What pain medication is available?
For the treatment of pain, there are now numerous drugs available, from freely available in pharmacies such as paracetamol, aspirin or ibuprofen to very strong prescription drugs such as oxycodone or fentanyl. Fortunately, there is a scheme by which pain medication can be divided up so that one can better assess how strong an active ingredient really is in the end. Roughly pain medication is divided into: non-opioid analgesics low-potency opioids high-potency opioids (co-analgesics)
- Non-opioid analgesics
- Low potent opioids
- Highly potent opioids
- (co-analgesics)
The non-opioid analgesics are also named after painkillers that are not opioids and are therefore at level 1 of pain medication.
These include above all the so-called non-steroidal anti-inflammatory drugs (NSAIDs for short, e.g. Ibuprofen, Diclofenac, Naproxen etc.). These are primarily used in pain therapy, but are also used in the treatment of rheumatism and have anti-inflammatory and antipyretic properties. Aspirin (active ingredient: ASS) also has a so-called thrombocyte aggregation-inhibiting effect, which is particularly important in heart diseases.
Due to their side effect profile, NSAIDs are given less in cardiovascular diseases. One exception is aspirin, which is used to thin the blood. Important effects of NSAIDs: pain relief anti-inflammatory effects fever reduction blood thinning (especially aspirin) Important side effects of NSAIDs: stomach ulcers and bleeding gastric mucous membrane inflammation or irritation can worsen kidney failure NSAIDs also include the so-called coxibe.
However, these have a slightly different mechanism of action from the other NSAIDs and “only” have a pain-relieving and anti-inflammatory effect. In addition, although they have fewer gastrointestinal side effects, they are associated with an increased risk of cardiovascular events, so that many coxibe have now been withdrawn from the market. Other painkillers that also belong to level 1 are paracetamol and metamizole (also known under the trade name Novalgin).
Like NSAIDs, paracetamol relieves pain and has antipyretic properties, but does not counteract inflammation. The active ingredient is considered to be well-tolerated and is the drug of choice during pregnancy and lactation if necessary. Metamizol has the strongest analgesic and antipyretic effect of the level 1 painkillers.
Although it has only a slight anti-inflammatory effect, it also relieves cramps.
- Pain relief
- Inflammation inhibition
- Fever reduction
- Blood thinning (especially aspirin)
- Stomach ulcers and bleeding
- Gastric mucosa inflammation or irritation may worsen
- Renal failure
Opioids are divided into low and high-potency opioids based on their analgesic effect. Examples of low-potency opioids are Tilidine Tramadol Dihydrocodeine If the stage 1 painkillers do not provide sufficient pain relief, stage 2 opioids are used first.
These are either administered in such a way that they can be taken when needed (acutely) or a fixed schedule is set for their use. If they are to be taken regularly, so-called retarded tablets are usually used, in which the preparations develop their effect throughout the day.
- Tilidin
- Tramadol
- Dihydrocodeine
The pain medication on level 3 then finally includes the highly potent opioids.
These include : Morphine Hydromorphone Oxycodone Fentanyl These are used when level 2 painkillers no longer have sufficient effect. Here, too, there are different dosage forms. For example, morphine can be given as tablets or injected.
Fentanyl can also be prescribed as a patch, for example, which releases the active ingredient over a longer period of time (up to 3 days). Side effects of opioids: Opioids can cause a variety of side effects. Some common ones (but by no means all) are listed below: Tiredness/drowsiness Dropping blood pressure Nausea & vomiting Constipation The potential for dependence on opioids should be emphasized here.This can manifest itself in three ways: Tolerance physical dependence psychological dependence Tolerance is roughly understood to be a habituation effect – after some time of opioid use, more active substance must be taken at some point to achieve the same effect.
If the dose is not increased, at some point there is no pain relief, for example. However, the dose should not be adjusted arbitrarily. Physical dependence describes the fact that we can become physically dependent on opioids and withdrawal symptoms occur when we stop taking the drug.
These include tremors, palpitations, vomiting, diarrhea and a bad mood. In most cases, however, mental dependence is the most persistent form. It is related to different effects of the opioid.
The effects of opioids are closely related to the state of health of the addict and include calming, well-being and euphoria. This can lead to so-called “craving” – the medical profession uses this term to describe the irresistible desire for the drug that has been taken for a long time. This “craving” also causes most relapses.
- Morphine
- Hydromorphone
- Oxycodone
- Fentanyl
- Tiredness/drowsiness
- Blood pressure drop
- Nausea & vomiting
- Constipation
- Tolerance
- Physical dependence
- Psychological dependence
Depending on what is responsible for your pain, the individual stages of drug pain treatment can be supplemented by so-called co-analgesics. These roughly comprise the following groups of drugs: Antidepressants Muscle relaxants Glucocorticoids It is not uncommon for chronic pain to lead to depressive moods or tangible depression in the long term. In this context, antidepressants can be given to help break the vicious circle of pain and depression.
Many forms of pain, especially back pain, have their origin in tense or permanently tense muscles. In this context, muscle relaxants can bring about a relaxation of the muscles and thus also a simultaneous relief of pain. Especially in combination with level 1 pain medication, pain can be quickly improved.
Finally, glucocorticoids, which belong to the steroid hormones, should be mentioned here. These have anti-inflammatory and analgesic effects, but have potentially dangerous side effects (including high blood pressure, osteoporosis, abnormal weight gain). The best known representative of glucocorticoids is cortisone.
- Antidepressants
- Muscle relaxants
- Glucocorticoids
So-called adjuvants can reduce the side effects of pain medication. They can be used both as a precautionary measure and to treat side effects that have already occurred. Examples of such adjuvants would be proton pump inhibitors such as Pantoprazole – this drug can be used to counteract the side effects of NSAIDs, which can cause stomach ulcers or bleeding if taken for long periods of time.
