Abstract Paracetamol is one of the most commonly used legal drugs in the western world. Substances Analgesics, Non-Narcotic Acetaminophen.
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Use of an oral contraceptive prevents the pain of dysmenorrhoea which is generally associated with ovulatory cycles. The vomiting and severe pain associated with dysmenorrhoea in women with endometriosis may call for an antiemetic in addition to an analgesic. Antispasmodics such as alverine citrate have been advocated for dysmenorrhoea but the antispasmodic action does not generally provide significant relief.
Aspirin is indicated for headache, transient musculoskeletal pain, dysmenorrhoea, and pyrexia. In inflammatory conditions, most physicians prefer anti-inflammatory treatment with another NSAID which may be better tolerated and more convenient for the patient. Aspirin is used increasingly for its antiplatelet properties.
Aspirin tablets or dispersible aspirin tablets are adequate for most purposes as they act rapidly. Gastric irritation may be a problem; it is minimised by taking the dose after food. Enteric-coated preparations are available, but have a slow onset of action and are therefore unsuitable for single-dose analgesic use though their prolonged action may be useful for night pain.
Aspirin interacts significantly with a number of other drugs and its interaction with warfarin sodium is a special hazard. Paracetamol is similar in efficacy to aspirin , but has no demonstrable anti-inflammatory activity; it is less irritant to the stomach and for that reason is now generally preferred to aspirin , particularly in the elderly.
Overdosage with paracetamol is particularly dangerous as it may cause hepatic damage which is sometimes not apparent for 4 to 6 days. Nefopam hydrochloride may have a place in the relief of persistent pain unresponsive to other non-opioid analgesics. It causes little or no respiratory depression, but sympathomimetic and antimuscarinic side-effects may be troublesome.
Non-steroidal anti-inflammatory analgesics NSAIDs are particularly useful for the treatment of patients with chronic disease accompanied by pain and inflammation. Some of them are also used in the short-term treatment of mild to moderate pain including transient musculoskeletal pain but paracetamol is now often preferred, particularly in the elderly. They are also suitable for the relief of pain in dysmenorrhoea and to treat pain caused by secondary bone tumours , many of which produce lysis of bone and release prostaglandins.
Selective inhibitors of cyclo-oxygenase-2 may be used in preference to non-selective NSAIDs for patients at high risk of developing serious gastro-intestinal side-effects. Compound analgesic preparations that contain a simple analgesic such as aspirin or paracetamol with an opioid component reduce the scope for effective titration of the individual components in the management of pain of varying intensity. Compound analgesic preparations containing paracetamol or aspirin with a low dose of an opioid analgesic e.
The low dose of the opioid may be enough to cause opioid side-effects in particular, constipation and can complicate the treatment of overdosage yet may not provide significant additional relief of pain.
A full dose of the opioid component e. Important : the elderly are particularly susceptible to opioid side-effects and should receive lower doses. In general, when assessing pain, it is necessary to weigh up carefully whether there is a need for a non-opioid and an opioid analgesic to be taken simultaneously. Caffeine is a weak stimulant that is often included, in small doses, in analgesic preparations.
It is claimed that the addition of caffeine may enhance the analgesic effect, but the alerting effect, mild habit-forming effect and possible provocation of headache may not always be desirable.
Moreover, in excessive dosage or on withdrawal caffeine may itself induce headache. Co-proxamol tablets dextropropoxyphene in combination with paracetamol are no longer licensed because of safety concerns, particularly toxicity in overdose. Co-proxamol tablets [unlicensed] may still be prescribed for patients who find it difficult to change, because alternatives are not effective or suitable.
Opioid analgesics are usually used to relieve moderate to severe pain particularly of visceral origin.
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