Opioid painkillers can give you a "high". This may lead to abuse and addiction. However, if used under instruction from a doctor for severe pain and for short periods, the risk is very low.