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Pain relieving medications or better known as analgesics, are the type of drugs used to relieve pain. The analgesics work by either stopping the pain signals from reaching the brain or they alter the brain’s perception to these signals. These medications prevent the brain by not allowing the pain signals to be processed. Analgesics do not depend on anesthesia or any loss of consciousness to achieve their pain relieving goal. Since the process of pain is complex, there are different types of drugs that provide relief by acting in different mechanisms. The different types of analgesics can be categorized as follows:
• Nonsteroidal anti-inflammatory drugs (NSAIDs) that act on substances in the body causing inflammation, pain, and fever.
• Corticosteroids are usually injected at the site of musculoskeletal injuries exerting powerful anti-inflammatory effects. Oral administration is also done to relieve pain from, for example, arthritis.
• Acetaminophen acts on the body's pain threshold by increasing it several folds having little or no effect on inflammation.
• Opioids (narcotic analgesics) act by modifying pain messages in the brain.
• Muscle relaxants produce sedative effect in the central nervous system thus, reducing pain from tense muscle groups.
• Anti-anxiety drugs work by reducing anxiety, relaxing muscles, and helping the patients cope with discomfort.
• Antidepressants, especially the tricyclics, reduce transmission of pain through the spinal cord.
• Anticonvulsant drugs relieve pain by stabilizing nerve cells.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are the choice of drugs for relieving pain as well as inflammation corresponding to conditions ranging from headaches to osteoarthritis. Aspirin, ibuprofen and naproxen are considered as the non prescription drugs that are available easily with any non-pharmaceutical retailer also.
NSAIDs are useful in relieving pain related to arthritis, gout, muscle sprains and strains, trauma pain, headaches, eye pain, ear pain, dental pain, orofacial pain, neck pain, shoulder pain, back pain, arm and wrist pain, menstrual cramps, joint pain, leg pain, fibromyalgia, chronic fatigue syndrome, complex regional pain syndrome etc.
NSAIDs work by interfering in the production of prostaglandins, the chemicals responsible for promoting inflammation, pain and fever. They are also helpful in protecting stomach and intestinal lining from the damaging effects of acid. They are also helpful in activating blood platelets for blood clotting and promote normal kidney functions. Prostaglandins are produced by enzymes called cyclooxygenases (COX), which are of two types COX-1 and COX-2. Both these enzymes promote inflammation, pain and fever, but, only COX-1 produces prostaglandins that activates platelets and protect intestinal and stomach lining. Since, NSAIDs block these COX enzymes reducing inflammation, pain and fever; they cause ulcers in the stomach and intestine increasing the risk of bleeding. Other side effects of NSAIDs include stomach upset, drowsiness, dizziness, skin rashes, high blood pressure, nausea, abdominal pain, kidney or liver problems.
All NSAIDs although have same mechanism of action but it is seen that individuals who do not respond to one type of this drug may respond to another one, reasons for which are still not known. NSAIDs differ in their potency, duration of action and their tendency to cause ulcers and cause bleeding as they all differ in their ability to inhibit COX-1 and COX-2.
NSAIDs are shown in approximately 25% of all adverse drug reactions, the most common adverse reaction being GI irritation. A 3-fold increase in gastrointestinal hemorrhages is seen by using these drugs, although 10-fold estimates have also been reported in the literature. These drugs are not considered appropriate for people who suffer from stomach problems as these people are at a higher risk for stomach bleeding. Aspirin is the only NSAID drug which is not involved in increasing the risk of adverse cardiovascular events example heart attack or stroke.