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Medically known as analgesics, these are medications used for the relief of pain. Depending on the severity of the pain, different painkillers will be helpful. There are four different types of painkillers, namely opioid, non-opioid, non-steroidal anti-inflammatory (NSAID), and compound options.

For mild to moderate pain, non-opioids and anti-inflammatory options are recommended; and for moderate to severe pain, opioids and compound pain treatments are recommended. It is important to know the severity of the pain before using any of the analgesics.

Pain meds come in different forms such as capsules or tablets, suppositories (through the rectum), and injections. The different painkiller types work in similar ways, for example, NSAIDs and non-opioids are said to block cyclo-oxygenase (COX) enzymes, which produces a chemical called prostaglandins (produces pain and inflammation) in order to relieve pain. While opioids work by binding to receptors in the central nervous system and gut in order to treat pain.

Side-effects of these analgesics range from short-term to long-term. Common short-term effects include drowsiness, dizziness, constipation, and stomach aches, among others. These effects usually last for the period of administration of the therapeutic and discontinue when the medication is not being used. Long-term side effects include heart, kidney, or lung problems, dependency, and addiction, among others.

These effects are only experienced if the patient prolongs the use of the analgesic. The type of analgesic a doctor will prescribe will depend on the severity of the pain, possible side effect, patient’s medical history, and any co-morbid ailments present.

This article aims to discuss the four painkiller types, common brand names, side effects as well as other relevant information.

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Opioid painkillers

According to Rosenblum A. et al. (2008), the word “opioid” or “opiate” derives from the opium poppy plant and describes the substance derived from the plant. This plant had been used for centuries for the treatment of pain and other conditions.

Today, opioids are regarded as one of the most strongest and effective treatments for acute pain, severe pain, and even mental illnesses. Opioids consist of synthetic opiates (such as fentanyl) and semi-synthetic opiates (such as heroin from morphine) (Rosenblum, 2008).

Opioid pain treatments are only recommended for moderate to severe pain. They work by interacting with the gut, receptors in the brain, spinal cord as well as other parts of the body. This medication relieves pain by increasing tolerance and decreasing the sensation of pain. Doctors may only prescribe opioids if the pain is severe or other medication was tested and did not work. This medication is usually prescribed after surgery, for cancer patients, severe injuries, or rheumatoid arthritis.

This therapeutic is divided into weak opioids (such as codeine and dihydrocodeine) and strong opioids (such as morphine, tramadol, fentanyl, and pethidine). Strong opioids are at least ten times stronger than weak opioids. The short-term side effects of this therapeutic are nausea, constipation, and drowsiness. The more serious side effects are dependency (if prolonged use) and withdrawal symptoms after discontinuation of the medication.

Non-opioid painkillers

Non-opioid analgesics are also used for the treatment of pain and are available at supermarkets, and over-the-counter (OTC), however, some do require a prescription. This therapeutic is most commonly used to treat mild to moderate pain such as headaches, osteoarthritis, and small injuries.  They are available in different forms such as oral medication, suppositories, gels, patches, creams, and sprays.

Common examples of non-opioid pain meds include paracetamol, aspirin, anticonvulsants, and gabapentin, among others. This occurs when a patient is not fully satisfied with the low dosage or the effects lasting a short period of time, therefore, they may medicate even more.

These low-dose opioids may be used to treat moderate to severe pain, especially after surgery, however, this increases the risk of dependency and addiction.  In a randomized clinical trial conducted, it was found that non-opioid medication serves just as well as opioids in the emergency department, relieving the extremity of pain experienced by some patients.  Non-opioids may also interact with non-steroidal anti-inflammatory (NSAID) medication and in some cases opioids to provide greater relief of pain.

The most common short-term side effects of this medication are nausea, dizziness, drowsiness, increased BP, and dry mouth. Long-term side effects due to prolong use include liver damage, gastrointestinal bleeding, and stroke.

Note: Following the recommended usage and dosage guidelines minimize any risks and maximize the intended benefits of the pain treatment.

Anti-inflammatory types of painkillers

These are also referred to as non-steroidal anti-inflammatory (NSAID). This type of analgesic is available over-the-counter, although a prescription is needed for some. This medication is used to decrease inflammation and relieve pain, especially long-term pain (like arthritis).

This medication has 20 different types and may be sold under brand names; a few examples are ibuprofen, indomethacin, naproxen, and diclofenac among 20 other NSAIDs.  Celecoxib and etoricoxib are the newest types of NSAID.

NSAID’s should not be taken together with aspirin or other NSAIDs as this may increase the risk of side effects. This analgesic should also not be taken over a long period of time unless advised by a doctor due to a small increase in the risk of heart attacks and strokes.

The side effects include stomach ulcers and aches, drowsiness, dizziness, and diarrhea. Individuals who are over 65 years old, smokers, on other medication (especially aspirin), pregnant or breastfeeding, or who have heart or liver problems are advised to use NSAIDs with caution or, if possible, to not use at all.

Compound painkillers

As the name suggests, this involves a combination of two different types of medication (usually regular painkillers and a low dose of opioids). This medication is used for mild to moderate pain for headaches, osteoarthritis, and injuries. Strong types of this medication will require a prescription, while less strong types are available over-the-counter. Examples include:

  • Co-codaprine: This is a combination of codeine and aspirin and is only available on prescription. The short-term side effects are indigestion, drowsiness, constipation, and heartburn.
  • Co-dydramol: Painkiller types here offer a unique combination – in this case, it consists of paracetamol and dihydrocodeine. Short-term side effects are nausea, constipation, and drowsiness, while long-term side effects include heart, kidney or lung complications.
  • Co-codamol: This is a combination of paracetamol and codeine which can be bought OTC or on prescription. The short-term side effects of this compound are drowsiness, dizziness, and constipation. Long-term side-effects include heart, lung, and kidney complications.