As of today, no single approach exists in clinical practice for prescribing pain killers. It is impossible to select the best pain reliever, which would be equally effective for alleviating physical and emotional suffering for each and every patient.
Before the attending physician prescribes one or another analgesic, he should inform the patient about the properties of the drug, its therapeutic action and possible side effects. Timely prescription of the drug helps to quickly eliminate the pain symptoms.
For an adequate analgesia, the best pain reliever should have the following characteristics:
- convenient dosing schedule;
- optimal method of application for the patient;
- fast analgesic effect, with a duration of at least 4 hours;
- low systemic toxicity and minimal risk of side effects;
- elimination of not only pain, but also somatic symptoms, like inflammation, edema, etc.
- if necessary, to provide additional effects to anaesthetizing action, like anti-inflammatory, antipyretic, etc.
An adequate analgesic effect depends on the type and degree of pain intensity, as well as on the pharmacological class of the drug. For example, the best pain reliever for arthritis can become one of the non-steroidal anti-inflammatory drugs (NSAID) – Diclofenac, Ibuprofen and others. Narcotic (opioid) drugs, such as Morphine or Tramadol, are an excellent treatment option for chronic and violent attacks of pain.
Best pain reliever for back pain
The problem of back pain is still unexplored. To date, there is no treatment methods that would provide complete relief from emotional and physical suffering. Therefore, it is difficult to determine which of the drugs is the best pain reliever for back pain.
The main principle of back pain pharmacotherapy is the prescription of several drugs from different pharmacological groups. Currently, solving the problem of back pain by using only one drug is almost impossible. The choice of one or another drug for back pain should be based on knowledge of the drugs’ action mechanisms.
Depending on the reasons for the occurrence of emotional and physical suffering, the best pain reliever for back pain can be:
- in myofascial pain syndrome – local anesthetic (Lidocaine)
- in local muscle hypertension – one of the muscle relaxants: Tizanidine, Tolperisone or Baclofen;
- in peripheral lesions of the spine – an opioid medication (Hydrocodone, Oxycodone) or an NSAID (Diclofenac, Meloxicam).
Best pain reliever for oncological pain
Relief of chronic pain syndrome in patients with oncological diseases is the main task of opioid drugs. To date, oncologists have about 60 different narcotic drugs, each of which can become the best pain reliever for oncological pain.
Due to the optimal therapeutic characteristics, Tramadol is the drug of choice for the relief of oncological pain. Oral opioid has a central and peripheral analgesic effect, and enhances the effect of sedatives, as well.
The prescription of the drugs, based on their mode of administration, is one of the possible strategies for alleviating the suffering of cancer patients. The best pain reliever for oncological pain, other than Tramadol, may also be injectable Trimeperidine or transdermal Fentanyl.
Best pain reliever for headache
Even though headache is not a serious clinical problem, it is one of the frequent reasons for contacting therapists and general practitioners. The drugs of choice for the treatment of headache are NSAID, as well as Paracetamol.
Aspirin is more common, than any other NSAID used for headache pharmacotherapy. The mechanism of its analgesic action consists of two components:
- peripheral – increasing the threshold of pain sensitivity
- central – inhibition of pain impulses along the nervous pathways of the spinal cord
A significant disadvantage of Aspirin, like of any other NSAID, is the ceiling effect, that is, the upping of the dose above the therapeutic dose does not increase the analgesic effect, while the severity of adverse reactions increases significantly.
Paracetamol is another drug that, according to popular opinion, is the best pain reliever for headache. It is a non-narcotic drug. However, Paracetamol does not belong to the NSAID, although it has similar therapeutic properties.
The reasons why Paracetamol is the best pain reliever for headache:
- can be used by all patients, regardless of age;
- significantly limits the severity of pain syndrome, reduces the intensity of pain impulses;
- significantly reduces the need for the use of strong analgesics, for example, opiates.
Causes of resistance to analgesia and ways to overcome it
Medications are not always able to relieve pain. Even if the attending physician prescribed the best pain reliever, the patient may not experience relief from emotional and physical suffering. The reasons why analgesic therapy may be ineffective:
- development of tolerance (with the use of narcotic drugs);
- progression of the underlying disease and increase in pain intensity;
- disruption of the drug absorption, which can arise because of gastrointestinal tract disorders;
- incorrect diagnosis, in which the attending physician did not take into account the patient’s somatic diseases (stomach ulcers, allergies and others).
The ineffectiveness of the analgesic therapy does not mean that the patient will always experience painful or unpleasant sensations of pain. There are several ways to revise and correct the dosing regimen of pain medications:
- titration of the drug dose;
- change of dosage forms (for example, tablets for injections);
- smooth transition from a weak analgesic to a stronger one (for example, from NSAID to opiate);
- combining the use of drugs with non-drug treatment of pain: massage, manual therapy, etc.
- using drugs for adjuvant pain therapy: antidepressants, antipsychotics, anticonvulsants, etc.
Choosing the best pain reliever is a difficult task. When prescribing an analgesic, it is important to strike a balance between their efficacy and the risk of side effects, while in combined therapy, to consider the possibility of drug interactions.