From Aspirin to Opioids: A Comprehensive Guide to Pain-Relieving Medications

Introduction

A Painkiller (also called pain killers, pain medications, pain relievers) and medically known as an Analgesic is defined as a drug used to relieve pain, or achieve analgesia, by blocking pain signals going to the brain or by interfering with the brain's interpretation of the signals.

Pain management medications, from common anti-inflammatory drugs to powerful prescription analgesics such as codeine and morphine, are designed to address diverse levels of pain intensity.

Main Digest

According to figures from the US Drug Enforcement Administration (DEA), in the last ten years the number of painkillers sold and distributed in the United States by hospitals, retail pharmacies, and doctors has risen by 600%. Most of the increased sales are painkiller pills that contain oxycodone, the active ingredient in the painkiller OxyContin, once known as "hillbilly heroin".

There are basically two kinds painkillers or analgesics: non-narcotic and narcotic.

Narcotic Painkillers

There are two types of narcotic analgesics, opiates and opioids.

Opiates

Opiate describes any narcotic alkaloids found in the opium plant (Poppy), as well as any derivatives of such alkaloids. The major biologically active opiates found in opium are thebaine, morphine, codeine, and papaverine. Synthetic opioids products like heroin and hydrocodone are derived from these substances, especially morphine and codeine.

Codeine Painkillers: Codeine or methylmorphine is an opiate used for its painkilling, antitussive and anti-diarrhea properties and is the most widely used opiate in the world today. Heavy use of codeine can cause an addiction to develop. Other effects of long term codeine use include depression, constipation and sexual problems. Withdrawal symptoms include yawning, sweating, restless sleep, weakness, craving, runny nose, stomach cramps, nausea, vomiting, diarrhea, muscle spasms, chills, irritability and pain. Codeine doesn't work very well on its own. It works better when taken with paracetamol and you can buy co-codamol (paracetamol and low-dose codeine) over the counter.

Morphine as a Painkiller: Morphine is a highly potent opiate analgesic drug and is the main active agent in opium and the prototypical opioid. Morphine acts directly on the central nervous system to relieve pain, and at synapses of the nucleus accumbens in particular. Its primary actions of therapeutic value are analgesia and sedation. The effects of morphine can be countered with opioid antagonists such as naloxone and naltrexone. Morphine is highly addictive with an addiction potential identical to that of heroin.

Withdrawal symptoms of morphine addiction include watery eyes, insomnia, diarrhea, runny nose, yawning, dysphoria, and a strong drug craving. Most withdrawal symptoms peak between 48 and 96 hours after the last dose and subside completely after 8 to 12 days. The heart rate and blood pressure are elevated and can lead to a heart attack, blood clot or stroke. Severe headache, restlessness, irritability, loss of appetite, body aches, severe abdominal pain, nausea and vomiting, tremors, and even stronger and more intense drug craving appear as withdrawal progresses. Chills or cold flashes with goose bumps alternating with flushing, kicking movements of the legs and excessive sweating are also characteristic symptoms. Severe pains in the bones and muscles of the back and extremities occur, as do muscle spasms. At any point during this process, a suitable narcotic can be administered that will dramatically reverse the withdrawal symptoms.

Opioids

Opioids are classified as a painkiller medication which binds to opioid receptors in the central nervous system or gastointestinal tract. Although the term opiate is often used as a synonym for opioid, it is more properly limited to the natural opium alkaloids and the semi-synthetics derived from them. Opioids are used in medicine as strong analgesics, for relief of chronic pain or severe pain making these painkillers invaluable in palliative care to alleviate the severe, chronic, disabling pain of terminal conditions such as cancer.

The four main classes of opioid painkillers being:

• Endogenous opioid peptides (produced in the body: endorphins, dynorphins, enkephalins)
• Semi-synthetic opioids (heroin, oxycodone, hydrocodone, dihydrocodeine, hydromorphone, oxymorphone, nicomorphine)
• Fully synthetic opioids (pethidine or Demerol, methadone, fentanyl, propoxyphene, pentazocine, buprenorphine, butorphanol, tramadol, and more)
• Opium alkaloids (morphine, codeine, thebaine)

Common Opioids based painkillers:

ULTRAM (tramadol hydrochloride) and ULTRACET (tramadol with acetaminophen): Prescription painkillers used to treat medium to moderately severe pain. Side effects may include: dizziness, drowsiness, or headache, anxiety; nausea, vomiting, constipation, diarrhea, nervousness, tremor, itching, dry mouth, and sweating. Tramadol can be addictive and withdrawal effects are possible if the painkillers are stopped suddenly after long or higher dosages.

Oxycodone: Used as an analgesic and can be made into other pharmaceuticals including OxyContin (a controlled-release painkiller) and with aspirin (Percodan) or with acetaminophen (Percoset). These drugs are prescribed for pain relief. They all require a doctor's prescription and are prescribed for moderate to severe pain.

Vicodin: A hydrocodone mixed with acetaminophen. Hydrocodone is a semi-synthetic opioid similar in effects to morphine and when abused, can lead to dependence, tolerance, and/or addiction. Vicodin is one of the most frequently prescribed painkillers. Other similiar products include Vicoprophen, Tussionex, and Lortab.

Cocaine: A stimulant crystalline tropane alkaloid that is obtained from the leaves of the coca plant. It is a stimulant of the central nervous system and an appetite suppressant. Because of the way it affects the mesolimbic reward pathway, cocaine is addictive. Cocaine is used in medicine as a topical anesthetic for pain, even in children, specifically in eye, nose and throat surgery. The major disadvantages of this use are cocaine's side effects and intense vasoconstrictor activity and potential for cardiovascular toxicity.

Non-narcotic Painkillers

The most commonly used non-narcotic painkillers used in the past and today include aspirin and other salicylates, acetaminophen, and non-steroidal anti-inflammatory drugs like ibuprofen, available by non-prescription and prescription for stronger painkillers. As well as controlling pain, these painkillers can also lower fever and counter inflamation.

Anti-inflammatories are used to ease pain in conditions including: arthritis, muscle and ligament pains including strains and sprains, period pain, pains after operations, headaches, migraines, and other types of pain.

For pain associated with inflammation, acute back pain or headaches, paracetamol and anti-inflammatory medicine can be taken.

Aspirin: Produces similiar side effects as other anti-inflammatories, but is not an effective painkiller. Aspirin generaly isn't usually prescribed for pain and can be very dangerous for children under 16 to take. Aspirin and the other non-steroidal anti-inflammatory drugs (NSAIDs) inhibit cyclooxygenases, leading to a decrease in prostaglandin production. Ibuprofen and aspirin are also used to bring down high body temperatures. Aspirin also has an anti-clotting effect and is used in long term, low doses to prevent heart attacks, strokes and blood clot formation in people at high risk for developing blood clots.

Paracetamol or Acetaminophen: (Marketed as Panadol in Europe, Africa, Asia, Central America, and Australasia), Lacks many of the side effects of aspirin, and is available without prescription. Commonly used for the relief of fever, headaches, and aches and pains. Used in combination with non-steroidal anti-inflammatory drugs (NSAIDs) or opioid analgesics, paracetamol is also frequently used for the management of more severe pain. Paracetamol is extremely toxic to cats, and should not be given to them under any circumstances. In dogs, paracetamol is a useful anti-inflammatory causing a lower incidence of gastric ulceration than NSAIDs, however it should be only administered on veterinary advice.

Naproxen: A non-steroidal anti-inflammatory painkiller used for the reduction of moderate to severe pains, fever, inflammation and/or stiffness caused by conditions such as osteoarthritis, rheumatoid arthritis, psoriatic arthritis, gout, ankylosing spondylitis, menstrual cramps, tendinitis, and bursitis. Naproxen can inhibit the excretion of sodium and lithium and extreme care must be taken by those who use this painkiller with lithium supplements. Naproxen is also not recommended for use with NSAIDs of the salicylate family (Aspirin) or with anticoagulants (may increase risk of bleeding).

Ibuprofen originally marketed as Brufen: Low doses of ibuprofen (200 mg, and sometimes 400 mg) are available over the counter (OTC) in most countries. Used to treat pain, fever and inflammation, and is also the most risk free painkiller in terms of adverse effects. Ibuprofen is used for relief of symptoms of arthritis, primary dysmenorrhea, fever, and as a painkiller.

Can I Give a Child Painkillers?

Important never administer aspirin to children under 16 years of age!

Babies aged between 2 - 3 months can usually take children's liquid paracetamol 4 - 6 hours apart for fever or discomfort, if they weigh over 4kg (9lb). Always follow the manufacturer's instructions for the correct dosage.

Children and babies over 3 months can be given liquid paracetamol (paediatric paracetamol oral suspension). Do not administer paracetamol if there is a history of adverse reactions, or sensitivity to paracetamol.

Children and babies over 3 months can take ibuprofen as long as they weigh over 5kg (11lb) and they don't have a history of heart problems, kidney problems, stomach ulcers, asthma, or indigestion.

Always ask your doctor or pharmacist, if you're unsure!

Caution

The United States FDA estimates that 200,000 Americans are hospitalized every year because of overdoses of painkillers and side effects of normal doses by causing gastrointestinal problems and liver damage, they also cause thousands of deaths a year. Use of Tylenol, particularly with alcohol, can readily cause hepatitis and liver failure. In people aged over 60, the most common cause of gastritis, peptic ulcers and upper gastrointestinal bleeding is the use of NSAIDs (Non-steroidal anti-inflammatory drugs).

At least half a million people receive treatment and rehabilitation for painkiller addiction and abuse per year. All painkillers have potential side effects so you need to weigh up the advantages against the disadvantages.

NOTE: Anti-inflammatories sometimes cause the lining of the stomach to bleed and a stomach ulcer could develop. Elderly people are more prone, but it can occur in anybody. The risk of stomach bleeding is increased if taking an anti-inflammatory plus warfarin, steroids, or low-dose aspirin. In some people with asthma, symptoms such as wheeze or breathlessness are made worse by anti-inflammatories. If you develop upper abdominal pains, pass blood or black stools, or vomit blood, then stop taking anti-inflammatory painkillers and see your doctor as soon as possible or go to the nearest hospital.

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Cite This Page (APA): Langtree, I. C. (2024, July 1). From Aspirin to Opioids: A Comprehensive Guide to Pain-Relieving Medications. Disabled World. Retrieved September 11, 2024 from www.disabled-world.com/medical/pharmaceutical/pain-med-types.php

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