How to choose painkillers for different pain groups? Keep these 4 points in mind

About pain

Pain is an unpleasant sensory and emotional experience caused by tissue damage or the potential for tissue damage.
According to the duration and nature of pain, it can be divided into acute pain and chronic pain (lasting more than 3 months). According to the pathophysiological mechanism, pain can be divided into nociceptive pain and neuropathic pain or a mixed type of pain containing both.

3 levels of pain

Pain is a subjective feeling. Clinically, nighttime sleep is an important criterion for determining the level of pain .
According to the patient's main symptoms, the severity of the pain can be determined by the following manifestations to better avoid under- or over-medication: Mild: Although there is pain, it is tolerable, and the patient can lead a normal life and his sleep is not disturbed.

Moderate: The pain is obvious and unbearable, sleep is shallow, and the patient is easily awakened by pain, and analgesics are required.

Severe: The pain is severe and unbearable, and sleep is severely disturbed. It may be accompanied by autonomic dysfunction or compulsive posture.

Clinically, drug therapy is one of the main measures to relieve pain. However, there are many types of clinical analgesics. How to use analgesics correctly and reasonably?
Types and selection of painkillers

Analgesics are mainly divided into non-steroidal anti-inflammatory drugs, central analgesics and narcotic analgesics, smooth muscle antispasmodics , etc.

1. Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs have antipyretic, analgesic and anti-inflammatory effects and are widely used in rheumatic diseases, inflammatory diseases, pain, soft tissue diseases, etc.

Commonly used drugs in clinical practice: Aspirin and ibuprofen are commonly used for headaches and fevers. Diclofenac sodium is commonly used for various types of inflammation, such as periostitis, arthritis, and gout. COX-2 inhibitors are commonly used for osteoarthritis, arthritis, and acute pain. Celecoxib is commonly used for various types of inflammation, such as periostitis, arthritis, and gout.

NSAIDs are not suitable for the following groups: (1) People with active gastrointestinal ulcers or recent gastrointestinal bleeding are contraindicated for use, and those undergoing coronary artery bypass grafting are contraindicated for use; (2) People who are allergic to aspirin or other NSAIDs, or have a history of allergies caused by other reasons, including patients with asthma, bronchospasm, rhinitis, angioedema, and urticaria should take them with caution. (3) For patients with renal insufficiency, propionic acid drugs such as ibuprofen and ketoprofen should be used with caution. (4) For patients with hypertension and congestive heart failure, NSAIDs are prone to cause water and sodium retention, and antagonizing the diuretic effect will aggravate the condition, so they should be used with caution. (5) Use with caution for patients with liver dysfunction and leukopenia. (6) During pregnancy and lactation, it should generally be avoided. If it is necessary to use it, the pros and cons must be weighed (low dose, less frequency). (7) For the elderly, those taking oral anticoagulants and hypoglycemic drugs, attention should be paid to drug interactions. (8) People who are allergic to sulfonamide drugs are prohibited from using celecoxib, parecoxib, nimesulide and other non-steroidal anti-inflammatory drugs containing sulfonamide structures.

2. Central analgesics

Central analgesics are mainly used for various moderate acute pains and postoperative pains, etc. Tramadol is a synthetic central analgesic, belonging to the second category of psychotropic drugs, and is a non-narcotic analgesic.

3. Narcotic painkillers

Narcotic analgesics are represented by opioids such as morphine (immediate-release tablets/sustained-release tablets) and pethidine. The country has strict management systems for these drugs and they cannot be used casually.

4. Smooth muscle antispasmodics

Such as atropine, belladonna tincture, scopolamine, propantheline, etc. This type of drug can relieve various visceral colic caused by smooth muscle spasm by relieving smooth muscle spasm. It is often used for gastrointestinal spasmodic pain, renal colic, biliary colic, etc.

Determine the cause before taking medication

When pain occurs, the cause should be determined before medication is used, so as to avoid using painkillers to mask the condition and delay diagnosis and treatment. How to choose painkillers for different pain groups?

1. Postherpetic neuralgia (PHN)

Postherpetic neuralgia refers to pain that persists for more than one month after the healing of herpes zoster lesions. It is a common neuropathic pain, which is mainly related to the damage of nerve cells by the varicella-zoster virus. The pain of postherpetic neuralgia varies in nature, and can be burning, electric shock, knife-like, needle-like, or tearing. It can be dominated by one type of pain or multiple pains can coexist. Some patients may also show mental system symptoms such as anxiety, depression, and inattention.

Commonly used analgesics: anti-epileptic drugs (such as gabapentin, pregabalin), antidepressants, and opioids.

2. Migraine

Commonly used analgesics: NSAIDs, opioids, glucocorticoids, chondroprotectants, anesthetics, calcitonins, auxiliary drugs (antidepressants, topical medications).

3. Trigeminal neuralgia

Trigeminal neuralgia is a recurrent, transient, paroxysmal, severe pain confined to the distribution area of ​​the trigeminal nerve. It is mainly electric shock-like pain, which lasts from a few seconds to a few minutes. Patients have specific facial pain contact points, also known as "trigger points", which are often located on the upper lip, both sides of the nose, corners of the mouth, cheeks, etc., and often produce severe pain during activities such as eating, talking, brushing teeth, and washing face. According to the cause of the disease, it can be divided into primary trigeminal neuralgia and secondary trigeminal neuralgia. Primary is more common in clinical practice.

Commonly used analgesics: (1) Carbamazepine tablets: Carbamazepine is the first choice for the treatment of trigeminal neuralgia and is also used as a long-term preventive medication after the pain is relieved. (2) Oxcarbazepine tablets: Compared with carbamazepine, oxcarbazepine is the second choice, which may be related to the better efficacy of carbamazepine, but the incidence of adverse reactions of oxcarbazepine tablets is lower.

4. Acute attack of gout

An acute attack of gout refers to abnormal purine metabolism in the human body, increased blood uric acid levels, and deposition of urate crystals in the joint cavity, causing sudden and acute inflammatory reaction with redness, swelling, heat and pain in the joints.

Commonly used analgesics: (1) Colchicine can treat acute attacks of gouty arthritis and prevent acute attacks of recurrent gouty arthritis. (2) NSAIDs: such as celecoxib capsules, diclofenac sodium sustained-release tablets, etc. (3) If colchicine and NSAIDs are not effective in relieving acute attacks of gout, you can also choose to take glucocorticoids for a short period of time, such as prednisone acetate tablets.

Principles of correct use of painkillers

Take medication on time

Oral medication is the first choice for pain. According to the degree of pain, regularity and the time of first effective pain relief, painkillers should be given on time to maintain the concentration of drugs in the blood.

Step-by-step medication

Depending on the severity and type of pain, choose analgesics of different strengths. For mild pain, NSAIDs, such as diclofenac or ibuprofen, are the first choice; if moderate pain occurs, low-dose strong opioids or weak opioids should be selected, and acetaminophen should be combined if necessary; if severe pain occurs, strong opioids should be selected, combined with nonsteroidal anti-inflammatory drugs or auxiliary analgesics.

Combination medication

For moderate to severe pain, it is best to use two or more analgesics, which can reduce their dosage and complications and enhance the analgesic effect.

Alternating medication

If the same painkiller is used repeatedly for a long period of time, the body will develop drug resistance, and the painkiller effect should not be achieved by increasing the dosage.

Drug dosage

According to actual needs and while ensuring safety, the drug dosage is increased from small to large until the patient's pain is relieved.

Different types of analgesics have certain adverse reactions. We should closely observe the changes in patients after taking the medicine, deal with the adverse reactions of various drugs in a timely manner, observe and evaluate the efficacy of the drugs, and adjust the drug dosage in a timely manner.

References:

[1] Zhang Bowen. Not all pains can be relieved by taking ibuprofen[J]. Wish you good health, 2022(06):35-36.

[2] Yin Yan, Liu Hui. Misconceptions about pain[J]. Jiangsu Health Care, 2022(04):23.