PAIN KILLERS

Pain killers are normally divided into two groups: the narcotic pain killers and the non narcotic pain killers. This classification excludes the anti epileptic group of drugs which are helpful in the management of neuralgic pain. It also excludes the antidepressant group of drugs which in high doses have a pain killing effect of their own.

The non narcotic pain killers can be roughly divided into the Aspirin like NSAID group of drugs and Paracetamol. Because of the propensity of the NSAIDS to produce gastric bleeding and ulceration, there is little good reason for not using Paracetamol for mild to moderate pain, whatever the cause.

When severe pain is the presenting symptom it is well to remember the pyramidal response to the process of pain. At the base of the pyramid is Paracetamol. In rare cases of severe arthritis the NSAIDS may better function as the baseline response. If more analgesia is required, further levels are added to the pyramid. The base should not be removed. It is expected to remain.

When greater relief is needed narcotic pain killers are added on top of the Paracetamol or the NSAIDS. Initially the combination may be one such as Paracetamol and Codeine as seen in Panadene, Dymadon Co, Panamax Co etc. If severe pain persists, a more potent narcotic like Morphine becomes preferable. Morphine can be given in tablet form or as a syrup which ever the patient prefers. The need to use Morphine fourth hourly has been overcome by the provision of a twice daily formulation.

If severe pain persists in the face of Paracetamol, Codeine and Morphine the time has come to add an antidepressant. 75 milligrams of Tryptanol or Sinequan at the tip of the pyramid adds the crowning analgesic effect. The antidepressants and major tranquillizers also act through the central nervous system to potentiate the action of Morphine and other narcotic pain relievers. Adjusting the dose of Morphine and the tricyclic antidepressant will provide relief for nearly all forms of ongoing, severe pain. In the few cases where relief is elusive surgical options remain to be explored.