Painkillers are analgesic medications. Pain is experienced when the special nerve endings in that part of the injured body send pain messages to the brain. Painkilling medicines interfere with these messages either at the site of the injury, in the spinal cord or in the brain and block the pain. Painkillers are available in different forms. They can be swallowed as tablets, capsules or liquids. There are painkillers in the form of injection, suppositories, creams or an ointment.
Painkiller abuse is on the rise all over the world and the US is possibly the largest consumer of Painkillers. One of the reasons is the easy availability of OTC Painkillers and possibly owing to the drug induced exuberance or 'high' associated with the intake of some kind of narcotic painkillers. The following pages offer a complete insight about the different types of Painkillers and their effects.
Pain killer medications are broadly classified into two main groups:
|Narcotic Painkillers||Non-narcotic painkillers|
|1. Act centrally to relieve pain||1. Act peripherally to ease pain|
|2. Can cause addiction/dependence||2. Do not cause addiction|
|3. Form part of schedule II/III controlled drugs||3. Not part of controlled drugs|
|4. Absence of gastric irritation||4. Possibility of gastric irritation|
|5. Possibility of sedation, respiratory depression.||5. Possibility of bleeding problems.|
|6. No anti-inflammatory effect||6. Has anti-inflammatory effect.|
Common Non-narcotic painkillers: Non narcotic painkillers include two types, namely Non steroidal anti inflammatory drugs (NSAIDs) and Acetaminophen.
Aspirin - Actual drug name : Acetylsalicylic Acid is one of the widest known/used drugs to manage pain and to some extent fevers. With its anti-coagulant properties Aspirin is used for lowering the risk of heart attack and strokes in low doses.
Dosage: For Pain management in Adults: 3 gm per day in divided doses.
Lowering of the risk of heart attack and strokes (Myocardial Infarction - Prophylaxis or Thromboembolic Stroke Prophylaxis): - Single dose between 75 and 325 mg.
Ibuprofen : Another potent Analgesic in the NSAID group, Ibuprofen is useful to treat mild to moderate pain and helps to relieve symptoms of arthritis (osteoarthritis, rheumatoid arthritis or juvenile arthritis), such as inflammation, swelling, stiffness, and joint pain. It is also used as an Antipyretic and for symptomatic treatment of menstrual cramps.
Dosage: For Pain management in Adults: 200 - 400 mg every 4 hours in a day if administered orally. 400 - 800 mg if administered intravenously over a period of 30 minutes every 6 hours.
Naproxen : This NSAID is effective to control pain, stiffness and inflammation associated with conditions like arthritis, ankylosing spondylitis, Tendonitis, bursitis and gout.
Dosage: For Pain management in Adults: 500 mg Naproxen twice daily or in divided doses subject to a maximum of 1 gm per day.
Diclofenac : This NSAID is useful for pain management when there is inflammation such as Arthritis, Dermatomyositis and Ankylosing Spondylitis.
Dosage: For Pain management in Adults: 50mg tablets 3 times a day subject to a maximum of 150mg per day.
Indomethacin : This drug is prescribed for fever, pain, stiffness and swelling especially for relieving symptoms of swelling and pain related to osteoarthritis, rheumatoid arthritis and ankylosing spondylitis. Indomethacin is effective also to treat acute shoulder pain and gouty arthritis.
Dosage: For Pain management in Adults: 25 - 50 mg every 8 hours subject to a maximum of 150 - 200 mg per day depending upon the severity of the pain.
Celecoxib: is used for rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, juvenile arthritis and menstrual pain.
Dosage:For Pain management in Adults: 200 mg once per day.
NSAIDs provide relief from pain associated with inflammation. They are commonly used for headaches, fever, dental pain, dysmenorrhea, bone pain, arthritis and muscle aches. If prescribed alone, NSAID relieves slight to moderate pain and for moderate to severe pain relief, NSAIDs are used in combination with opioids. Some NSAID can be purchased over-the-counter and does not require a prescription from a medical doctor. Do not use this class of drug immediately before or after Coronary Artery Bypass Graft (CABG). Generally NSAIDs are not advisable when Dengue fever is present as this class of analgesics may induce capillary leakage which can lead to hemoconcentration and serous effusions resulting in circulatory collapse.
Acetaminophen: is available under many trade names. e.g.; Tylenol, Panadol
Being an Analgesic and an Antipyretic (drug to reduce fever), Paracetamol (Acetaminophen) is used to treat many conditions such as headaches, muscles aches, arthritis, backache, toothaches, colds and fever caused by infection. Acetaminophen is available in the form of chewable tablets, capsules, liquid as well as in the form of suppositories. Acetaminophen can be taken after or before food unless specifically directed by the doctor.
Contraindication: Certain prescription medications when taken along with Paracetamol can cause problems. Paracetamol is not to be used without recommendation from a doctor under any of these circumstances.
Paracetamol during pregnancy
Paracetamol is not to be used by pregnant women without recommendation from the doctor. Taking Paracetamol while breast feeding can harm a nursing baby as Paracetamol can pass into breast milk. Signs of allergic reaction to Paracetamol include hives, difficulty breathing, and swelling of the face, lips, tongue or throat. Without further delay seek medical help.
Dosage: For Adults: 500 mg tablets every four hours per day subject to a maximum of 4 gms.
Narcotic painkillers: When the OTC painkillers do not provide the much needed relief from pain, narcotic painkillers are prescribed by the doctor. Narcotic are powerful painkillers effective in relieving severe pain. If not taken correctly or as directed by the doctor, narcotic painkillers can have serious side effects.
Codeine is used to treat mild to moderately severe pain. It is also used to reduce severe cough and diarrhea. Codeine is available in the form of a tablet, a capsule, and a solution (liquid). Codeine can be taken with or without food. Narcotic medications should never be combined with alcohol as it can lead to dangerous side effects or even death. If there is a history of hypersensitivity to Codeine, it should not be prescribed. Also, Codeine is not to be used under these circumstance:
Codeine during pregnancy
FDA has categorized Codeine in Category C. Pregnant women or women planning to conceive should inform the doctor before using Codeine. If potential benefits outweigh potential risks, Codeine may be recommended for use during pregnancy. Codeine can pass into breast milk and may harm a nursing baby. Mild side effects include dizziness, lightheadedness, headache, drowsiness, mood change, nausea, vomiting, constipation, stomach pain and difficulty urinating. Serious side effects include difficulty in breathing, palpitations, hives, change in vision and seizures.
Fentanyl is prescribed to treat pain in cancer patients. Fentanyl is particularly used for 'breakthrough pain', pain that is not controlled by other medicines. Fentanyl is usually not prescribed for treating or relieving pain other than cancer related. Fentanil is available in the form of buccal tablet, buccal film, nasal spray, oral transmucosal lozenge, transdermal film extended release. Fentanyl is not for casual use as this drug is far more potent than Morphine. Do not use this medication to relieve mild, short-term, or sudden pain.
Fentanyl is contraindicated for select health conditions and circumstances. Those with a known history of substance abuse should keep away from Fentanyl. If MAOI has been taken within 14 days, Fentanyl should be avoided as it may cause seizures, hyperthermia, and hypertension and in serious cases loss of life.
Fentanyl during pregnancy
FDA has categorized Fentanyl in Category C. Pregnant women or women planning to conceive should inform the doctor before using Fentanyl. There is a possibility of addiction or withdrawal symptoms in newborns if the pregnant mother takes Fentanyl during pregnancy.
Meperidine (or Pethidine as it is commonly known)is prescribed to ease moderate to severe pain as determined by the doctor. In particular, Meperidine is used to ease pain that is experienced before or during surgery, for pain during labor and delivery. In some cases, Meperidine is prescribed for pain occurring from chronic conditions like sickle cell anemia and some type of cancers. Meperidine is available in the form of tablets as well as oral solution. Meperidine can be taken with or without food or as directed by doctor.
Pethidine is contraindicated in patients who are hypersensitive to Pethidine and those who have received recently. Also, patients who have breathing problems, respiratory depression, paralytic ileus, severe infectious diarrhea should avoid Meperidine. Do not take Meperidine while taking medicines like ritonavir, sibutramine or sodium oxybate.
Meperidine during pregnancy: FDA has categorized Meperidine in Category C. As there is a high possibility of respiratory depression in newborns, Meperidine should not be used in pregnant woman.
Side effects may be mild or severe. Less serious effects of Meperidine include constipation, loss of appetite, headache, feeling weak, dry mouth, excessive sweating, and unusual itching, below normal urinating, loss of interest in sex.
Morphine is used for severe pain, cough suppression and sometimes before surgery. In most cases, Morphine is prescribed when the patient requires relief from pain for longer than a few days. Morphine is available in the form of capsules, oral solution, syrup or tablets. It is advantageous to drink plenty of liquid while taking Morphine.
Morphine is contraindicated in patients who have undergone surgery unless Morphine was used before surgery.
Morphine during pregnancy
FDA has categorized Morphine as Category C. Pregnant women or women planning to conceive should inform doctor before using Morphine. There is a possibility of addiction or withdrawal symptoms in newborn if the pregnant mother takes Morphine during pregnancy. Morphine can pass into breast milk and may harm a nursing baby.
Morphine side effects
There can be mild and severe side effects of Morphine. Look out for these side effects and remember to discuss with the doctor without delay. Besides these in case of any unusual body response, seek medical attention without delay.
Similar to Morphine, Oxycodone is used for severe pain, cough suppression and sometimes before surgery. In most cases, Oxycodone is prescribed when the patient requires relief from pain for longer than a few days. Oxycodone is available in the form of a pill and liquid form. Drink plenty of water to avoid constipation. Oxycodone like many other Narcotic Pain Killers can be dangerous if alcohol is consumed. It is contraindicated for Asthma patients or those who suffer from paralytic ileus.
Oxycodone during pregnancy The FDA has assigned category B for Oxycodone. Unless the potential benefits outweigh the risks, Oxycodone is not given to pregnant women as this narcotic drug is habit forming. Though Oxycodone is excreted into breast milk, the potential effects are not well-established.
Tramadol is prescribed to relieve pain and is recommended for short term use only. Tramadol is effective in managing pain for rheumatoid arthritis, fibromyalgia and restless legs syndrome. Tramadol is available in the form of tablets, capsules, liquid and injection form.
Contraindication: Tramadol is contraindicated in patients who are suffering from epilepsy, previous head injury as it can induce seizures. Tramadol should not be prescribed to those with allergic reaction to any narcotic drug. Tramadol should not be taken with other medications like muscle relaxants, anti nausea medicines and anti depressants as it can exacerbate other underlying conditions.
Tramadol during pregnancy
The FDA has categorized Tramadol under category C. There are significant chances of the unborn baby developing problems and hence pregnant woman should not use Tramadol. Further, as Tramadol can pass into breast milk and harm a nursing baby, it should not be used while breast feeding.
Tramadol side effects
Most common side effects of Tramadol are constipation, diarrhea, drowsiness, dry mouth or nausea. If these persist seek medical attention immediately. Some of the serious side effects of Tramadol include severe or mild headaches, difficulty with swallowing, sudden mood swings, seizures, blurred vision, ringing in the ears and colored stools. Contact your doctor or go to the nearest emergency hospital.
Hydrocodone - a narcotic analgesic is usually available in combination with other ingredients like Paracetamol which contributes to better effect in pain control. There are Hydrocodone combinations to relieve moderate to severe pain and some to relieve cough. Hydrocodone is available in the form of tablet, capsule, syrup, solution and extended-release capsule as well as extended-release suspension. A normal diet would suffice unless specifically directed by doctor while using Hydrocodone.
Hydrocodone is contraindicated in patients with hypersensitivity to Hydrocodone or any ingredient of the formulation. Those with CNS (Central nervous system) depression and severe respiratory depression should avoid hydrocodone.
Hydrocodone during pregnancy
Hydrocodone is categorized under C by the FDA. As there is certain amount of risk associated, Hydrocodone is prescribed for pregnant women only if the potential benefits outweigh potential risks. Some of the side effects include nausea, headache, chest constriction, irregular heartbeat, allergic reactions and trouble urinating.
Hydromorphone is used to treat longer bouts of pain that do not respond to OTC painkillers. Being stronger than Morphine, hydromorphone is preferred to regulate pain from injuries, surgery, cancer and severe migraine headaches. Hydromorphone is normally given through parenteral administration as other ways of administrations result in poor absorption.
Hydromorphone is contraindicated in these circumstances.
Hydromorphone during pregnancy
As per FDA classification, Hydromorphone falls under category C. Unless, the potential benefits outweigh potential risks, doctors will not prescribe hydromorphone for pregnant women. Nausea and vomiting are very common side effects that occur initially. Serious side effects of Hydromorphone include allergic reaction, hives, confusion, severe weakness, losing consciousness and seizures. Seek medical attention immediately without any delay.
FDA Pregnancy Categories Drugs are divided into many categories based on the given drug and its effects on the fetus or its mother during pregnancy:
A non steroidal anti-inflammatory drug NSAID, Mefenamic acid is predominantly used for treating mild to moderate dysmenorrhea or menstrual pain for a short term, for not more than a week. It may also be used for treating other symptoms at the discretion of the doctor. Mefenamic acid helps to reduce inflammation and thereby pain by blocking the production of some of the body chemicals that cause inflammation, pain, tenderness, stiffness, swelling and increased temperature.
Mefenamic acid blocks the body from producing prostaglandins that are linked to inflammation, thus treating the symptoms of pain and inflammation. In muscles and joints, Mefenamic acid helps to improve movement by reducing inflammation, although it may take a few weeks to relieve pain after the first few doses. This medicine is normally prescribed at the lowest possible dose for the shortest period of time to reduce chances of any side-effects. However, Mefenamic acid should not be taken if the patient exhibits the following:
Before using Mefenamic acid, a woman must check the following:
Using Mefenamic acid
There are some medicines which could interact with Mefenamic acid and the healthcare provider has to be informed if any one of the following is taken:
This acid has to be used with great caution as it could cause dizziness or drowsiness. This can get worse if you take it with alcohol or certain medicines. As Mefenamic acid may interfere with certain lab tests, be sure that the doctor or lab technologist knows that Mefenamic acid is being taken - especially in case of blood cell counts, blood pressure, kidney function tests.
Aspirin - Acetylsalicylic Acid
Developed by German chemist Felix Hoffmann in 1897, acetylsalicylic acid or Aspirin as it is popularly known is a safe and effective treatment for many an ailment ranging from moderate fever to swelling or even blood clotting. This over-the-counter medication is probably one of the widest selling drugs.
Aspirin: Interestingly, Aspirin is a medicine that has found its way into the Guiness Book of Records. In the year 1950, aspirin recorded entry into the Guinness Book of Records as the highest selling drug product. People are familiar with a common adage which says 'take aspirin at bed time to cut heart attack risk in the morning'. This is a finding of a research that is popular amongst people but has not been published in a peer-reviewed medical journal.
World over, millions of people are familiar with Aspirin as a medicine to relieve pain, aches, fever and inflammation. In such instances, Aspirin is an anti-prostaglandin. Aspirin is also antiplatelet blood thinner medicine. It restricts the ability of the platelets to stick together which in turn reduces the risk of formation of blood clots.
Aspirin is used to treat headache, migraine, muscular pain, neuralgia and sore throat. Aspirin or acetylsalicylic acid has anti-coagulant properties as well as analgesic and antipyretic properties. This drug is a NSAID - non steroidal anti inflammatory drug. Prostaglandins - a family of chemicals are produced within the body's cells by the enzyme cyclo oxygenase (COX).
Further there are 2 kinds of COX enzymes - COX 1 and COX 2 which produce prostaglandins which in turn promote pain, inflammation and fever. Non steroidal anti inflammatory drugs - NSAIDS act by blocking the COX enzymes and reduce prostaglandins thereby reducing the pain, fever and inflammation. In this process of reducing the prostaglandins, NSAID promotes bleeding and may contribute to stomach ulcers. Aspirin is an unique NSAID in the sense that it inhibits clotting of blood for prolonged period - up to 4 to 7 days. It is used to reduce temperature and is commonly recommended for pain relief as in the case of dental pain. Aspirin works as a pain killer by working on the sensitivity of the nerves both at the site of the pain as well as the central nervous system. FDA has approved the use of aspirin in the following conditions:
Heart conditions : The FDA has approved the use of aspirin to reduce the risk of fatality in the event of a heart attack. Aspirin taken during a suspected heart attack can also lessen the damaging effects of the heart attack. Persons who have already suffered a heart attack or unstable angina are put on a course of aspirin to reduce the risk of another heart attack. Aspirin is also recommended for use in people who have suffered transient ischemic attack (TIA or mini-stroke). FDA has endorsed the use of low dose aspirin (75 and 325 mg) for lowering the risk of heart attack and strokes. Aspirin helps in improving blood flow through narrowed blood vessels.
Side Effects of Aspirin: Side effects from aspirin are relatively rare. If you are prone to heartburn or indigestion, ensure that you take aspirin after food. Some people experience rashes or vomiting or stomach pain after taking aspirin. Rarely are side effects such as ringing in the ears, dizziness or mental confusion noticed. In such a case, consult a doctor immediately. Recent research indicates that regular intake of Aspirin on a daily basis can increase the risk of age related Macular Degeneration. Rarely some men have reported blood in the semen - a condition called as Haematospermia.
Contraindications: Aspirin must not be taken on an empty stomach. Persons suffering from peptic ulcer must consult the doctor for the recommended dosage. Aspirin must not be taken along with alcohol. Aspirin and other salicylates should not be taken during the last 3 months of pregnancy or while breast-feeding. It is essential to keep the doctor informed if you are allergic to aspirin If you are taking medications for high blood pressure, diabetes or any anticoagulants, you must inform your physician before he prescribes aspirin.
Bibliography / Reference
Collection of Pages - Last revised Date: March 23, 2019