We all take painkillers. But do we know how they work? Preparations available to doctors belong to three groups. Each contains pharmaceuticals with a slightly different mechanism of action. Their choice depends on the intensity and nature of the pain.
The World He alth Organization has developed a chart describing how and when to administer the individualpain medicationsand other medications for pain relief. This isanalgesic ladder(from the word "analgesia" - pain relief). It has 3 steps. The first one includes non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol, the second - weak opioids (tramadol, codeine and dyhydrocodeine), and the third - strong opioids (e.g. morphine, fentanyl, methadone). Each of them is treated with adjuvant drugs supporting the treatment of pain.
How do NSAIDs work?
NSAIDs work in an inflamed area that irritates the pain receptors. These drugs inhibit the production of cyclooxygenase, an enzyme necessary for the synthesis of prostaglandins, molecules found in all tissues and body fluids.
Paracetamol does not inhibit prostaglandin synthesis, it does not work in the inflammatory focus, but in the central nervous system.
Some prostaglandins have a beneficial effect on our body (they regulate various physiological processes), and some participate in the development of inflammation and pain. NSAIDs reduce the concentration of both, hence their side effects.
How do opioids work?
Opioids act on opioid receptors located in the central nervous system. They inhibit or reduce the transmission of pain in specific places in the spinal cord, called control gates. Strong opioids differ from weak opioids in that they do not have a ceiling effect. As the dose increases, the analgesic effect of these drugs increases.
How do adjuvant drugs work?
Adjuvant drugs also play an important role in the treatment of pain. These are mainly anticonvulsants used to treat epilepsy and some antidepressants. The former are effective because the mechanisms that lead to seizures also contribute to the production of pain. By reducing the hyperactivity of the nervous system, they reduce pain transmission. They are used primarily in the treatment of weak neuropathic painthey relieve classic painkillers (analgesics). On the other hand, some antidepressants inhibit the reuptake of serotonin and noradreanlin, which causes pain stimuli to be conducted with resistance, blocked in these control gates.
ImportantNumerical pain scale
Pain is subjective, but its intensity can be defined. This task is facilitated by a numerical pain scale from 0 to 10, where 0 is no pain and 10 is the strongest pain imaginable. Pain 1 to 3 is weak, you can function normally with it, so it does not require treatment. From 4 to 7 pain is severe, and above 7 - very strong. Pain above 3 must be treated. Although the numerical pain scale is subjective, it is very useful, for example, for assessing the effectiveness of therapy.
Painkillers for ulcers
Of over-the-counter (OTC) painkillers, ulcers should avoid aspirin in the first place. It contains acetylsalicylic acid, which irritates the stomach and, as an anti-inflammatory drug, inhibits the synthesis of prostaglandins, including those responsible for the secretion of mucus that protects the stomach. For this reason, ulcers should not take NSAIDs at all, although not all of them are as harmful to the stomach as aspirin. Ideal for them are paracetamol preparations that do not inhibit the synthesis of prostaglandins, and therefore do not affect the production of mucus.
Pseudoephedrine not for everyone
Pseudoephedrine is not a pain reliever. It constricts the blood vessels in the mucosa. It reduces swelling, congestion and mucus secretion. Therefore, it is often a component of combined anti-inflammatory, analgesic and antipyretic drugs. The effect of pseudoephedrine is not harmful to the mucosa if you take medication containing it sporadically and for a short time. Its longer use causes ischemia of the mucosa. Don't use pseudoephedrine supplements if you have high blood pressure. By constricting blood vessels, it can cause a dangerous rise in blood pressure.
ImportantDoes it matter what I sip my painkillers with?
There are none, as they do not interact with beverages (e.g. grapefruit juice, milk) or food, except paracetamol. Pectin contained in fruits (currants, gooseberries) weaken its effect. All medications, however, are best washed down with still water. Then you do not have to remember which liquids they must not be combined with. Pain medications should be taken after eating. It is worth remembering this principle. Taking them on an empty stomach increases the risk of gastric mucosa damage.
Sea painkiller
A species of carnivoresnails scale of sea pain (cones) produces a strong poison that kills fish - conotoxin. Its minimal amount relieves severe and difficult to treat neuropathic pain. A large dose can kill a person painlessly, because conotoxin has an anesthetic effect. So far, it can only be administered directly to the spinal cord, because in oral form it is broken down by digestive enzymes and has numerous side effects (e.g. it causes hallucinations). However, research is underway on a synthetic conotoxin devoid of the disadvantages of the natural one. It is a hope for those suffering from chronic neuropathic pain who are not helped by classic painkillers.
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