Drugs used to treat mild pain There are two main drug types used to treat mild pain – acet- aminophen and non-steroidal anti-inflammatory drugs (NSAIDs). These drugs are most effective in musculoskeletal pains and pain due to underlying inflammatory processes. Acetaminophen Acetaminophen is a widely used baseline analgesic drug. It can be obtained by prescription as well as over-the-counter (OTC). Dur- ing an injury, chemical substances such as prostaglandins are being released into the bloodstream. These prostaglandins provoke pain response in the human body. Acetaminophen hinders the produc- tion of prostaglandins; thereby reduce the pain caused by the in- jury. Alternatively, acetaminophen acts upon the thermoregulatory area of the brain and lowers the body temperature [18] . Acetaminophen is available in various forms such as tablets, cap- sules, oral suspension, and suppositories. In some cases, it is com - bined with other drugs to enhance the effectiveness (e.g., Tylox, a more powerful pain reliever, is a combination of acetaminophen and oxycodone). Side effects of acetaminophen are very minimal compared with other drugs. However, there can be serious overdose reactions (e.g., hepatotoxicity, seizures, coma, and even death). Liver failure may result from long-term acetaminophen use. Table 1: Indications and Side Effects in Commonly Used NSAIDs Drug Dosage Indications
Non-steroidal anti-inflammatory drugs (NSAIDs) NSAIDs provide pain relief and help reduce erythema, edema, and fever. Sprains, strains, headaches, joint pains (e.g., rheuma- toid arthritis, osteoarthritis), and some infections can be treated by NSAIDs. These drugs block cyclooxyganase (COX) enzymes, specifically COX-2 enzymes, which promote pain and the inflammatory pro- cess by producing prostaglandins. Although they can provide pain relief, COX-2 inhibitors may lead to other health complica- tions like indigestion and stomach ulcers. They may also induce the risk of cardiac diseases [19] . As the dosage of a drug increases, the effect of that drug pro- gressively decreases by imperceptibly small amounts. This is the ceiling effect. When considering NSAIDs, the ceiling effect can be helpful because, though the drug dosage is increased, the anal- gesic effect does not change. Additionally, the severity of side ef- fects and the risk of overdose increase with the increased dosage. NSAIDs cannot be used in pregnant or breast-feeding women, nor in patients with kidney disease, liver disease, and stomach ulcers. The dosage, indications, and side effects of some commonly used NSAIDs are shown in Table 1 [16][19][20] .
Side Effects
• Sensory problems. • Fluid imbalance. • Digestive problems.
• Drowsiness. • Fatigue. • Depression.
Aspirin
650mg (every 4 hours). 975mg (every 6 hours).
• Mild pain. • Fever. • Swollen, red & tender tissues. • Rheumatoid arthritis. • Rheumatic fever. • Mild pain. • Fever. • Swollen, red & tender tissues. • Rheumatoid arthritis. • Back pain. • Gout. • Mild pain. • Fever. • Swollen, red & tender tissues. • Stiff joints.
• Headache. • Dizziness. • Thirst, sweating. • Ringing in the ears. • Blurred vision.
• Ankle swelling. • Numbness in hands & feet. • Abdominal pain.
Ibuprofen (Advil, Motrin)
400–600 mg (every 6 hours).
• Diarrhea or
Naproxen (Aleve, Naprosyn)
250–275 mg. (every 6-8 hours).
• Breathing difficulties. • Confusion. • Constipation. • Sleeping difficulties. • Dizziness. • Drowsiness. • Headaches. • Kidney problems. • Liver problems. • Sweating. • Hypertension. • Nausea & vomiting. • Diarrhea. • Headaches • Dizziness. • Indigestion. • Nausea & vomiting.
constipation. • Bladder irritation & pain. • Insomnia. • Anemia. • Peptic ulcers. • Kidney/liver impairments. • Depression. • Anxiety & paranoia. • Loss of appetite. • Skin problems. • Stomach pain. • Vertigo. • Skin allergies.
Diclofenac (oral). (Voltaren - 1% topical; Pennsaid - 1.5% topical)
50 mg (orally- 2-3 times a day); 32 g/d topical.
• Mild pain. • Fever. • Swollen, red & tender tissues. • Stiff joints.
Drugs used to treat moderate and severe pain Opioids are mostly used to treat moderate to severe pain. They can be combined with adjuvants, drugs that address the symp- toms, and enhance the analgesic effect for specific conditions. Opioids Mild opioids are used to treat moderate pain, whereas strong opi- oids are used for severe pain. Opioids act centrally on the pain-
sensitive areas in the brain and decrease the intensity of signals brought by the afferent pathway of pain. Opioids do not have ceiling effects; therefore, if the dose is in- creased, the analgesic effect is also increased accordingly. The long-term dispensation of opioids may lead to tolerance (the body being capable of bearing the effects of a drug, so that it is less responsive to the drug) and physical dependence (physi-
Page 58
Book Code: PTCA2624
EliteLearning.com/Physical-Therapy
Powered by FlippingBook