There are three kinds of painkillers: paracetamol, NSAID’s (Non-Steroidal Anti-Inflammatory Drugs), and opiates. Antidepressants and epilepsy medication are also commonly prescribed for nerve pain.
Paracetamol is one of the most commonly used painkillers. It is a relatively safe and inexpensive medication. Apart from an analgesic effect, it also has an antipyretic effect. Paracetamol has, unlike NSAID’s, no anti-inflammatory effect.
The major benefit of paracetamol as opposed to NSAID’s is that it upsets the stomach less. It is available in various forms and dosages. For adults, the maximum dose is 3000 mg per day. Taking more does not make a difference: the analgesic effect is not increased.
Not for prolonged use
As with all painkillers, prolonged use is not recommended. Prolonged use of high doses of paracetamol can cause liver damage. There are many combined preparations with paracetamol. These are generally more expensive, but not more potent than paracetamol alone.
There are a lot of NSAID’s on the market. Some are available over the counter without a prescription (aspirine, ibuprofen, naproxen). These medications are chemically derived from aspirin, which was originally made from the bark of willow trees. All NSAID’s are not only analgesic and antipyretic, but also strongly anti-inflammatory. Therefore, they are widely used with illnesses where the pain is caused by inflammation (such as rheumatism).
There are too many NSAID’s to mention here. What is important to know, though, is that they can have serious side effects. The best known side effect is stomach pain and the risk of an ulcer. This risk increases with age. Even if one drinks a large quantity of alcohol or takes medication like prednisone, there is a greater chance of an ulcer with the use of NSAID’s. If stomach pain is experienced with the use of NSAID’s, it is advisable to report this to a doctor. Other side effects include delayed clotting, causing easier bruising and longer bleeding time. Patients taking anticoagulants should not take NSAID’s. NSAID’s also inhibit renal function, making one retain fluids. Older people with cardiac or renal dysfunction should therefore be careful with NSAID’s. Although NSAID’s have such serious side effects, they are effective analgesics when used properly. Prolonged use should be avoided.
These drugs are derived from morphine. Morphine was formerly made from poppy bulbs (opium). Well known medications are codeine, tramadol, morphine, methadone, fentanyl (the patch). Codeine and tramadol are weak opiates. That means that the analgesic effects are less that with ’real’ morphine. Codeine especially has a low analgesic effect, it is mostly used as an antitussive. Morphine and methadone are strong opiates. They are very strong painkillers.
In contrast to the NSAID’s and paracetamol, there is no actual maximum dose. In theory, a higher dose always gives more analgesia. In practice, this obviously does not always work, because one can experience side effects. Side effects There can be many side effects. The most common is constipation. Most doctors prescribe laxatives to go with opiates. Other side effects include nausea but it usually goes away after a few days. Drowsiness can also occur, but this can also be a sign that the dosage is too high. Addiction and reducing Some explanation about addiction is warranted. Addiction to morphine occurs, but not nearly as much as people think. It is not the case that one always gets addicted to morphine. Most patients can easily reduce the use of morphine. It is true, though, that it is habituation. This means that people can’t suddenly stop taking morphine tablets. To avoid withdrawal symptoms one must reduce slowly. Therefore, the fear of addiction is uncalled for and should never be a reason to take too little, or no morphine at all.
Not just with cancer
Opiates have previously only been used during and after surgery, and for the treatment of pain in cancer. In recent years, opiates are also being prescribed to patients with pain which is not due to cancer. Morphine is given to patients with rheumatoid arthritis, osteoarthritis, or pain after an injury to the nervous system (e.g. spinal cord injury). There are many different preparations. The most common are morphine retard and the fentanyl patch. Morfine retard (brand names are Kapanol, MS Contin, Noceptin) is a so-called depot preparation. This means that the tablet slowly releases the drug after ingestion. A major advantage is that you only have to swallow a pill twice a day. The disadvantage is that increasing the dosage has a slow effect. With so-called ’breakthrough’ pain, one has to take a faster acting medication, like a morphine drink. The Fentanyl-patch (Durogesic patch) is a patch that is put on the skin. In the patch is fentanyl, a strong opiate. This substance passes through the skin into the bloodstream and provides a strong analgesic effect. The effects are noticeable after about 12 hours and it lasts for about three days. A new patch needs to be applied every two or three days. The fentanyl patch is patient-friendly, but also has the disadvantage that with a rapid increase in pain, one needs to take a different (faster-working) medication. It is important to realize that the doses of morphine tablets does not correspond to the dose of fentanyl patches.
Please note: Only a doctor can, after examination, advise you on possible treatments.
Introducing our Pain Specialist
Introducing our Pain Specialist
Dr, Henk van Driel
Dr. Henk van Driel is operating as an anesthesiologist in the field of chronic pain for more than 25 years. After having initiated the pain management department in the Amphia Hospital in The Netherlands, the largest in the country, he opened Optimal Care Pijnklinieken back in 2008, the first clinic to offer the full range of pain management procedures available in The Netherlands.
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