Medications for Pain Relief
Pain treatment is often associated with medication, and especially in UK. And that you may need medical help is quite obvious. However, in a chronic illness – which pain is usually – and when there is no curative medication, one has to think differently than medication in order to cure or prevent future deterioration.
Medication for long-term pain may at best be soothing; The inconvenience decreases to make you feel better when taking the medicine. But there is no medicine that will make you healthy so that you can manage without medicine, such as for example. an infection, and there is also no medicine that protects against future deterioration such as blood pressure medications do. Long-lasting pain is also not a disease that affects the life expectancy, so you have to think about possible side effects of long-term medication in a different way than for example. a cancer disease.
This means that long-term pain medication has to be handled in a different way. However, there are several different types of medicines that can alleviate inconvenience and improve quality of life, provided it is valued against risks and side effects.
Paracetamol (alvedon, panodil, pamol) is an analgesic medicine that is often insufficient. The advantage is that in the correct dose (ie max 4 grams per day or slightly lower if you have other diseases) they can alleviate the pain somewhat and completely without side effects. Overdose of paracetamol does not increase pain relief but can cause liver damage, especially if combined with alcohol.
NSAIDs (diclofenac, ipren, pronaxen, magnecyl, treo, mm, mm) are medicines that alleviate tissue pain and suppress inflammation by affecting substances called prostaglandins. In the right dose you often have no side effects, but if you have sensitive stomachs, they may trigger gastric ulcers and increased risk of bleeding. And they can – especially in the elderly and in people with a tendency to heart failure – cause extra fluid to accumulate, which increases blood pressure and increases heart stress.
Paraflex is the only variant of muscle relaxant medicine we have today. It works in the brain, which makes you tired of it. It does not have its own analgesic effect, but it enhances the analgesic effect of other medicines. It can therefore be combined with nsaid preparations, with paracetamol and with different opioids.
Opioids – that which is usually called ‘morphine preparations’ is made up of two types: partial agonists or complete agonists. The difference between these is that the partial agonists have an effect, which means increasing the dose in addition to this, there is no increased effect but only increased side effects. Today, there are three partial agonists available: tramadol, tapentadol (palexia) and buprenorphine (norspan)
Tramadol is a so-called dirty preparation. This means that it causes pain relief to maxdos in the same way as morphine, but it also affects the noradrenaline system in the brain. The risk of dependence is significant for tramadol, but appears to be very individual. Probably, it is likely to be linked to the effects on the noradrenaline system. The maximum dose of tramadol is 400 mg per day. Doses over it only give side effects and no positive effects.
This is a development of tramadol, with stronger pain relievers.
This is also a partial opioid agonist that both pain relieves through certain mechanisms while inhibiting morphine’s effects in other parts. May often work well in elderly patients. The dosage with patches is good as it provides an even concentration, but it can also be difficult to titrate at the same time.
The advantage of pure opioids is that they have no thanks; In a cancer disease where pain only increases you can continue and increase the dose at the same rate anyway. The disadvantage of them is that there is an acute risk of breathing if you overdose. In addition, they give fatigue and there is a risk of addiction especially if you overdose. Even at the right dose, where the pain is only reduced to tolerable levels, there are some important side effects that become extra clear in long-term pain: constipation and affect on the autonomic (self-governing) nervous system.
Codein (Included in Citodon and Panocod)
Codeine is not an opioid in itself, but in the body, codeine is converted to morphine. Conversely, the effect becomes slower than pure morphine, which reduces the risk of addiction. Another advantage is that it is good to combine codeine with pure opioids without the risk that the drugs will counteract each other, such as mixing tramadol with a pure opioid. However, not all people have the enzyme needed to convert codeine to morphine. If you miss it, you will not get any pain relief at all by code.