Here’s everything you need to know about painkiller

painkiller have been highly valued by doctors and patients since ancient times. With the continuous advancement of medicine and the research of medical workers on painkillers, various types of painkillers have appeared on the market. So what types of painkillers are there? What functions do they have? How to choose painkiller for different types of pain? There are many types of painkillers, and we will introduce them to you one by one.

Category 1

Non-steroidal anti-inflammatory drugs. These are what we generally call antipyretic analgesics. As we can see from the name, this type of drug can not only relieve pain, but also reduce fever. The well-known over-the-counter drugs ibuprofen, diclofenac sodium and acetaminophen belong to this category. This type of substance is added to general compound cold medicines. Not only can it reduce fever, but it can also relieve headaches caused by colds. There is also a category like celecoxib, loxoprofen, and flurbiprofen, which also belong to this category, but they are mainly used for analgesia and anti-inflammation in clinical practice.

Category 2

Central analgesics. Mainly including opioid alkaloids, synthetic analgesics, and other categories.

Opioid alkaloids mainly include morphine, codeine, etc. Synthetic analgesics are a type of analgesics that are artificially synthesized by modifying opioid alkaloids and retaining the configuration of the effective molecular structure, including pethidine (pethidine), tramadol, fentanyl, etc. This type of analgesic is mainly used for moderate to severe pain such as cancer.

The analgesics used clinically are not limited to the above two categories. There are also analgesics specifically used for neuropathic pain such as postherpetic neuralgia and trigeminal neuralgia, such as gabapentin, pregabalin and carbamazepine; analgesics for the treatment of migraines, such as ergotamine and sumatriptan. When treating pain caused by intestinal spasms, we will choose to add scopolamine because it has an antispasmodic effect and can also assist in analgesia. There are also some antidepressants that are ideal drugs for treating neuropathic pain.

You must consult a doctor or pharmacist about how to choose painkiller. Only when the cause of the disease is clear can the right medicine be prescribed.

Should we use painkiller?

When it comes to painkillers, you may have a lot of confusion. For example, should we endure the pain or take medicine? Will painkillers become addictive? How long should we take painkillers? Should we stop taking them when the pain is gone? We will answer them one by one below.

Relieving physical pain is the main function of painkiller. In addition, taking painkiller can also help to alleviate the body’s adverse physiological reactions caused by pain to a certain extent, and prevent acute pain from developing into chronic pain [1]. In other words, taking painkillers is not just for “pain relief”. After the pain occurs, if it is unbearable, you should seek medical attention in time. This is because it is generally difficult for ordinary patients to determine the cause of physical pain, such as abdominal pain, chest pain, and back pain. These pains may be just ordinary muscle pain, or they may be caused by problems with the internal organs, or even the pain manifested by myocardial infarction. If patients take painkiller without understanding the cause of the pain, it may delay the treatment of the disease, and it may also aggravate the condition or even endanger their lives.

Painkillers can eliminate the distress caused by pain, thus improving our life and work conditions, such as headaches caused by colds, or muscle pain caused by excessive exercise.

So, how do we usually choose to treat common pains such as headaches, muscle pain, toothache, and female dysmenorrhea?

1. Headache

Clinically, most pain is secondary. There are many causes of headaches, such as cerebrovascular disease, intracranial infection, trauma, neuralgia, etc. In some cases, clinicians will not use medication simply to relieve headaches. Often, after successful treatment of the cause, the headache will disappear. For example, headaches caused by colds and pain caused by sinusitis will disappear when the cold and sinusitis are cured. However, headaches can sometimes affect the quality of our daily lives and even affect our normal study and work, such as tension headaches and migraines.

Headache caused by cold. Conventional compound cold medicines contain acetaminophen, which we can buy and take on our own. It can not only reduce fever, but also relieve headaches caused by colds.

For tension headaches, we can take some antipyretic and analgesic drugs. The most common ones are acetaminophen, ibuprofen, etc.

For chronic migraine, doctors generally choose antipyretic analgesics (acetaminophen, ibuprofen, etc.), including their combination preparations, such as the combination preparations of ibuprofen and caffeine available on the market, triptan drugs (rizatriptan, etc.), ergotamine drugs, etc. according to the patient’s condition.

For the prevention of chronic migraine, calcium ion antagonists (flunarizine, etc.), antiepileptic drugs (topiramate), antidepressants (amitriptyline, duloxetine), beta-blockers (propranolol, metoprolol, etc.), ion channel blockers (gabapentin, pregabalin, etc.) are generally chosen. Doctors and pharmacists will make a comprehensive evaluation before choosing which one to use in clinical practice.

Tension headaches and chronic headaches cannot be cured at present, but we can effectively prevent and control them. Some patients may have misunderstandings about the medicines prescribed by doctors. For example, why did the pain come back after taking the medicine after a while? They think the doctor’s medical skills are not good; or why did the doctor switch to another triptan painkiller when rizatriptan did not work? This is because one triptan painkiller is ineffective for the patient’s pain, but another triptan painkiller may still be effective for the patient’s pain. For these problems, patients should actively communicate with their doctors and pharmacists. This will allow for better treatment and prevention and improve our quality of life.

2. Muscle pain

There are many causes of muscle pain, such as systemic infection, rheumatic diseases, drug factors, vitamin D deficiency, mental illness, etc., which can cause diffuse muscle pain. For example, adverse reactions caused by statins, ciprofloxacin, and bisphosphonates can cause diffuse muscle pain. If patients experience similar symptoms, they must consult a doctor or pharmacist to effectively choose drugs to avoid further aggravation of the condition.

In daily life, the most common thing is local muscle pain, which is mainly caused by strenuous exercise. For this situation, we can use some external antipyretic analgesics, such as diclofenac diethylamine cream. You can also use some Chinese patent medicines, such as Yunnan Baiyao aerosol, etc.

3. Toothache

It is say that toothache is not a disease, but it can be fatal. Toothache is also a common pain in our daily life. Toothache may be cause by tooth decay, tooth fracture, damage to the dental nerve, gingival inflammation, etc. The most important thing when you have toothache is to seek medical attention in time to find out the cause and treat it. If the pain is unbearable, you can also take some antipyretic analgesics to temporarily relieve the pain.

4. Stomach pain

Stomach pain is more common among young people. Most of them are cause by bad habits such as sleeping late and not eating breakfast on time, working overtime and staying up late to forget to eat dinner, eating supper in groups after get off work, and overeating. Over time, it will cause stomach diseases.

If you experience acute stomach pain, you can take antacids such as aluminum carbonate on your own, but you must seek medical attention immediately after the pain, because these drugs cannot treat stomach diseases, but can only relieve symptoms. Only after a detailed understanding of the condition can the doctor make a detailed and accurate treatment plan.

Here are a few points to explain, or some misunderstandings. In daily life, many people have serious stomach diseases. Which are relieve after taking medicine. But recur after stopping the medicine, so they think that stomach diseases cannot be cure and can only control symptoms. In fact, this idea is wrong. As long as we follow the advice of doctors and pharmacists, eat at regular times and places, and take medicine on time, this includes the dosage and time of taking medicine. Even if you don’t feel pain anymore and feel better, you must continue to take the medicine until you have taken it for the prescribed time. For many stomach diseases, we take medicine for as little as one month and as much as three months to half a year.

5. Dysmenorrhea

The most commonly used drugs for women with dysmenorrhea are antipyretic and analgesic drugs, such as acetaminophen, ibuprofen and diclofenac sodium.

Are painkillers addictive? What are the dangers of long-term abuse of painkillers?

Will taking painkillers be addictive? Opioid painkiller such as morphine and fentanyl are addictive to a certain extent. If you only take them for a short period of time, no matter what type of painkiller you take, you will not be addict. However, if your condition is serious and you really need to use opioid painkillers for a long time, there is indeed a risk of addiction. However, you don’t need to worry too much. As long as you use them reasonably under the guidance of a doctor, the probability of addiction to opioid painkiller is very low. Therefore, we must not use and abuse painkillers on our own.

Like all other drugs, painkillers also have side effects. Different painkillers have different types and severity of side effects. For example, opioid painkillers may cause constipation and vomiting, and long-term use may also increase the risk of addiction. Nonsteroidal anti-inflammatory drugs may cause gastrointestinal damage, etc.

It is particularly important to note that some seemingly commonly used painkillers, such as acetaminophen (paracetamol), can also cause serious liver damage if used in excess (the maximum daily dose for adult Asian men is about 2g). Patients with a history of upper gastrointestinal bleeding and cardiovascular disease need to take them with caution, and it is best not to buy painkillers on their own. Usually, when we take related antipyretic analgesics on our own, we must not take two or more of the same type of drugs at the same time. This will not only fail to increase the efficacy, but will increase the incidence of adverse reactions.

If we don’t feel pain anymore, can we stop taking the medicine? The answer is not necessarily. If we only use antipyretic and analgesic painkillers occasionally, it is fine to stop taking the medicine after the pain disappears. However, if we take painkillers for a long time, especially opioid painkillers, if we stop taking them rashly, it is easy to cause withdrawal reactions, such as nausea and vomiting, rapid heartbeat, abdominal pain and diarrhea, convulsions, chills and other serious adverse reactions. Therefore, if we use painkillers for a long time, we must consult a doctor’s advice before stopping the medicine, and stop taking the medicine gradually under the doctor’s guidance.

In general, the choice of painkillers is a very individual and complex issue that requires comprehensive consideration of many factors. Professional doctors need to make a detailed assessment of each patient’s condition and make a comprehensive decision based on the patient’s personal wishes. Fortunately, many hospitals now have pain clinics that can provide professional advice to help everyone choose painkillers reasonably and better relieve pain.

Which painkiller is right for me for joint pain?

1. Should you use painkillers for joint pain?

In life, many people suffer from joint fever, pain, and swelling. So when these symptoms occur, should painkiller be use? Before answering this question, let us first understand the causes of joint pain: osteoarthritis, gouty arthritis, rheumatism and rheumatoid arthritis, ankylosing spondylitis and other diseases are the main causes of joint pain1. Different medications should be use for joint pain of different causes. For the most common osteoarthritis in life, our treatment goals are to relieve pain, correct deformities, improve or restore joint function, and improve the patient’s quality of life. The overall treatment principle is to choose stepped and individualized treatment according to the individual patient’s situation. First, basic treatment, then drug treatment, and finally restorative and reconstructive treatment.

The basic treatment is to educate patients to change their bad living and working habits, do more exercise, mainly some low-intensity aerobic exercise, training of muscle strength around joints, etc., and also avoid strenuous exercise such as long-term running, jumping, climbing stairs, climbing mountains, etc.)

When the patient’s condition worsens, drug treatment can be consider. We have a lot of drugs to choose from, including local or systemic non-steroidal anti-inflammatory drugs, intra-articular injections, slow-acting drugs for relieving osteoarthritis, anti-anxiety drugs and Chinese patent medicines.

If the condition worsens further, surgical treatment is require if basic treatment and drug treatment are ineffective.

In short, once you suffer from osteoarthritis, you must seek timely treatment to avoid delaying and worsening the condition.

2. What does drug treatment include?

Take the drug treatment of osteoarthritis as an example: according to the location and degree of the patient’s lesions, non-steroidal anti-inflammatory drugs are mainly use clinically, including external patches and oral medications. We usually give priority to local topical medications because they can quickly and effectively relieve mild to moderate joint pain, and their adverse reactions are mild. Only a few patients will experience some local adverse reactions such as rashes.

There are many choices for oral non-steroidal anti-inflammatory drugs, such as ibuprofen, diclofenac sodium, loxoprofen, etc. However, you must follow the doctor’s instructions during medication and cannot use them at will. Doctors and pharmacists will develop individualized dosing plans based on each person’s situation before using the drug. During medication, you should also always pay attention to the risks of some medical diseases. Nowadays, some new drugs and preparations have emerged to avoid the occurrence of some adverse reactions. For example, traditional non-steroidal anti-inflammatory drugs can achieve the same or similar blood drug concentrations as oral administration through new transdermal drug delivery technology, even if used externally. There are also some new drugs, such as celecoxib, etoricoxib, etc., which greatly reduce the irritation to the stomach compared with traditional non-steroidal anti-inflammatory drugs.

During the treatment process, there will be a very small number of patients who are refractory to or intolerant of non-steroidal anti-inflammatory drugs. At this time, it is generally necessary to carefully select some opioid analgesics, including combination preparations of acetaminophen and opioids.

In addition to the topical and oral nonsteroidal anti-inflammatory drugs mentioned above, osteoarthritis also includes some intra-articular injection drugs, anti-anxiety drugs, slow-acting drugs to relieve arthritis symptoms, and finally surgical treatment.

Who should not take painkiller?

People are often torture by painful diseases, such as headaches, toothaches, stomachaches, menstrual cramps, etc. Therefore, painkillers are a must-have in almost every household, and some patients tend to take the attitude of “stop when there is pain.” However, painkillers themselves have many side effects and should not be take casually; taking painkillers for some pains may mask the true condition. So, which groups of people are not suitable for taking painkillers? The following groups of people should be cautious when taking painkillers:

1. Patients who are allergic to aspirin (aspirin asthma) are strictly prohibit from using any nonsteroidal anti-inflammatory drugs.

2. Patients with cardiovascular disease Nonsteroidal anti-inflammatory drugs, such as ibuprofen, naproxen and diclofenac, are often consider harmless, but many clinical studies have found that such drugs can greatly increase the risk of myocardial infarction, heart failure and stroke. Nonsteroidal anti-inflammatory drugs are generally believe to affect platelet aggregation, which in turn leads to arterial constriction, increased edema and increased blood pressure. Therefore, patients with cardiovascular disease or those with cardiovascular risk factors should try to avoid the use of nonsteroidal anti-inflammatory drugs.

2. Pregnancy and lactation. The most common indications for painkillers are headaches and musculoskeletal pain. We do not recommend the use of nonsteroidal anti-inflammatory drugs for analgesia in pregnant women (acetaminophen can be use for a short period of time after weighing the pros and cons in the early stage). Especially in the middle and late stages, it is strictly forbid to use any nonsteroidal anti-inflammatory drugs (causing premature closure of arterial blood vessels). Acetaminophen is generally the first choice for lactating women, which is the drug with the most existing safety evidence.

3. Patients with gastric disease. Taking non-steroidal anti-inflammatory drugs for pain relief is undoubtedly worse for patients with gastric disease. Because non-steroidal anti-inflammatory drugs are very irritating to the gastric mucosa, they will cause damage to the gastric mucosa after being ingest, causing the gastric disease to worsen. Therefore, friends with gastric disease are best not to take painkillers. If a patient with gastric disease needs to take non-steroidal anti-inflammatory drugs for pain relief due to other reasons, clinicians generally choose COX-2 inhibitors such as…, and give acid-suppressing drugs to protect the stomach.

4. Patients who are taking anticoagulants. Anticoagulants are widely use in the prevention and treatment of diseases. If a patient is taking anticoagulants, the doctor and pharmacist will assess the patient’s bleeding risk. If the patient’s bleeding risk is too high, the combination of nonsteroidal anti-inflammatory drugs and anticoagulants is not recommend.

5. Patients who are currently taking hormone drugs.

Patients with rheumatic diseases, autoimmune diseases, and allergic diseases such as allergic rhinitis, eczema, and asthma generally improve their condition by using hormonal drugs. Oral or injected glucocorticoids increase the risk of gastrointestinal adverse reactions, so their combined use with nonsteroidal anti-inflammatory drugs will further increase the incidence of gastrointestinal adverse reactions (4 times that of nonsteroidal anti-inflammatory drugs used alone), and severe cases may cause gastric perforation, etc.

6. The elderly and patients with liver and kidney dysfunction should use it with caution. Patients with severe liver and kidney dysfunction are prohibit to use it.

Elderly people who use NSAIDs are at increased risk of serious cardiovascular, gastrointestinal, and renal adverse reactions. People over 60 years old cannot purchase and take related drugs on their own and must use them with caution under the guidance of a doctor or pharmacist. Patients with renal insufficiency should also consult a doctor and pharmacist, because NSAIDs themselves have potential adverse renal reactions, and taking this drug may further aggravate the kidney condition. Patients with liver insufficiency should also take this drug with caution.

Which drugs should not be take together with painkillers?

NSAIDs interact with many drugs, and each drug has different interactions. Many patients with chronic diseases, especially the elderly, also take many other drugs or supplements at the same time. Some drugs or supplements may cross-react with the ingredients of painkiller, affecting the liver’s degradation function of other drugs and analgesics, increasing side effects and adverse reactions. So, which drugs should not be taken with painkiller? We mainly need to grasp the following points:

1. Avoid blindly taking different painkiller together. Taking different painkillers together can easily lead to risks due to overdose.

2. Cold medicines, antipyretics and antipyretic analgesics all contain acetaminophen (paracetamol). Taking them at the same time will cause excessive intake of paracetamol, causing acute liver damage, and in severe cases, liver failure or even death.

3. We usually use a lot of ibuprofen, which cannot be use with anticoagulants (warfarin), antiplatelet drugs (aspirin), and certain antidepressants (SSRIs, SNRIs). Co-use will increase the risk of bleeding. It cannot be use with digoxin, methotrexate, and oral hypoglycemic drugs, as it will increase the blood concentration of these drugs (digoxin may cause poisoning, and hypoglycemic drugs may cause hypoglycemia). It cannot be use with antihypertensive drugs such as ACEI (prils, such as pertopril) and ARB (sartans, losartan, valsartan, etc.), as it may cause hypotension.