All of us at some point in our lives have experienced pain, of various kinds and degrees of severity, the threshold that each of us can bear, tolerate or coexist is also different.

Pain is the most frequent reason for consultation in the world and generates significant burdens in the health sector, both public and private. When it comes to seeking pain relief, there are a wide range of therapeutic options for pain management, including pain relievers .

The analgesics are constituted as a heterogeneous group of drugs that are responsible for generating temporary relief (the duration of the therapeutic effect) of pain experience a person at a given time.

The so-called NSAIDs (Non-Steroidal Anti-inflammatory Drugs) are the most common, among them aspirin is one of the most representative. There are also other analgesics such as weak and strong opioids with a different mechanism of action than NSAIDs and which, in some cases, can lead to dependence.

How do NSAID-type pain relievers work?

NSAIDs form an important and numerous group of drugs that share therapeutic actions and adverse effects. Their primary effect is to inhibit the synthesis of prostaglandins, which are pro-inflammatory mediators, achieved through the inhibition of the cyclooxygenase enzyme, which is responsible for catalyzing the reaction from arachidonic acid.

Analgesics such as NSAIDs, such as ibuprofen or acetylsalicylic acid (aspirin), relieve mild to moderate pain quickly, as well as are also used in the same way to lower fever (for example, paracetamol), due to their antipyretic effect as well of analgesic; for this reason they are widely used, and a prescription is not usually necessary for their acquisition and use.

However, the indiscriminate use of analgesic drugs such as NSAIDs, despite being fairly well tolerated and safe when used correctly, also carries risks of various kinds, especially when there are risk conditions inherent to each patient, in terms of to comorbidities, such as heart disease, liver or kidney, digestive, hematological diseases, etc., as well as, the simultaneous intake of various drugs that generate drug interactions and prolonged use with multiple doses that generate adverse health effects.

With regard to weak opioid analgesics, we find active principles such as codeine, hydrocodone, dihydrocodeine, buprenorphine, among others. This group of anti-inflammatory drugs are used for moderate or more intense pain, especially of visceral origin, in contrast to the usual ones that can be treated with NSAIDs that are more of musculoskeletal origin.

Strong opioid analgesics are usually used for the management of severe, extreme pain, and in many cases of chronic and oncological origin, or after major surgery, which are not relieved by other therapies or drugs. Examples of these drugs are morphine, methadone, fentanyl, heroin, delayed-release oxycodone, among others.

How do opioid pain relievers work?

Opioids are all those endogenous or exogenous substances with an affinity for opioid receptors that are generally found mainly in the gastrointestinal tract and the central nervous system.

These opioid analgesics bind to specific cell receptors, which generate reactions that reduce the intensity of pain signals that reach the brain and affect the cortical areas that control emotions, thus reducing the effects of a painful stimulus.

Side effects of pain relievers

  1. Hypersensitivity reactions, in which the patient may have allergic reactions that can range from mild to severe.
  2. Peptic or gastrointestinal ulcers and digestive bleeding; prolonged use of some NSAIDs such as ibuprofen and diclofenac, for example, can compromise the gastric mucosa and cause tissue damage that over time becomes an ulcer lesion.
  3. Blockage of platelet aggregation, a therapeutic effect that is often sought with the use of aspirin, but it also entails monitoring and medical indication due to the risks of bleeding that it could generate as an adverse effect.
  4. Liver damage, for example, in the case of acetaminophen intoxication or its prolonged and indiscriminate use, can lead to liver failure, due to tissue damage of the hepatocytes.
  5. Renal insufficiency, kidney failure can be generated with the misuse of analgesics, because for some its route of elimination is the kidney and with toxic levels the filtering function of the nephron can be affected and lead to acute kidney failure .
  6. Increased Blood Pressure, is the case of some NSAIDs such as Diclofenac Sodium.
  7. Pharmacological dependence, especially regarding the use of strong opioids such as morphine, oxycodone, etc., being one of its main side effects.

By Dr. Eric Jackson

Dr. Eric Jackson provides primary Internal Medicine care for men and women and treats patients with bone and mineral diseases, diabetes, heart conditions, and other chronic illnesses.He is a Washington University Bone Health Program physician and is a certified Bone Densitometrist. Dr. Avery is consistently recognized in "The Best Doctors in America" list.

Leave a Reply

Your email address will not be published. Required fields are marked *