March 19, 2020 pain medication

A Guide to Safe Use of Pain Medicine

What are the types of pain medications?

Pain medications are the drugs that are useful in the treatment of discomfort associated with injury, disease, or surgery. The pain is a complex process, and there are many different types of medications that provide relief to the pain by acting through a number of physiological mechanisms. Thus, effective medicines for arthritis pain will have a different mechanism of action than a nerve pain medication.

NSAIDs or non-steroidal anti-inflammatory drugs act on the substances in our body that cause inflammation, fever, and pain.

Corticosteroids are injections to be taken at the site of musculoskeletal injuries. They provide powerful anti-inflammatory effects and are also available as oral medications to relieve pain from arthritis and other conditions.

Acetaminophen is commonly known as paracetamol, which increases the pain threshold of our body but has a little or no effects on the inflammation.

Opioid analgesics, also known as narcotic pain relievers, modify the pain messages our body sends to the brain.

Muscle relaxants are the pain relievers that reduce pain from tense muscle groups, by a sedative action in the central nervous system.

Anti-anxiety medications work on the pain in three different ways: by reducing anxiety, relaxing muscles, and by helping people cope with the discomfort.

Several antidepressants, especially the tricyclic antidepressants, may also reduce the transmission of pain through the spinal cord.

Several anticonvulsants also relieve pain of neuropathies by stabilizing the nerve cells.

For what condition we use pain medications?

Generally, all diseases, as well as injuries and surgical procedures, involve some degree of pain. Due to this, it is known that pain medications, also called analgesics, are the most commonly used medicines in the United States.

Different pain medications are helpful, depending on the type and severity of pain. For minor pain or discomfort, such as headaches or muscle sprain, over-the-counter (OTC) pain killers will usually do. Prescription pain relievers, such as opioid analgesics, are generally for the moderate to severe pain conditions, such as pain after surgery, trauma, or specific acute or chronic diseases like cancer or rheumatoid arthritis.

Other painful conditions for which doctors often prescribe pain medications are labor, back pain, urinary tract infection, and fibromyalgia.

What are the significant differences among pain medications?

Experts broadly classify pain medication into two significant categories: prescription and non-prescription. The latter group includes several mild anti-inflammatory drugs like naproxen and ibuprofen as well as acetaminophen. These medications are mainly for use with short term and acute pain conditions such as tension headaches, menstrual cramps, or minor sprains, which are commonly known as everyday pains and aches.

Over-the-counter (OTC) pain killers, especially acetaminophen, are sometimes used for the treatment of chronic pain, such as arthritis. These medicines also lower fever, and people often use them for this purpose.

The prescription pain medications are extensive. They include NSAIDs that are more powerful than their over-the-counter partners as well as opioid analgesics. There are also some unconventional analgesics which initially were not developed as pain relievers, but they have pain-relieving properties in some conditions. For example, the medications for fibromyalgia include an antidepressant-like duloxetine hydrochloride (Cymbalta) and an anti-seizure drug-like pregabalin (lyrica).

The major difference between anti-inflammatories and opioid pain medications is that the former medicines have a “ceiling effect,” or in other words, the continuous dose increase does not provide a concomitant increase in pain relief. One reason why opioids are so useful in treating chronic pain is that their dose can be raised to have increased effects of tolerance to the medication develops. In fact, there is no limit of the dosing, keeping in mind that higher doses can cause unpleasant and dangerous side effects.

What are the most potent pain medications?

In general, the most potent pain medications are opioid analgesics. The benchmark medicine in the opioid class of drugs is morphine, with other opioid analgesics falling below or above it in terms of their potential of pain relief. Codeine is near the bottom of the list and is usually prescribed in combination with acetaminophen for mild pain relief, such as pain due to some dental work. Codeine is the one-tenth times as powerful as morphine. Some more potent opioids than morphine include oxymorphone (Opana) and hydromorphone (Dilaudid). The most powerful opioid in the community of opiates is fentanyl, whose intravenous form is 70 to 100 times more potent than morphine. Fentanyl also comes as a long-release patch and as a lozenge that dissolves in the mouth.

Are there any side effects of the pain medications?

The different pain medications have different side effects according to their mechanism of action. Following are the side effects of some most popular categories of pain medications:

Non-steroidal Anti-inflammatory Drugs

All the NSAIDs come with the potential risk of gastrointestinal ulceration and bleeding. Experts developed a new class of anti-inflammatory drugs, the COX-2 inhibitors, to reduce this risk. However, it did not eliminate it; in fact, another big issue emerged with these drugs, which is the possibility of severe and life-threatening vascular problems with long-term use, including stroke and heart attack.

Acetaminophen

Most people using acetaminophen experience only a few side effects. But it can cause liver damage, mainly when someone takes it in higher doses or with alcohol.

Opioids

Opioid analgesics most commonly cause dizziness, drowsiness, and respiratory depression. However, these are the side effects that usually go with continued use. Constipation is another common side effect that tends to persist. Additionally, continued opioid use may lead to addiction or dependence. Other possible side effects of opioids include agitation hallucination, euphoria, dysphoria, seizures, low blood pressure, muscular rigidity, nausea, vomiting, non-allergic itching, sexual dysfunction, pupil contraction, and urinary retention.

Mixed Opioids

People taking mixed opioid agonist or antagonist experience symptoms of opioid withdrawal if they take a single ingredient opioid such as morphine along with the medications. Other side effects include the common adverse effects of opioids such as headache, drowsiness, dizziness, constipation, nausea, and others.

Muscle Relaxants

The main side effect caused by muscle relaxant is drowsiness. It is maybe due to how they work to relieve pain. Additionally, carisoprodol (soma) use may lead to dependence as it gets converted into the body to a drug similar to barbiturates. Cyclobenzaprine can cause constipation, dry mouth, confusion, and loss of balance. Methocarbamol causes urine discoloration to brown, green, or black. Metaxalone and chlorzoxazone are dangerous for people with liver problems.

Anti-anxiety Agents

Anti-anxiety medications also carry the risk of sedation, especially if combined with other opioid medications or alcohol. Other potential side effects include headache, psychological changes, visual problems, nausea, nightmares, and restlessness. Chest pain and heart-pounding may also occur.

Antidepressants

Some antidepressants useful for pain relief are the older tricyclic ones. These come with many side effects, including difficulty urinating, dry mouth, blurred vision, and constipation. Other side effects include fast heartbeat, lower blood pressure, weight gain, heart palpitations, and fatigue.

A few new antidepressants also reduce pain and have lesser side effects or anticholinergic issues. Still, the SNRIs (serotonin-norepinephrine reuptake inhibitors) may cause the following effects such as anorexia, constipation, asthenia, dry mouth, dizziness, headache, ejaculation problems, nausea, insomnia, and sweating.

Anti-seizure Agents

The anticonvulsants used for pain management have side effects that usually disappear over time. These effects include drowsiness, dizziness, and less severe swelling.

Corticosteroids

Generally, short-term and low doses of corticosteroids use have only a few side effects. However, taking them for long-term can result in several severe consequences, including atherosclerosis, adrenal insufficiency, cataract, bone death, glaucoma, elevated blood pressure or blood sugar levels, fluid retention, mood changes, gastrointestinal bleeding, trouble sleeping, suppression of immune system, weight gain, and damage to the local tissues.

What are the precautions associated with pain medications?

NSAIDs may cause stomach bleeding. You should take them with food to reduce this possibility. People with kidney and liver diseases should take them with caution as they can cause kidney failure. Besides, some NSAIDs also increase the risk of cardiovascular events.

Acetaminophen is toxic to the liver, and people with liver diseases should take it very cautiously, if at all. The maximum acetaminophen dose is 4 grams per day, but moderate to high alcohol drinkers need to have much lesser dosages.

Opioid analgesics result in dependency and addiction. Operating any heavy machinery or motor vehicle may be dangerous if you are on the opioid medication as they cause drowsiness. Opioids may also slow down the breathing. Mixing opioid analgesics with alcohol or certain centrally acting drugs could make this effect even worse. Severe side effects and death occurred with the use of transdermal fentanyl patches. Methadone affects the heart. People who have heart abnormalities should not take methadone therapy.

Muscle relaxants cause high levels of drowsiness. Chlorzoxazone and metaxalone can cause liver failure, so the people with liver diseases should use them with caution. Dantrolene is also toxic to the liver, and carisoprodol use results in dependence.

Anti-anxiety medications, particularly the benzodiazepine class of drugs, cause drowsiness. They also result in withdrawal symptoms, so a sudden withdrawal from benzodiazepines may cause seizures and even death.

Antidepressants also cause drowsiness. Tricyclic antidepressants interact with many drugs to produce fatal results, affecting the heart.

Anticonvulsants, as well as new antidepressants, cause suicidal thoughts. People taking them should be properly monitored for the signs and symptoms of suicidal thoughts.

Corticosteroids also cause withdrawal symptoms when used for acute inflammation. People should gradually taper their doses following the instruction of use given by a health care expert.

A list of common pain medications

Some common pain medications include:

Tramadol

Tramadol is a pain medication that helps relieve moderate to moderately severe pain. It works similarly like opioids to change the way of how pain responds. It is very useful in the treatment of pain and also causes very few side effects as compared to the opioids. The medication is a narcotic-like analgesic that can also relieve around the clock chronic pain in its extended-release formulation.

Carisoprodol

Carisoprodol is a muscle relaxant that helps relieve muscular-skeletal pain conditions. It is sold under the brand name soma. The medication is only for short-term use, such as two to three weeks. Its long term use is not recommendable due to two main reasons: the skeletal muscle conditions generally last for less than four weeks, and no studies establish the effectiveness of Carisoprodol. The medicine has no to a few side effects, mainly drowsiness and dizziness.

Fioricet

Fioricet is a combination of pain medication that consists of Butalbital, acetaminophen, and caffeine. It is useful in the management of tension headaches. Fioricet is an inexpensive medication popular for its effectiveness. It is a brand name version also available in many other trade names. The medicine has a high degree of tension headache relief and fewer side effects.

Butalbital

Butalbital is a barbiturate that has an intermediate duration of action. It is a pain medication often available as a combination with other medicines such as acetaminophen or aspirin for the management of pain and headache. Its combination with codeine is an FDA approved medicine for the treatment of tension headaches. It treats mild pain conditions and tension headaches.

Valium

Valium is a pain medication falling under the category of benzodiazepine derivatives. The remedy is available in different strengths of 2 mg, 5 mg, and 10 mg of the active ingredient diazepam. It is useful for the management of anxiety disorders or relief of symptoms of anxiety. As a pain medicine, valium is a helpful adjunct for the relief of skeletal muscle spasm due to reflex spasm to pathology, spasticity caused due to upper motor neuron disorders, and stiff-man syndrome.

Ativan

Ativan is a benzodiazepine pain medication that contains lorazepam. It is an anti-anxiety agent that also treats pain conditions caused by anxiety disorders. The medication is one of the most effective and safest medicines. The WHO’s List of Essential Medicines has Ativan included in it. It is a popular medication in the United States, helping in the management of multiple conditions.

Xanax

Xanax is the most widely used benzodiazepine in the United States. Most doctors prescribe Xanax for the management of different anxiety disorders. It also treats the pain related to the symptoms of generalized anxiety disorders and panic disorders. The medication is very effective but may cause side effects like sedation, drowsiness, dizziness, and lightheadedness.

There are many other pain medications, apart from the ones mentioned above. However, these are the safest pain management medicines with the least adverse effects.

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