Effectiveness of analgesic therapy for acute and chronic diseases, surgical interventions, as well as injuries depends on choice and use of one or another pain medication. Therapy, aimed at alleviating physical and emotional suffering, should begin as soon as possible – at the first signs of pain occurrence.
Regardless of causes of pain occurrence, there are no adequate methods of examination confirming this diagnosis. Diagnosis is based on the patient’s description of pain characteristics and accompanying symptoms, herewith absence of any deviations during medical examination is mandatory.
During medical examination, the patient should describe pain symptoms as detailed as possible. It is very important to inform the doctor how often and in what doses the patient uses analgesics and whether he observes all recommendations for use.
Choice of pain medication is determined in accordance with such pain characteristics as:
- intensity and type
- the patient’s individual characteristics
There is no pain medication, universal for all patients. However, based on medical indications, the attending physician will be able to prescribe a medicine that is effective for analgesic therapy of the particular patient.
All painkillers are divided into three large groups:
- non-narcotic (non-opioid)
- narcotic (opioid)
Non-opioid analgesics include drugs of such pharmacological groups as non-steroidal anti-inflammatory drugs (NSAIDs), Pyrazolone derivatives and others. All non-narcotic drugs do not differ by prolonged anesthetic effect and are not capable to relieve severe pain, but can weaken it and reduce a need for opioids.
Analgesic effect of non-narcotic analgesics is manifested in neuralgic, muscular, articular, dental and headache. However, to alleviate emotional distress during injuries, burns and pain associated with diseases of the internal organs, none of the non-narcotic pain medications will be effective.
Advantages of non-narcotic drugs comparing to opioids:
- do not depress breathing
- do not cause drug dependence
- both adults and children can use
Opioid analgesics are the drugs of choice for alleviating pain symptoms of moderate and high intensity in different fields of medicine. By degree of anesthetic effect, they are significantly superior to all non-narcotic drugs. Opioid drugs have central mechanism of action, realized by interaction with opioid receptors of different brain parts and central nervous system.
The most common opioid pain medication is Codeine. It has several dosage forms (tablets, syrup, injections) and it is widely used in clinical practice. Compliance with the rules for clinical use of all opioid drugs is a prerequisite for preventing risk of possible complications.
The main disadvantage of opioid drugs is a risk of drug dependence. Tolerance is caused by the person’s addiction to the applied dose of an opioid and decrease in analgesic effect during prolonged therapy. Due to the increased risk of dependence, there is a special system for monitoring the use of opioids to prevent possible abuse in many countries.
Combined pain medications are created on the basis of Paracetamol in combination with small narcologically safe doses of opioid analgesics – Codeine, Tramadol and others. Combination drugs surpass Paracetamol in its pure form by their analgesic effect and do not belong to narcotic drugs.
Thanks to several active ingredients, combined analgesics have such effects as:
- spasmolytic (eliminate spasm of smooth muscles and improve blood circulation)
For chronic pain treatment, there are several principles for taking medications. One of them is sequence of application, that is, from weaker drugs to stronger ones. This principle is called a stepwise approach to the use of analgesics.
Depending on the pain severity, systemic analgesic therapy is divided into three stages:
- Non-opioid drugs should be used in patients with mild pain.
- Low doses of opiates should be used in patients with mild to moderate pain, as well as in those who did not achieve the maximal anesthetic effect with non-opioid drugs.
- Therapeutic doses of opiates should be used in patients with severe pain syndrome or in those who are unable to achieve adequate analgesia while using anesthesia scheme of stage 2.
At all stages of alleviating physical and emotional suffering, adjuvant therapy should be used together with analgesics. These are additional methods of treating pain symptoms aimed at increasing effectiveness of pain medication. Adjuvant drugs to reduce pain symptoms can be anxiolytics, antidepressants, antipsychotics, anticonvulsants and other drugs.
If opioid pain medication is used along with non-narcotic drugs and adjuvant therapy, effectiveness of analgesic therapy will significantly increase. An integrated approach to alleviating physical and emotional suffering significantly reduces risk of side effects and complications that can be caused by narcotic drugs.
Many patients, who need pain medication, do not receive adequate pain therapy. This is largely due to an erroneous medical diagnosis or incorrect evaluation of pain severity by the treating physician. The most important condition for alleviating emotional distress is prescription of a drug for regular use, rather than by the patient’s need (i.e., ahead of pain resumption).
Non-pharmacological methods of relieving physical and emotional suffering (relaxing massages, physiotherapy, and moderate physical activity) are very helpful when used along with pain medication.