2012

UNIKL ROYAL COLLEGE OF MEDICINE, PERAK

FOUNDATION IN SCIENCE AND TECHNOLOGY UNIKL SPT 2011/2012

[ANALGESIC]
ADVISOR : DR. NORAINI BINTI ABAS

NUMBERABDUL MUHAIMIN AB RAHIM931005145395ASHRAFUL NIL BINTI AHMAD R MUSADAD930520075710NORAZAH BINTI BAHARI M 930406015298KHAIRIAH BINTI MOHD 9 KHAIR930311075802 K

N NAMEIC

TABLE N TITLE O. 1. 2. 3. 4. 5. 6. 7.

OF CONTENT

PA GE 2 3 5 6 17 20 24 27 31 35 36

Abstract Literature review Definition Classification Forms of analgesic How Analgesic works Precaution on using Analgesic 8. Advantage and disadvantage of analgesic 9. Other alternative to reduce pain 10 Conclusion . 11 References .

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ABSTRACT

In this modern era of medicine, only using one tablet of analgesic can cure many common problems like headache, fever, joint pain and many more. Based on a survey conducted by Youthtoday website, at least 87% people around the world had been consumed painkillers without getting description from doctors. People felt the urge to take pain reliever whenever they feel the pain. However they may not know the risk of their action. Analgesic or known as painkiller is a drug that can relieve pain and it exists in two major type, opioid (strong) and non-opioid (slow to moderate) and some of the analgesic can relieve inflammatory called Non-Steroidal Anti Inflammatory drug (NSAID). Some of the examples of opioid are morphine and codeine. Opioids have greater effects in relieving pain than non-opioids. The examples of non-opioid are paracetamol and aspirin. Analgesic can affect mentally and physically by manipulating the human nervous system, moreover it also can cause various side effects such as like ulcer, allergic and also kidney failure. It also can cause addiction if taking regularly. For most of the painkillers, it is a common practice to start at a low dose at first. This may be sufficient to ease the pain but often the dose needs to be increased if the effect is not satisfactory. This is usually done gradually, from time to time. Any increase in dose may be started after a certain numbers of days or weeksdepending on the medicine. Thus, people will be more expose to the risk of regularly taking painkillers. On the other hand, there are other alternatives to relieve pain. The effects may not be as fast as painkillers, but the side effects may be less. Using heat and ice, acupuncture, physical treatments, and meditation can temporarily help to reduce the pain. On top of that, the costs to these treatments are likely to be cheaper than getting various kinds of painkillers off the counter. Despite of taking the safest way, people prefer painkillers as their major choice in relieving pain. So it is our responsible to expose the advantages and disadvantages of painkillers to the people around us.
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LITERATURE REVIEW

WHY

WE DO RESEARCH ON

ANALGESIC ?

People nowadays very struggle to keep living in this world, working 24 hours per day to earn money for daily uses. Yes it is good, but whenever there is an obstacle they just take it by the easiest way. For instance is headache. Headache does disturb their work nonetheless it is actually a small matter so take some time to rest their body. However, people do not give a chance for their body to strengthen their own defensive system by giving their body a chance to control the situation but they take analgesic, not knowing what is analgesic and what will happen when they take analgesic. We as medical-to-be students want to do a research on analgesic so that some part of the society realizes what it means by analgesic.

WHEN

DO PEOPLE USE

ANALGESIC

COMMONLY

Headache is the most common problem face by people in this modern lifestyle. People tend to overwork themselves until they cannot handle stress which then lead into headache. They use painkillers because they act fast, causing the pain to relieve immediately. People who have fever tend to consume paracetamol because it is easy to obtain. They only need to go to the pharmacists counter. They do not have to go to the doctors because they know that paracetamol can reduce fever.

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WIDELY

USE OF

ANALGESIC.

There are two main types of analgesics available in the market. They are the opioid analgesic and non-opioid analgesic. Some of the analgesics are available to the patients with prescription only. Whereas, some of the analgesics can be obtained without prescription. from the doctors. Morphine is an opioid type of analgesic which can only be obtained with prescription. Morphine is often used before or after surgery to alleviate severe pain. It is also widely used in cancer patients especially in their late stage of cancer. This is because of its effectiveness in alleviating severe pain. Codeine is used for milder pain and as a cough suppressant. Currently Codeine in cough suppressant is not available in Malaysia. It was banned from the market because of being widely abused especially by the drug addicts. Oxycodone (OxyContin an oral, controlled release form of the drug); hydrocodone (Vicodin taken orally); hydromorphone (Dilaudid a long-acting painkiller); and meperidine (Demerol) which is also used before and after surgery but less often because of its side effects. Pentazocine produces similar effects to oxycodone. Long term use of analgesics without proper advice from the doctors and pharmacist can lead to addiction. Fentanyl is used extensively for anaesthesia and analgesia. Duragesic is a transdermal patch used in chronic pain management. Actiq is intended for opiate-tolerant individuals and is effective in treating breakthrough pain in cancer patients. Carfentanil (Wildnil) is used in veterinary practice to immobilize certain large animals. May also be smoked or snorted. This allows for a rapid release of the medication, causing a rush of euphoria similar to heroin.

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DEFINITION

`An analgesic (also known as a painkiller) is any member of the group of drugs used to relieve pain (achieve analgesia). The word analgesic derives from Greek an- ("without") and algos ("pain"). There are a number of mechanisms by which analgesics produce painkiller effect. Nonopioid analgesics produce action by blocking the production of prostaglandins and hence, the nerve signal cannot be send to the brain. The opioid analgesics produce effects through interaction with opioid receptors. Three major classes of opioid receptors are mu, kappa, and delta. Examples of analgesics according to their classifications are as follows:

1. Opiod analgesic (Narcotic analgesics) Opiates- morphine derivatives Example : morphine, codeine, heroin,fentanyl, Uses : moderate to severe pain

2. Non-opioid analgesic Weak analgesics (non-narcotic analgesic or non-steroidal anti-inflammatory drugs)

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Examples : aspirin, acetaminophen (Tylenol), ibuprofen (Advil,Motrin) Uses: mild pain, anti-inflammatory

CLASSIFICATION

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Drug Class Opioids*

Characteristics Acts on pain receptors in both spinal cord and brain;may be used with tranquilizers to induce a state of potent sedative (neuroleptanalgesia)

Example Morphine

Comments Stimulates vomiting and vagal CNS centres; Can cause excitement in cats, horses and food animals; 4-6 hours duration; May be given SC or IM to help prevent hypotension; For moderate to severe pain Greater analgesic cause IV,

Oxymorphone

and

sedative cause

effects than morphine; Does not hypotension; May SC, IM, or excitement in cats; May be given epidurally; Approximate 4 hour duration; For Meperidine (Demerol) moderate to severe pain Rapid IV injection may cause severe hypotension, seizures; excitement given and IM; Painful if

Preferred administration is SC; Used in dogs, cats, and rodents; A synthetic opioid; not as potent as above drugs; Often used with NSAIDs or as a preanesthetic; For mild to moderate pain Fentanyl One of the most potent analgesics; Rapid onset-short duration (IV injection=30minutes); Usually administered by continuous IV drip or transdermal patch; Can cause panting and increased sensitivity to sound; For severe to moderate pain. Butorphanol (Torbutrol) Synthetic opioid- has both agonist and antagonist properties; Effective and safe post-op analgesic for mild to moderate pain, especially cranial visceral; Extensively used in dogs, cats, and horses; May be used to
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help

reverse

effects

of

other

opioids (respiratory depression and sedation), while still maintaining

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NSAID (Non-steroidal antiinflammatory drugs)

Analgesic, for

antipyretic,

and Aspirin pain;

May

cause

gastric

anti-inflammatory;

Effective

irritation and prolonged bleeding time; Prolonged half-life in cats, geriatrics and neonates

musculoskeletal

Requires 30-60 minutes for full analgesic properties to take effect; Metabolized in the liver; Negligible effect on cardiovascular and respiratory systems Acetaminophen

Toxic gastric

to

cats

and than effects;

hepatotoxic to dogs; Less irritation gastric Aspirin Renal,

Ibuprofen

Narrow safety margin in Flunixin (Banamine) cats Significant renal toxicity is possible in hypotensive patients; Do not use with Ketoprofen Methoxyflurane Potent analgesic, especially for orthopedic patients; and Gastric irritation

ulceration may occur at Carprofen (Rimadyl) therapeutic doses. Less potential for gastric ulceration seen in than dogs some with NSAIDs; Renal toxicity prolonged use (especially Meloxicam Labrador Retrievers) Can cause vomiting and diarrhea; Less potential for gastric ulceration than some Local Analgesia Can be sprayed, injected at Lidocaine surgical site, or infiltrated (Xylocaine) around a nerve supplying the affected area; May be
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NSAIDs; 5-day

limit for treatment of cats Immediate onset; Lasts about without 1-2 hours (with epinephrine) or 1 hour

used to desensitize an entire area by using an epidural injection

OPIOIDS
Opioids for severe pain include

Morphine Diamorphine Fentanyl and Alfentanyl Buprenorphine Oxycodone Hydromorphone Methadone

These are commonly used to treat cancer pain. Opioids for mild to moderate pain include

Codeine Tramadol

MORPHINE
There are lots of different preparations of morphine that can be given in different ways, including

An immediate release liquid or tablet that can take every 2 to 4 hours Slow release tablets, capsules or powders that can take every 12 or 24 hours A liquid that can be injected into a vein or given through a drip A liquid that can be given through a small needle under the skin Suppositories inserted into the back passage Tablets people dissolve under tongue (transmucosal tablets) Patches that stick on to the skin (transdermal patches)

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DIAMORPHINE
Diamorphine is a form of morphine that is very easy to dissolve in very small amounts of water. So it may be used when morphine needs to be given by injection, especially in a syringe driver. This is a battery operated or clockwork pump. It gives liquid from a syringe through a small tube placed just under the skin. The pump can give tiny amounts continuously. So it is used when good regular pain control is needed for people who have sickness or find it difficult to swallow tablets. It may be used for people who are terminally ill, but being cared for at home. A nurse changes the syringe every 24 or 48 hours.

FENTANYL AND ALFENTANIL

Fentanyl is a manmade (synthetic), slow release opioid. There are several brands including Durogesic. The drug is absorbed through a patch stuck onto our skin. So we don't have to take any tablets or have any injections. When someone starts fentanyl, it can take up to 72 hours to get the right level of drug in their bloodstream. Fentanyl is also available as a lozenge that can be dissolved under tongue. It is called Actiq. It works very quickly and gives fast pain relief. It is helpful for pain that comes on quickly, such as when we need to have a dressing changed or move around. This type of pain is called incident pain. Fentanyl has recently become available as a tablet that is placed between gum and cheek, and dissolves. It is also called Effentora and Abstral. It has also become available in Europe as a nasal spray and is called PecFent. The tablet and the nasal spray are for breakthrough pain. Alfentanyl is a type of fentanyl. It is also called Rapifen. It dissolves in water and so may be used when fentanyl needs to be given by injection, especially in a syringe driver. This is a battery operated or clockwork pump. It gives liquid from a syringe through a needle just under the skin. The pump can give tiny amounts continuously. So it is used when good regular pain control is needed for people who have sickness or find it difficult to swallow tablets. It can be used for people who are terminally ill, but being cared for at home.
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Alfentanyl is also available as a lozenge that can dissolve under tongue. It works very quickly and can be used for breakthrough pain.

BUPRENORPHINE
Buprenorphine is more commonly known by its trade names, Transtec and Butrans. They are stick on patches, similar to fentanyl. They are useful if we find swallowing pills and medicines difficult. It takes at least 24 hours for the right level of the drug to build up in our bloodstream when we start the patches.

OXYCODONE
This opioid can be useful if we have both bone and nerve pain. Particularly if morphine has not helped our pain or has given us unpleasant side effects. Oxycodone is available as an injectable liquid, a liquid that we drink or as capsules to swallow. These preparations are called OxyNorm. There is a slow release tablet called OxyContin.

HYDROMORPHONE
Hydromorphone is a strong opioid. It is also called Palladone and is available as

Immediate release capsules Slow release capsules that you take every 12 hours (Palladone SR) An injectable liquid

METHADONE
Methadone is a strong opioid. It works very well at controlling nerve pain. It is available as

Tablets A liquid that we swallow An injectable liquid

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CODEINE
Codeine is a weak opioid and is usually the first choice of drug if non opioid drugs are not enough to control our pain. A number of tablets combine codeine and paracetamol, for example co codamol or co dydramol.

TRAMADOL
Tramadol is a weak opioid and is available as

Tablets or capsules (Tramacet or Zamadol) Slow release tablets or capsules that take every 12 hours (Dromadol, Nobligan Tablets that dissolve on tongue (Zamadol melt)

or Tradorec)

NON

OPIOID DRUGS

These include drugs such as paracetamol and anti-inflammatory drugs. Anti inflammatories are often called non-steroidal-anti-inflammatory drugs (NSAIDs for short). These drugs are very good for relieving bone and muscle pain. They can help improve pain relief when you take them with stronger painkillers. There are many different non-steroidal anti-inflammatory drugs. They include

Aspirin Ibuprofen Diclofenac (Voltarol)

We can have these drugs in different ways including

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As a liquid or tablet every 4 to 8 hours As slow release tablets that you take every 12 hours As an injection

As a suppository (into your back passage)

OTHER

DRUGS FOR PAIN CONTROL

Co analgesics include Steroids Bisphosphonates Antidepressants Drugs to prevent fits (anti convulsants) Local anaesthetics

Steroids
Steroids reduce swelling. These are useful for pain control because swelling around a tumour increases pressure on surrounding tissues and so may increase pain. Steroids are made naturally in the body and can also be made artificially and used as drugs. Doctors prescribe steroids for many different reasons and for many different illnesses and conditions. They can be tablets or injections. In cancer care, people are most likely to have either prednisolone or dexamethasone.

Bisphosphonates
Cancer that has spread to the bone can cause pain. This can be a problem in advanced cancer, especially with breast cancer, prostate cancer and myeloma. Bisphosphonates are a group of drugs that may help to

Control bone pain and so lower the amount of painkillers you need to take Slow down or prevent damage caused by cancer spread to the bones

Antidepressants
Some types of antidepressant can help to relieve nerve pain that is not controlled by other painkillers. They can also help with depression that may be caused by long term chronic pain.

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Drugs to prevent fit (anticonvulsants)

This group of drugs is usually used to control fits (seizures). But they can often help to relieve burning or tingling pain (nerve pain). The anticonvulsant drugs used include gabapentin (Neurontin), topiramate (Topamax), lamotrigine (Lamictal) and pregabalin (Lyrica).

Local anaesthetics
These drugs are used for pain problems in a specific part of the body. Some local anaesthetic drugs can relieve pain from mouth ulcers. Doctor may suggest gel that forms a protective coating over the ulcer such as Gelclair (Orabase). Or they may suggest mouthwashes such as benzydamine (Difflam), Gelclair, MuGard or Caphosol. These drugs coat the lining of mouth and can relieve pain from mouth ulcers caused by chemotherapy or pain caused by radiotherapy. Local anaesthetic can be given by injection or infusion into the spine to help relieve severe back pain. This type of infusion is called an epidural or spinal anaesthetic.

Drugs, J

FORMS
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OF

ANALGESIC

There are some form classified by the researchers around the world, and 4 of them are Combination, Topical, Psychotropic and Atypical adjuvant & potentiators analgesics. Each of them has variety uses either on body or mentality.

COMBINATION
Analgesics can also be are found frequently in used in with combination, vasoconstrictor such drugs as such the paracetamol and codeine preparations found in many non-prescription pain relievers. They combination as pseudoephedrine for sinus-related preparations, or with antihistamine drugs for allergy sufferers. While the use of paracetamol, aspirin, ibuprofen, naproxen and

other NSAIDS concurrently with weak to mid-range opiates (up to about the hydrocodone level) has been said to show beneficial synergistic effects by combatting pain at multiple sites of action,[11] several combination analgesic products have been shown to have few efficacy benefits when compared to similar doses of their individual components. Moreover, these combination analgesics can often result in significant adverse events, including accidental overdoses, most often due to confusion which arises from the multiple (and often non-acting) components of these combinations

TOPICAL
Topical analgesics are pain-relieving creams, lotions, rubs, gels, and sprays that you rub on the skin over the affected joint. Doctors often recommend these products in addition to other medications to help temporarily ease pain. There are 2 main types of topical analgesics: capsaicin, a preparation derived from plants, and methylsalicylates, which are derived from willow bark and often combined with menthol. You should not use topical analgesics with bandages or near your eyes. Also, do not put them on irritated, cut, or bruised skin.

Bothersome Side Effects

Irritation upon breathing (This especially results from using rubs containing menthol.)

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redness slight burning stinging

PSYCHOTROPIC
Psychotropic drugs, which are sometimes called psychoactive drugs, affect the central nervous system and can cause a variety of changes in behaviour or perception. Many people think psychotropic drugs are only of the illegal variety, such as lysergic acid diethylamide (LSD), angel dust and marijuana, but even something as relatively benign as caffeine is considered one of many psychotropic drugs. These drugs have various uses and can be divided into four major groups: hallucinogens, antipsychotics, depressants and stimulants. Some drugs fit into multiple categories because they produce more than one type of effect. Marijuana, for example, is considered a depressant, stimulant and hallucinogen.

ATYPICAL, ADJUVANT

ANALGESICS

&

POTENTIANTORS

The atypical antipsychotics (AAP) (also known as second generation antipsychotics) are a group of antipsychotic tranquilizing drugs used to treat psychiatric conditions. Some atypical antipsychotics are FDA approved for use in the treatment of schizophrenia. Some carry FDA approved indications for acute mania, bipolar depression, psychotic agitation, bipolar maintenance, and other indications. Both generations of medication tend to block receptors in the brain's dopamine pathways, but atypicals differ from typical antipsychotics in that they are less likely to cause extrapyramidal motor control disabilities in patients, which include unsteady Parkinson's disease-type movements, body rigidity and involuntary tremors.[1] These abnormal body movements can become permanent even after medication is stopped.

Adjuvant analgesics are drugs that have weak or non-existent analgesic action when administered alone but can enhance analgesic actions when coadministered with known analgesic agents. Such agents are often administered in cases of refractory pain. For some chronic pain syndromes, however, they may constitute a first-line approach. Because pain is
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such an individual experience, analgesic regimens may require several drugs at varying dosages to confer a comfortable state. Adjunctive therapies such as the tricyclic antidepressants, anticonvulsants, N-methyl-D-aspartic acid receptor antagonists and low-dose intravenous local anesthetics, to name a few, have proved to be efficacious in relieving certain types of pain, especially neuropathic and cancer pain. Their use in animals is increasing, with anecdotal reports of some success. Potentiate analgesic is interaction between two or more drugs or agents resulting in a pharmacologic response greater than the sum of individual responses to each drug or agent. (single drug use to intensify other drug effect)

HOW ANALGESIC WORK

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NSAIDs work on a chemical level. They block the effects of special enzymes cyclooxygenase enzymes type 1 and type 2 abbreviated as COX-1 and COX-2 enzymes. These enzymes play a key role in making prostaglandins. By blocking the Cox enzymes, NSAIDs stop your body from producing prostaglandins. This means less swelling and less pain.Ibuprofen, Ketoprofen and Naproxen are categorised as poison C which can only be dispensed by pharmacist. They are not available over-the-counter. Other NSAIDs are available by prescription. They include:

Daypro Indocin Lodine Naprosyn Relafen Voltaren

Aspirin has some benefits that other NSAIDs do not. The biggest is that aspirin works against the formation of blood clots. As a result, you are less likely to form the clots that can cause heart attacks and strokes. Other NSAIDs do not have this effect. COX-2 inhibitors are a newer form of prescription NSAID. As you might guess, they only affect COX-2 enzymes and not COX-1. Two of them -- Bextra and Vioxx -- are no longer sold because of concerns about their side effects. The third, Celebrex, is still available.

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Pain information is carried in fiber bundles in the lateral part of the cord. Common pain killer drugs act at different levels of the pathway.

HOW

DO ANTI-INFLAMMATORY PAINKILLERS WORK?

They work by inhibiting (blocking) the effect of enzymes (chemicals) called cyclo-oxygenase (COX) enzymes. COX enzymes help to make other chemicals called prostaglandins. Some prostaglandins are involved in the production of pain and inflammation at sites of injury or damage. A reduction in prostaglandin production reduces pain and inflammation. There are two types of COX enzymes - COX-1 and COX-2. It is the COX-2 enzyme that is mainly involved in making the prostaglandins that are involved with pain and inflammation. Anti-inflammatory painkillers are sometimes classified into two main groups:

Nonselective or standard NSAIDs. Most fall into this group, including diclofenac, ibuprofen, indometacin, and naproxen. These block both COX-1 and COX-2 enzymes. Coxibs. For example, celecoxib and etoricoxib. These mainly (selectively) block just the COX-2 enzyme

In very simple language, they work in 2 ways.First, the drug attaches to opioid receptors (proteins) on the surface of brain cells, spinal cord, and gastrointestinal tract.Then they all stop the pain message to the brain. Second , they go to work in the brain only to alter the sensation of pain. It doesn't take the pain away, only reduces your perception of it.

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Targeting pain with anti-nerve growth factor antibodies. Inflammation produces several inflammatory factors, most notably nerve growth factor, which sensitize nerve cells by acting on their cognate receptors and activating signal transduction. These activated pathways phosphorylate transient receptor potential (TRP) channels, which alter their trafficking and reduce the membrane's threshold, resulting in an increased excitability of pain neurons. Image courtesy of Nat. Rev. Drug. Disc. (8, 5556, 2009).

PARACETAMOLS

WORKING PATH

Anadin paracetamol tablets contain the active ingredient paracetamol, which is a simple painkilling medicine used to relieve mild to moderate pain and fever. (NB. Paracetamol is also available without a brand name, ie as the generic medicine.)

Despite its widespread use for over 100 years, we still don't fully understand how paracetamol works to relieve pain and reduce fever. However, it is now thought that it works by reducing the production of prostaglandins in the brain and spinal cord.

Prostaglandins are produced by the body in response to injury and certain diseases. One of their actions is to sensitise nerve endings, so that when the injury is stimulated it causes pain
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(presumably to prevent us from causing further harm to the area). As paracetamol reduces the production of these nerve sensitising prostaglandins it is thought it may increase our pain threshold, so that although the injury remains, we can feel it less.

It is thought paracetamol reduces fever by affecting an area of the brain that regulates our body temperature (the hypothalamic heat-regulating centre). Paracetamol is about as effective as aspirin at relieving mild to moderate pain and reducing fever, but unlike aspirin it has no anti-inflammatory effect. Paracetamol can be used to relieve mild to moderate pain associated with conditions such as headaches, migraine, toothache, teething, colds and flu. It is also useful for reducing fever and discomfort associated with colds and flu and following vaccinations.

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PRECAUTIONS
Allergic reactions
Tell your doctor or pharmacist if you are allergic to aspirin or any of the NSAIDs. Certain individuals sensitive to one of the NSAIDs may also be sensitive to other NSAIDs.

Pregnant women
Safety of NSAIDs for use in pregnant women has not been established. Nonetheless, the medications are not recommended for use during second half of pregnancy due to potential undesirable effects on the foetal or newborns blood flow as well as the possibility of causing complications during delivery.

Nursing mothers
Most of the NSAIDs have not been documented to cause problems in breast-fed babies. However, use of indomethacin by nursing mothers should be avoided since the drug passes into human breast milk and may cause untoward adverse effects in nursing infants.

Children
The balance of clinical benefits against potential risks must be carefully considered when the NSAIDs are prescribed in children. Because of possible deleterious effects, caution is recommended especially with indomethacin and naproxen. Both the medications should preferably be used only for cases unresponsive to less toxic NSAIDs, with dosage adjustments where necessary.

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Elderly people
Elderly people are generally more inclined to develop untoward effects of medicines than younger adults. Since the NSAIDs may cause unwanted effects on the gastrointestinal tract, kidney and liver, the elderly adults are therefore at higher risk of NSAID-induced toxicity, attributed primarily to ageing kidney, liver and other vital organs. In order to avoid potential increased risk of adverse reactions, elderly patients treated chronically with NSAID therapy should be under close medical supervision. A reduction in dosage may be necessary to prevent the possibility of excessive drug accumulation in these patients.

Combinations with other drugs

Drug interaction is basically a reaction between two chemical or medicinal substances in the body resulting in an alteration of the effects of the drug in question. The following medications are found to interact with the NSAIDs when administered simultaneously. Because of the possibility of drug-drug interference, NSAIDs are not recommended in combined therapy with these drugs unless under the direction of physician.

Digitalis glycosides (heart medicine) Coumarin- or indandione-derivative anticoagulants (blood thinners) Heparin (anticlotting agent) Phenytoin (fits medicine) Triamterene (high blood pressure medicine) Cefamandol, cefoperazone, cefotetan, moxalactam (antibiotics) Colchicine, probenecid (gout medicines) Lithium (mania/depression medicine) Methotrexate and some cancer medicines Penicillamine (medicine for severe rheumatoid arthritis) Zidovudine (AIDs medicine) Ticlopidine (antiplatelet agent)

Note: Unless directed by physician, avoid co-administration of two or more NSAIDs on a regular basis as this may increase the risk of undesirable effects especially gastrointestinal problems.

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Contra-indications
The NSAIDs should not be given to patients with the following co-existing conditions unless otherwise directed by physician.

Active ulceration of esophagus, stomach, or duodenum Recurrent history of gastrointestinal bleeding A known blood disorder (including haemophilia) Hepatitis or other liver disease History of kidney disease Heart disease Known allergy to NSAIDs

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ADVANTAGE

AND DISADVANTAGE OF

ANALGESIC

The Disadvantages of Analgesic

OPIOIDS :
Skin Problems
Painkillers can also give rise to itchy skin. Presence of sensitive skin all over the body will also be observed in some cases as a result of painkiller side effects. Development of hives is also observed in some people.

Indigestion Problems
The most common problems of painkiller is, it causes stomach related problems. It gives rise to indigestion, stomach ache, nausea, constipation and diarrhea. In some cases, it can also cause disorders like vomiting and difficulty in urination.

Psychological Problems
In rare cases, painkiller can also be a cause of psychological disorders. It can cause problems like hallucinations and confusion. In some cases, the person might also tend to feel agitated. Unusually vivid dreams will also be experienced by some people.

Other Problems
It can also give rise to other problems like dizziness, drowsiness and weakness. Some people might also develop fever, cough and cold. It might also make the person feel weak. In some cases, the person might also experience increase or decrease in the appetite all of a sudden. It might also lead to dryness of mouth. and some people experience difficulty in sleeping while, others might sleep a lot.

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NON OPIOIDS :

LIVER

PROBLEM

Large doses(more than 4 grams in 24 hours) can damage the liver. Use by persons who have 3 or more alcoholic drinks per day may cause liver damage.

Stomach Problem
It also can irritate the stomach and increase the risk of further ulceration. It can cause bleeding of the stomach lining, especially if combined with alcohol or if you smoke. If you have history of peptic ulcer disease you should consult your doctor before taking any analgesic.

Cardiovascular Effects
Pain killers have dramatic effect on the function of your cardiovascular health. They slow the heart rate and even cause heart attack. Thrombosis (blood clot) and stroke can be also caused by painkillers. This heart beat fluctuations can occur if you consume too much or misuse painkillers.

Advantages of Analgesic
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OPIOIDS :
BLOCK
TUMOR GROWTH

Morphine is currently the gold standard of analgesics used to relieve severe pain and suffering. Angiogenesis, or new blood vessel growth, is critical for tumor progression from dormant to malignant. Morphine is commonly used to treat cancer pain, but the effects of morphine use on new blood vessel and tumor growth remain controversial.

RELIEF

OF PAIN

Codeine is commonly prescribed for the treatment of mild to moderate types of pain. It is one of many alkaloids in opium that has pain-relieving or analgesic effects. One just has to make sure to take codeine in the right dosage as prescribed by doctors because this drug can be addictive. In oral form, codeine is usually prescribed to be taken 4-6 hours a day using 15-50 mg. tablets.

RELIEF

OF COUGH

codeine is also an active ingredient that can commonly be found in medicines for people with coughs. Specifically, codeine acts as a suppressant or as anti-tussive relieving people from the constant urge to cough. Anti-tussives like codeine are especially helpful for people who are said to have unproductive or dry coughs, the type where there is less or no production of phlegm.

NON

OPIOIDS

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PREVENT

ASTHMA

Womens Health study suggests that use of aspirin in small doses may help prevent the onset of asthma and other respirator-related diseases. In one study, a group of people given aspirin showed significant improvement after few days, while those on placebo developed respiratoryrelated complications.

LOWERS

HIGH BLOOD PRESSURE

Health care providers recommend use of aspirin to avert the onset of pre-eclampsia, high blood pressure common in expectant women, who have increased risk of this condition. Additionally, aspirin also reduce the chance of cataracts.

ANTICOAGULANT

EFFECTS

There is evidence that heparin and aspirin can help treat problems related to miscarriage. However, studies are still ongoing to determine whether these theories are factual. As a precaution, it is always advisable to consult a doctor when the pain persists to avert increased risk of potential health complications.

OTHER
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ALTERNATIVE TO REDUCE PAIN

HEAT

AND I CE

Ice-packs and heating pads are two longstanding remedies for pain relief. For a recent injury, ice is the first recommendation. It prevents swelling and can help numb the pain. When you prevent swelling to the area, you are helping it to heal faster. Heat helps relieve stiffness in joints and muscles. Heat also encourages circulation to the injured area. Increased circulation brings more oxygen and nutrients to the damaged tissue, helping it heal more quickly.

PHYSICAL THERAPY

Physical therapy can help relieve pain caused by muscle spasms and joint injuries. Moving joints through range-of-motion exercises and massaging injured muscles helps relieve pain by increasing circulation and encouraging normal movement of the injured area. This type of therapy helps to regain muscle strength and flexibility. Physical therapy works by relieving inflammation, stiffness and joint weakness. A physical therapist can show you ways to move that won't cause pain and won't restrict your lifestyle.

MEDITATION

Researchers from the Department of Physiology at the University of Montreal reported that Zen meditators have a decreased sensitivity to pain. These findings were published in the January 2009 issue of the "Journal of Psychosomatic Medicine." They explain that the meditators continue to feel pain, but it does not take over their thoughts. Participants who use meditation for pain control are not distracted by their pain and do not suffer side effects from analgesic medications.

ACUPUNCTURE

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Acupuncture is one of the oldest forms of medicine practiced in the world. Multiple studies have been completed on the use of acupuncture for pain conditions, including back pain, jaw pain, headaches and fibromyalgia. The National Center for Complementary and Alternative Medicine reports as of August 2010, many of the studies have shown benefits for some types of pain such as carpal tunnel syndrome, osteoarthritis and tennis elbow. They also note that there are fewer adverse effects with acupuncture than with standard drug treatments.

FEVERFEW

Feverfew (Tanacetum parthenium) is a common medicinal herb. It has been used for centuries to treat conditions, such as fever, arthritis and digestive problems. Feverfew interacts with serotonin and prostaglandin pathways, two substances in the body thought to contribute to blood vessel spasm and subsequent headaches. Multiple double-blind trials and safety studies have shown Feverfew to be an effective and safe treatment for headaches. One caution with feverfew is that it increases bleeding times (blood takes longer to clot) and may interact with warfarin (Coumadin).

BUTTERBUR ROOT EXTRACT

Butterbur root extract (Petasites hybridus) is another common medicinal herb used historically to treat pain, fever and spasms. It is mainly used today to treat asthma and headache. It has been shown through research trials to prevent migraine as well. It is an anti-inflammatory substance, inhibiting the COX enzymes as well as interacting with calcium channels. COX enzymes are involved in inflammatory processes in the body. Since butterbur contains chemicals toxic to the liver, it has to be prepared through a patented process. This safe herbal extract is marketed under the name Petadolex.

RIBOFLAVIN

Riboflavin (Vitamin B2) has been studied using a daily dose of 400 mg. It is typically split into smaller doses taken multiple times daily. Your healthcare practitioner can help

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you determine the best way for you to use it. Riboflavin is considered safe to use in pregnancy and is a common alternative treatment for headaches during pregnancy. One drawback is that Riboflavin can take several months to produce the maximal effect.

MAGNESIUM
Magnesium is a mineral necessary to our diet. It can also be used to treat and prevent headaches. Intravenous (IV) magnesium seems to be quite effective in treating an acute headache. Magnesium can also be taken orally in doses of 400 mg to 600 mg per day. One potential drawback in using magnesium orally is that one study found patients had an increased chance of developing diarrhea.

COGNITIVE BEHAVIORAL THERAPY

Cognitive behavioral therapy (CBT) is a counseling technique effective in treating a variety of mood disorders, including anxiety and depression. It involves identifying negative thoughts and attitudes that may contribute to a headache, developing an action plan to deal with the headache and encouraging patients to come up with a long-term treatment solution. CBT has been used with other behavioral techniques, but is quite effective on its own.

BIOFEEDBACK
Biofeedback is a technique that uses external monitoring to help a patient discover how his body responds physiologically to certain situations or stimuli. The patient can then
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learn, with the help of an experienced practitioner, to alter his own body's response to these outside forces, producing an effective coping strategy. Biofeedback can effectively be combined with other prescription or nonprescription treatments for headaches.

RELAXATION TRAINING
Relaxation training involves progressive muscle relaxation, breathing exercises and/or guided imagery. Various studies suggest that relaxation training can be as effective as biofeedback for treating headaches. It can also be combined with other forms of headache treatment to provide a more effective and lasting result.

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CONCLUSION
When analgesics are compared to each other, none appears to offer greater benefits relative to adverse effects at this time. Trade-offs between benefits and adverse effects appear to differ across analgesics, increasing the need to consider individual patient priorities when choosing among these medications. No significant analgesic differences were found in the benefits offered by NSAIDs or opioids. Evidence suggests that age, body conditions, and concomitant medication are key considerations affecting decision making. Taking more than the maximum allowable dose or taking it for long duration can increase the risk of liver damage. Alcohol consumption when using analgesics also increases the risk of liver damage or may have fatal consequences. Patients must be aware of the cumulative effect of analgesics since they are found in so many products, including cold, sinus, cough, and allergy medications. It is critical that exact directions be followed when using these drugs. Respiratory depression and fatal overdose are possible with analgesics used. Hence, to avoid such side effects, people must be aware of continuous taking analgesics to relieve pain. To make the pain less unpleasant, people can choose the other alternatives such as acupuncture, meditation, ice treatment and many more. These types of treatment have no side effects at all. However, the effects of these kind of treatments may be slower than analgesics Last but not least, as the most influent people in the world history, Muhammad ibn Abdullah once said: Two graces that many people wasted it the most, health and leisure time.. People must be realize that they have the power to choose whatever best for them, consider this matter of health is very important and could affect their futures.

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REFERENCES
1.

Avecennia, Canon of Medicine, Differences Between Analgesic and Anasthetic.

2. Chief Medical Editor; Professor John A. Henry MB FRCP, New Guide To Medicine and Dugs; Chapter 3, Major Drug Group, Analgesic MS 80-81
3.

DEA; NIDA Infofacts, Pain Medications and Other Prescription Drugs, June 2006 http://www.sunshinecoasthealthcentre.ca/pain-killer-addiction.html

4. Open source http://opioids.com/abstract/adjunct.html 5. Open source http://medical-dictionary.thefreedictionary.com/Atypical+Antipsychotic+Drugs 6. Open source http://www.wisegeek.com/what-are-psychotropic-drugs.htm 7. Open source http://health.discovery.com/centers/articles/articles.html? chrome=c04&article=LC_58&center=p02 8. Open source http://en.wikipedia.org/wiki/Analgesic 9. Open source http://www.lar.iastate.edu/index.php? option=com_content&view=article&id=150&Itemid=173 10. Open source http://www.isteroids.com/Different_types_of_steroids.html

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11. Open source

http://www.sooperarticles.com/health-fitness-articles/drugs-articles/side-effectspainkiller-drugs-41931.html
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http://www.sunshinecoasthealthcentre.ca/pain-killer-addiction.html
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www.medicalnewstoday.com/releases/33959.php

14. Professor S. Pridmore, Department of Psychiatry, Royal Hobart Hospital, Hobart,Tas.,Australia http://apy.sagepub.com/content/11/1/59.abstract
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B Raffa, PhD, The Science and Practice of Pharmacy 21st edition , Chapter 83;

Analgesic, Antipyretic, and Anti-Inflammatory Drugs MS 1524

16. Sean

C Sweetman, The Complete Drug Reference, Part 1; Monographs on Drugs and

Ancillary Substances, Analgesic Anti-inflammatory Drugs and Antipyretics MS 1

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