Analgesics are medications designed to relieve the symptoms of pain. There are a number of different groups of analgesics:

  • Simple analgesics
  • Non steroidal anti inflammatory drugs (NSAIDS)
  • Opioids (opium or morphine –like activity)

There are many different drugs in each group as well as frequent additions, but examples of the most commonly used are:

Simple analgesics such as:

  • Paracetamol (e.g. Brand names – Panadol, Panamax, Herron)
  • Aspirin (e.g. Brand names – Aspro clear, Aspro, Dispirin)

Non steroidal anti-inflammatory drugs such as:

  • Ibuprofen (e.g. brand name -Nurofen)
  • Diclofenac Sodium (e.g. brand name – Voltaren)
  • Naproxen Sodium (e.g. brand name – Naprogesic)

Analgesics

(pain relievers)

Weaker opioids such as:

  • Combinations including codeine phosphate (e.g. brand names – Panadeine, Panadeine forte, Mersyndol, Mersyndol Daystrength, Nurofen plus)
  • Tramadol hydrochloride (e.g. brand names – Tramal, Tramhexal)
  • Dextropropoxyphe hydrochloride & paracetamol (e.g. brand name – Paradex, Di-gesic)

Stronger opioids such as:

  • Morphine sulphate (e.g. brand names – Kapanol, MS Contin, MS Mono)
  • Oxycodone (e.g. brand name- Oxycontin)
  • Pethidine hydrochloride

Tolerance and dependency

Most people can take the simple analgesics and NSAIDS without developing a dependency on these drugs.

With opioids, in the longer term, however, people may develop a tolerance to the medications resulting in a reduction of efficacy. With tolerance comes breakthrough withdrawal, which can be worse than the pain which occasioned the use of analgesics initially. A typical example of this is analgesic rebound headaches which can result in the patient taking more pills to reduce the ever increasing pain – resulting in a chronic headache which becomes difficult to treat.

Chronic pain of any type is difficult to treat because of the effect of tolerance. It is considered that all long term users of opioids will develop physical dependence and it is, therefore essential that the amount of medication is not increased beyond certain limits.

Some problems with analgesic use

  • Paracetamol – in recommended daily doses, even used long term, it is relatively harmless. In large doses it is harmful to the liver and kidneys and in rare cases can cause heart failure. It also has the potential to damage auditory nerves.
  • Aspirin – is not recommended for children, pregnant women, asthmatics or those susceptible to stomach ulcers. In large doses it can be harmful to the kidneys.
  • NSAIDS – in people already at risk, large doses can increase the risk of life-threatening heart or circulation problems, including heart attack or stroke. Prolonged use increases this risk. With prolonged use, there is potential for serious harm to the gastrointestinal system, including ulcers, bleeding or perforation. These conditions can be fatal and gastrointestinal effects can occur without warning at any time while taking NSAIDS. Older adults may have an even greater risk of these serious gastrointestinal side effects. Prolonged use can also affect the kidneys.