Analgesics are medications that can reduce or eliminate pain. There are narcotic and non-narcotic analgesics. Narcotic painkillers are prescribed extremely rarely for certain indications. But we often resort to using non-narcotic analgesics if we are bothered by pain.

Features of narcotic analgesics

Narcotic painkillers inhibit the structures of the central nervous system, perceiving pain. This group of drugs is represented by opioid receptor agonists: morphine, promedol, codeine, fentanyl and others.

This group of drugs has a strong analgesic effect. However, narcotic analgesics affect not only the pain center, but also other parts of the central nervous system. Thus, these drugs depress the respiratory, cough, vasomotor, and thermoregulatory centers. In addition, a person’s behavior is disrupted due to decreased self-control. Dependence on narcotic analgesics and, as a consequence, drug addiction develops.

Important! Given the wide range of side effects, as well as the risk of developing drug dependence, narcotic analgesics can only be used when prescribed by a doctor.

These drugs are mainly used for acute, life threatening human pain, as well as in pain syndrome due to inoperable malignant neoplasms.

Features of non-narcotic analgesics

Non-narcotic pain medications reduce the severity of pain and do not affect other structures of the nervous system. The mechanism of their action is based on reducing the excitability of the subcortical pain center, increasing the threshold of its pain sensitivity, and inhibiting the synthesis of prostaglandins - mediators of inflammation. Thanks to this multicomponent action, non-narcotic analgesics have not only analgesic, but also anti-inflammatory and antipyretic effects.

Non-narcotic painkillers have a less pronounced analgesic effect compared to narcotic drugs. However, their action is sufficient to relieve muscle pain that we often encounter. The main advantage of non-narcotic painkillers is the absence of drug dependence on them. It is due to these properties that non-narcotic analgesics are widely used in medicine.

The use of non-narcotic analgesics may be accompanied by the development of side effects:

• Ulcerogenic effect (ulceration of the gastric mucosa, duodenum);
• Nephro- and hepatotoxicity.

The main contraindications to the use of medications from this drug group are peptic ulcer, blood coagulation disorders, liver disease, pregnancy, lactation.

note : in the annotations for many painkillers, manufacturers indicate that joint use Contraindicated with other analgesics. This is fraught with the occurrence of undesirable clinical effects.

Popular painkillers

The group of non-narcotic analgesics is represented by a wide variety synthetic drugs. The following non-narcotic analgesics are distinguished depending on their origin:

1. Derivatives salicylic acid: ;
2. Aniline derivatives: , phenacetin;
3. Derivatives of alkanoic acids: , diclofenac sodium;
4. Pyrazolone derivatives: butadione, analgin;
5. Anthranilic acid derivatives: mefenamic acid;
6. Others: piroxicam, dimexide.

In addition, many pharmaceuticals now they offer combined medications, which contain several drugs at once.

Analgin

This drug is known to everyone; it was synthesized in 1920. And although metamizole sodium (analgin) belongs to the group of NSAIDs, its anti-inflammatory and antipyretic effects are insignificantly expressed. But analgin has a pronounced analgesic effect.

Analgin is rapidly absorbed from gastrointestinal tract, therefore the analgesic effect occurs quickly, although it does not last very long. Analgin is used for muscle, menstrual pain,.

Important!A dangerous side effect of Analgin is the development of agranulocytosis. This pathological condition, which is characterized by a critical decrease in the level of leukocytes due to granulocytes and monocytes, ultimately increasing the body’s susceptibility to all kinds of infections. Because of this, Analgin was withdrawn from circulation in many countries. The risk of agranulocytosis when using Analgin is estimated at 0.2-2 cases per million.

Aspirin

Acetylsalicylic acid () is used not only as an analgesic and anti-inflammatory agent. The drug inhibits platelet aggregation, which is why it is used for the prevention of c. However, it is necessary to take into account the fact that if there is a blood clotting disorder (in particular with), bleeding may occur.

Aspirin is not recommended for use in children, especially if a viral infection is suspected. When using aspirin in this case, there is a risk of developing Reye's syndrome. The disease is characterized by rapidly progressing encephalopathy and fatty liver. The mortality rate in children with Reye's syndrome is approximately 20-30%.

It is also important to consider that with prolonged, uncontrolled use of aspirin, ulceration of the mucous membrane of the stomach and intestines occurs, as well as gastric bleeding. To reduce the ulcerogenic effect, aspirin should be taken after meals.

Ketanov

Ketanov (ketorolac) is a non-narcotic analgesic from the group of acetic acid derivatives. Ketanov is produced in the form of tablets, as well as a solution for intramuscular injection. After intramuscular injection Ketanov solution and after taking the tablet, the analgesic effect is observed after half an hour and an hour, respectively. And the maximum effect is achieved after one to two hours.

Ketanov has a pronounced analgesic effect, exceeding the effect of other non-narcotic painkillers. Therefore, it is not surprising that many people with severe dental pain and headaches manage to get rid of unpleasant sensations only with the help of Ketanov.

In addition to the traditional side effects of non-narcotic analgesics, when using Ketanov, side effects from the central nervous system (drowsiness, etc.) may occur. Therefore, when using Ketanov, it is recommended to avoid driving a car.

Dolaren

This is a combination drug that also contains diclofenac sodium. Both of these medicinal substances enhance the effect of each other. After consuming Dolaren tablets, the maximum concentration of active ingredients is achieved after an hour and a half. Many people note the pronounced analgesic effect of Dolaren in comparison with other non-narcotic painkillers.

Dolaren is used for all kinds of diseases of the musculoskeletal system, as well as pain syndrome of any origin. The use of Dolaren will have to be abandoned in the presence of a hypersensitivity reaction to any NSAIDs, in the period after surgery, liver and ulcerative defects of the gastrointestinal tract, gastric bleeding. In addition, the drug is used with caution if a person has chronic and.

Nimesil

The active ingredient of the drug is nimesulide, an NSAID from the sulfonamide class. Nimesil is available in the form of powder packets. The contents of the sachet must be dissolved in a glass with one hundred milliliters of water.

Analgesics (analgetica; Greek negative prefix a- + algos)

Traditionally, a distinction is made between narcotic and non-narcotic A. s. Narcotic A. s. characterized by high analgesic activity - they are effective for very intense pain; have an impact on the emotional sphere - they cause euphoria, general well-being, and reduce a critical attitude towards the environment. With prolonged use, drug dependence may develop (Drug dependence). Some drugs in this group can cause dysphoria. Most of them (especially in high doses) are depressing.

Non-narcotic A. s. the severity of the analgesic effect is inferior to narcotic ones; they are less effective for intense pain (for example, for pain associated with myocardial infarction and malignant neoplasms, trauma, postoperative pain). Their analgesic effect manifests itself mainly in pain associated with inflammatory processes, especially in joints, muscles, and nerve trunks. Non-narcotic A. s. do not cause euphoria, drug dependence, and do not depress breathing.

Narcotic analgesics include morphine and related drugs (opiates) and synthetic compounds with opiate-like properties (opioids). In the medical literature, both opiates and opiate-like compounds are often referred to as opioid analgesics. The pharmacological effects of narcotic analgesics are due to interaction with opiate receptors in the central nervous system. and peripheral tissues. Morphine, trimeperidine (Promedol), fentanyl, sufentanil, alfentanil, pyritramide, tilidine, dihydrocodeine constitute a group of full opiate receptor agonists, showing the greatest affinity for mu receptors. By binding to opiate receptors, these drugs cause physiological effects characteristic of endogenous ligands (enkephalins, endorphins). Butorphanol, nalbuphine, pentazocine belong to the group of agonists-antagonists of opiate receptors (thus, pentazocine and nalbuphine exhibit antagonistic properties towards mu receptors, agonistic properties towards kappa receptors). Buprenorphine is a partial opiate receptor agonist that interacts with mu and kappa receptors. Tramadol is a narcotic analgesic with a mixed mechanism of action; it is a pure agonist of the opiate mu, delta and kappa receptors with a higher affinity for the mu receptors. In addition, the analgesic effect of this drug is associated with inhibition of norepinephrine reuptake in neurons and enhancement of the serotonergic response. Various effects narcotic analgesics are associated with stimulation of different subtypes of opiate receptors.

Morphine is one of the alkaloids of opium, an air-dried milky juice released from cuts in the unripe pods of the sleeping pill poppy. The main effect of morphine is an analgesic effect that develops while maintaining consciousness. may be accompanied mental changes: decreased self-control, increased imagination, in some cases euphoria, sometimes drowsiness.

The analgesic effect of morphine is due to its influence on the interneuronal transmission of impulses to different levels c.s.s. By interacting with opiate receptors located on the presynaptic membrane of thin primary afferents of the spinal cord, morphine reduces the mediators of nociceptive signals (substance P, etc.). As a result of excitation of opiate receptors of the postsynaptic membrane, the latter occurs and, in connection with this, the activity of neurons posterior horn involved in the conduction of pain impulses. In addition, morphine enhances the descending inhibitory effects of a number of structures and medulla oblongata(for example, periaqueductal gray matter, raphe nuclei, etc.) on the spinal cord. Morphine-induced changes in emotional sphere may cause a decrease in the emotionally negative connotation of pain.

Morphine depresses breathing in proportion to the dose administered. In therapeutic doses, it causes a slight decrease in the minute volume of pulmonary ventilation, mainly due to a decrease in respiratory rate, without having a noticeable effect on the inspiratory volume. When exposed to toxic doses of morphine, the volume of pulmonary ventilation is sharply reduced. becomes very rare and superficial, periodic breathing of the Cheyne-Stokes type may develop. Morphine also depresses cough center, thereby providing an antitussive effect. It causes due to the excitation of the centers oculomotor nerves. Sharp constriction of the pupils is a differential diagnostic sign of acute morphine. However, with deep hypoxia, miosis is replaced by mydriasis.

In some cases, morphine, by stimulating the chemoreceptors of the trigger zone of the vomiting center, can cause nausea and vomiting. In this case, morphine has a direct inhibitory effect on the neurons of the vomiting center. There is considerable variation in individual sensitivity to the emetic effects of morphine. In the mechanism of nausea and vomiting during the administration of morphine, vestibular influences apparently play a certain role. For this reason, morphine causes nausea and vomiting much more frequently in ambulatory patients than in bed rest patients.

Under the influence of morphine, smooth muscles increase internal organs, which is due to the interaction of the substance with opiate receptors of smooth muscles. It promotes contraction of the sphincters of the gastrointestinal tract, increasing the tone of the intestinal muscles, up to periodic spasms, accompanied by impaired peristalsis. This leads to a sharp slowdown in the movement of contents through the gastrointestinal tract and, as a result, to a more complete absorption of water in the intestines. In addition, morphine reduces the secretion of gastric and pancreatic juices, as well as bile. That is, the volume of intestinal contents decreases and increases, which further weakens intestinal motility. As a result, it develops, which is also facilitated by the suppression of the normal urge to defecate due to central action morphine.

Acute morphine poisoning is characterized by loss of consciousness, respiratory depression, sharp constriction of the pupils (with asphyxia, the pupils dilate), and a decrease in body temperature. Severe poisoning can result in death as a result of respiratory arrest (see Poisoning). Naloxone or nalorphine are used as antagonists for morphine poisoning (see Antagonists of Narcotic Analgesics).

Omnopon contains a mixture of 5 opium alkaloids - morphine, narcotine, codeine, papaverine and thebaine. Due to the high content of morphine (48-50%), omnopon has all the properties characteristic of this alkaloid and is used for the same indications as morphine. The side effects of omnopon, signs of poisoning and use are similar to those of morphine. morphine omnopon differs in that it has less effect on the smooth muscles of internal organs, because contains alkaloids papaverine and narcotine, which have an antispasmodic effect. In this regard, for pain associated with spasms of smooth muscles, for example, with renal or hepatic colic, omnopon has some advantage over morphine.

Of the codeine preparations, dihydrocodeine is mainly used as an anesthetic. Its analgesic effect is weaker than morphine, but stronger than codeine. When administered orally, the duration of analgesia is 4-5 h. It also has an antitussive effect. It is used for moderate to severe pain, including in the postoperative period, for injuries, and in oncological practice. Side effects: nausea, vomiting, drowsiness. With long-term use, symptoms similar to those that occur when taking codeine are possible. Not recommended for children under 12 years of age.

Trimeperidine, a synthetic derivative of phenylpiperidine, is close to morphine in its analgesic effect and has a less pronounced effect on the smooth tissues of internal organs. for use are the same as for morphine. It is also used for pain relief during childbirth. Side effects (mild nausea, ) are rare. Contraindication for use: respiratory depression, up to 2 years.

Acetylsalicylic acid disrupts platelet aggregation and, as a result, prevents thrombus formation (see Antiplatelet agents). Ketorolac is an NSAID with a pronounced analgesic effect, inhibits platelet aggregation and can increase. Used as A. s. for pain in the postoperative period, for injuries, acute pain in the back and muscles. Butadione is superior to analgin and amidopyrine in analgesic and, especially, anti-inflammatory properties. In addition, butadione is effective against gout (see Antigout drugs).

Side effects of non-narcotic A. s. manifests itself differently. For salicylates and pyrazolone derivatives, side effects from the gastrointestinal tract (nausea, vomiting, abdominal pain) are typical. It is also possible gastrointestinal bleeding and the occurrence of stomach and duodenal ulcers, which is mainly associated with the inhibitory effect of drugs of these groups on the synthesis of prostaglandins in the wall of the stomach and intestines. To prevent these complications, salicylates and pyrazolone derivatives should be taken after meals, the tablets should be crushed and washed down with milk or alkaline mineral water. With prolonged use of salicylates and intoxication with them, it occurs and decreases.

Pyrazolone derivatives inhibit, which is manifested mainly by leukopenia, and in severe cases - agranulocytosis. During treatment with these drugs, it is necessary to periodically examine the cellular composition of the blood. Butadione and amidopyrine can contribute to water retention in the body and the development of edema due to decreased diuresis. The side effects of phenacetin are manifested mainly by methemoglobinemia, anemia and kidney damage, and side effect paracetamol - impaired renal and liver function. Taking ketorolac can lead to dyspepsia, in rare cases, gastritis, erosive and ulcerative lesions of the gastrointestinal tract, impaired liver function, headache, sleep disturbance, edema, etc. All non-narcotic A. s. may cause allergic reactions (, skin rashes and etc.). In case of special high sensitivity patient to certain drugs may develop anaphylactic shock. Acetylsalicylic acid can cause so-called aspirin asthma. If allergic reactions occur, the drug that caused them will be discontinued and antihistamines or others will be prescribed. It should be borne in mind that often to non-narcotic A. s. has a cross-link, for example, to all drugs from pyrazolone or salicylic acid derivatives. In patients with bronchial asthma, salicylates and pyrazolone derivatives can worsen the course of the disease.

Non-narcotic A. s. Contraindicated in case of hypersensitivity to them. In addition, amidopyrine and analgin are not prescribed for hematopoietic disorders, and analgin is not prescribed for bronchospasm. Salicylates are contraindicated for peptic ulcers, decreased blood clotting; butadione - for peptic ulcers, heart failure, disorders heart rate, diseases of the liver, kidneys and hematopoietic organs; paracetamol - for severe liver and kidney dysfunction, glucose-6-phosphate dehydrogenase deficiency, blood diseases; ketorolac - for nasal polyps, angioedema, bronchospasm, bronchial asthma, peptic ulcer, severe liver dysfunction, high risk bleeding, hematopoietic disorders.

The forms of release and use of the main non-narcotic analgesics are described below.

Ketorolac(ketanov, ketorol, nato, toradol, torolac, etc.) - 10 tablets mg; 3% solution for injection in ampoules of 1 and 3 ml (30 mg in 1 ml). Use intramuscularly, intravenously and orally. A single dose for adults with parenteral administration averages 10-30 mg, maximum daily - 90 mg. When taken orally single dose - 10 mg, maximum daily - 40 mg. The drug is administered every 6-8 h. Duration of use is no more than 5 days. Elderly people are prescribed smaller doses, the maximum daily dose for parenteral administration is 60 mg. The dose is also reduced if renal function is impaired. Children are administered only parenterally, a single dose at intramuscular injection - 1 mg/kg, with intravenous - 0.5-1 mg/kg. Duration of use in children is no more than 2 days.

Metamizole sodium(analgin, baralgin M, nebagin, spazdolzin, etc.) - powder; tablets 50; 100; 150 and 500 mg; drops for oral administration in bottles of 20 and 50 ml(in 1 ml 500 mg); 25% and 50% injection solutions in ampoules of 1 and 2 ml(250 and 500 mg in 1 ml); rectal suppositories 100 each; 200 and 250 mg(for children); 650 mg(for adults). Prescribed orally, rectally, intramuscularly, intravenously. Oral or rectal doses for adults are recommended: 250-500 mg 2-3 times a day, for rheumatism - up to 1 G 3 times a day. Children under 1 year of age are usually prescribed 5 doses orally and rectally. mg/kg 3-4 times a day, over 1 year - 25-50 mg for 1 year of life per day. Adults are administered parenterally 1-2 ml 25% or 50% solution 2-3 times a day, children under 1 year - at the rate of 0.01 mg 50% solution for 1 kg body weight, over 1 year - 0.01 ml 50% solution for 1 year of life 1 time per day (no more than 1 ml). Highest single doses for adults when administered orally and rectal use- 1 g, daily - 3 g; with parenteral administration - respectively 1 G and 2 G.

Metamizole sodium is part of many combination drugs containing, along with it (spasmoanalgesics), caffeine, phenobarbital, etc. Thus, baralgin (maxigan, nebalgan, piafen, spazgan, trigan), produced in the form of tablets, solution in ampoules of 5 ml, rectal suppositories, contains analgin, antispasmodic pitofenone and ganglion blocker fenpiverine. Doses of relevant ingredients: tablets - 500 mg; 5 mg and 0.1 mg; solution (5 ml) - 2.5 g; 10 mg and 0.1 mg; in candles - 1 G; 10 mg and 0.1 mg. It is used as an analgesic and antispastic agent, especially for renal, hepatic and intestinal colic, algomenorrhea. Prescribed orally (for adults) 1-2 tablets 2-3 times a day; intramuscularly or intravenously - 5 each ml with repeated administration (if necessary) after 6-8 h.

Andipal tablets include analgin (250 mg), dibazole, papaverine hydrochloride and phenobarbital 20 each mg. They have antispasmodic, vasodilating and analgesic effects. Take mainly for vascular spasms, 1-2 tablets 2-3 times a day.

Pentalgin tablets contain analgin and amidopyrine 300 each mg, codeine (10 mg), caffeine sodium benzoate (50 mg) and phenobarbital (10 mg). Tablets are also available that replace amidopyrine with paracetamol. Take orally as an analgesic and antispasmodic, 1 tablet 1-3 times a day.

Paracetamol(aminadol, acetaminophen, bindard, dolomol, ifimol, calpol, mexalen, pamol, panadol for children, pyrimol, prodol, sanidol, febricet, efferalgan, etc.) - powder; tablets, incl. instant (effervescent) 80; 200; 325 and 500 mg; Chewable tablets for children 80 each mg; capsules and caplets 500 each mg; , mixture, elixir, suspension and solution for oral administration in bottles (120; 125; 150; 160 and 200 mg at 5 ml); rectal suppositories 80 each; 125; 150; 250; 300; 500; 600 mg and 1 G. Prescribed orally for adults, usually 200-400 mg for reception 2-3 times a day. The maximum single dose is 1 g, the daily dose is 4 g. The frequency of administration is up to 4 times a day. The maximum duration of treatment is 5-7 days. Rectally, adults are usually administered 600 mg(up to 1 G) 1-3 times a day.

Single doses of the drug for children when taken orally are on average at the age of 3 months - 1 year - 25-50 mg, 1 year - 6 years - 100-150 mg, 6-12 years - 150-250 mg. The frequency of administration is usually 2-3 times a day (up to 4 times). The duration of treatment is no more than 3 days. For children under 7 years of age, the drug is administered rectally and orally, in the form of a powder dissolved in water or liquid dosage forms. For rectal administration to children under 1 year of age, use suppositories containing 80 mg paracetamol, children 1 year - 3 years - 80-125 mg, 3 years - 12 years - 150-300 mg.

Numerous combination drugs containing, in addition to paracetamol, codeine, caffeine, analgin and others, for example, panadol, proxasan, solpadeine, fervex. Panadol extra - tablets (regular and soluble), include paracetamol (500 mg) and caffeine (65 mg). Adults are prescribed 1-2 tablets 4 times a day, the maximum daily dose is 8 tablets. The interval between doses is at least 4 h. Used for headaches, migraines, myalgia, neuralgia, algomenorrhea, ARVI, etc. Contraindicated in children under 12 years of age.

Proxasan (co-proxamol) - tablets containing paracetamol (325 mg) and the non-narcotic analgesic dextropropoxyphene (32.5 mg). Prescribed to adults for pain of mild to moderate intensity, 2-3 tablets orally 3-4 times a day, up to 8 tablets per day.

Solpadeine - dissolvable tablets containing paracetamol (500 mg), codeine (8 mg) and caffeine (30 mg). Used for headaches, migraines, neuralgia, algomenorrhea, etc. Adults are prescribed 1 tablet, children 7-12 years old - 1/2 tablet per dose. The maximum daily dose for adults is 8 tablets, for children - 4 tablets.

Fervex granulate in sachets (with sugar, without, for children), for the preparation of an oral solution containing paracetamol, ascorbic acid and pheniramine, an antihistamine. Doses of ingredients in sachets for adults - 0.5, respectively G; 0,2 G and 0.025 G, in bags for children - 0.28 G; 0,1 G and 0.01 G. Used as a symptomatic remedy for ARVI, allergic rhinitis. The contents of the sachet are dissolved in water before use. Dosage for adults - 1 sachet 2-3 times a day. Children are prescribed 1 children's sachet per appointment, at the age of 6-10 years 2 times a day, 10-12 years - 3 times, over 12 years - 4 times. The interval between doses is at least 4 h.

Sedalgin- a combined tablet preparation containing codeine phosphate, caffeine, phenacetin, acetylsalicylic acid and phenobarbital, respectively, 0.01 g - (from the Greek analgetos painless) (analgesics, painkillers srva, painkillers srva), lek. in va, weakening or eliminating the feeling of pain. Narcotic A. s. act on thalamic. and other centers of the brain, connecting with the so-called. opiate... ... Chemical encyclopedia

ANALGESICS- (Analgetics), medicinal substances, selectively suppressing pain sensitivity as a result of a direct effect on the central nervous system of A. s. reduce the summative ability of the central nervous system in relation to... ... Veterinary encyclopedic dictionary

Lek. in VA for general anesthesia in humans. Depending on the method of their use, a distinction is made between inhalation and non-inhalation S. d.n. The former include a number of volatile (easily evaporating) liquids and gases. Of liquids most meaning… … Chemical Encyclopedia - I Medicines chemical compounds of natural or synthetic origin and their combinations, used for the treatment, prevention and diagnosis of human and animal diseases. Medicines also include drugs for... ... Medical encyclopedia

Active ingredient ›› Propofol* (Propofol*) Latin name Recofol ATX: ›› N01AX10 Propofol Pharmacological group: Anesthetics Composition and release form Emulsion for intravenous administration 1 mlpropofol 10 mg 20 mg auxiliary... ... Dictionary of medicines

General Systematic n... Wikipedia

- (gr.; see analgia) analgesics, painkillers: narcotic (morphine, promedol, etc.) and non-narcotic (antipyretics, for example, analgin, amidopyrine, etc.). New dictionary foreign words. by EdwART, 2009.… … Dictionary of foreign words of the Russian language

anesthesia- ▲ pain relief, pain relief, pain relief during surgery. numb. anesthesia. anesthetize. artificially induced anesthesia deep dream with loss of pain sensitivity, used for pain relief in medical operations.… … Ideographic Dictionary of the Russian Language

PAIN IN THE LOWER AND LOWER LIMB- According to prevalence, lumbodynia (pain in the lumbar or lumbosacral region) and lumboischialgia (back pain radiating to the legs) are distinguished. For acute intense pain in the lower back, the term “lumbago” (lumbago) is also used.... ... encyclopedic Dictionary in psychology and pedagogy

Content

When a person experiences any physical suffering, he wants to get rid of the pain as quickly as possible. The patient rushes to the nearby pharmacy to choose an effective painkiller, but the range of modern drugs is so huge that it is very difficult to find a medicine.

Analgesics - list of medications

Analgesics are painkillers that can eliminate or reduce pain. Their impact is not accompanied by impaired motor function or loss of consciousness. These painkillers are divided into narcotic (containing morphine) and non-narcotic. The second group of analgesics is divided into several subgroups:

1. Salicylic acid derivatives. These include: , Sodium salicylate.
2. Pyrazolone derivatives. This is Analgin, Amidopyrin.
3. Derivatives propionic acid . These include medications such as Ketoprofen, Ibuprofen.
4. Anthranilic acid derivatives. These are Mefenamic acid, Flufenamic acid.
5. Acetic acid derivatives. The most popular: Indomethacin, Tryptophan.
6. Aniline derivatives (anilides). This is Phenacetin, Paracetamol.

Narcotic painkillers

This is a group of drugs with analgesic action, which reduces the autonomic accompaniment of pain, but causes drug dependence. A narcotic pain reliever may consist of a natural alkaloid (Codeine, Morphine) or a synthetic compound (Fentanyl, Promedol). The most effective analgesics in this group are:

1. . Synthetic alkaloid long acting. Used as an analgesic and in the treatment of opiate or heroin addiction.
2. Omnopon. An opioid combination medicine, which is available in ampoules in the form of a solution. Used for severe pain syndrome of any origin.
3. Morphine. Strong narcotic drug. Released in the form of a solution. Prescribed for severe injuries, heart attack, angina pectoris and other conditions caused by severe pain.
4. Promedol. Semi-synthetic opiate. The solution and tablets are prescribed for severe and moderate pain. It is quickly addictive.

Cheap pain pills

Many people cannot afford to buy their medications at high price. Any pharmacy chain offers a choice of inexpensive painkillers, which also effectively relieve pain of various etiologies. These include:

1. (Mig, Nurofen). Reduces symptoms of the inflammatory process, reduces high temperature bodies. It is especially effective in numbing joints.
2. Paracetamol (Efferalgan, Panadol). Has a pronounced antipyretic effect. Works great for headaches and toothaches.
3. Ortofen (Diclofenac). Reduces swelling, joint pain, quickly reduces inflammatory processes after injuries.

Potent

The most powerful painkillers are the narcotic group. Given the danger of addiction, their independent use is strictly prohibited. Affordable and safe drugs for strong pain relief:

1. . NSAID (antiplatelet agent). It showed excellent results in pain relief during a heart attack and angina pectoris. Prescribed when viral infections.
2. Voltaren. Non-steroidal medicine pronounced anti-inflammatory, antipyretic, analgesic effect.
3. Ibufen. Non-narcotic analgesic. Widely used for acute viral infections, influenza and in pediatric practice.

Without prescriptions

Pharmaceutical companies offer many pain medications that can be purchased without a prescription. It should be remembered that self-medication is unsafe, since drugs do not treat the underlying disease, but only relieve symptoms. Over-the-counter medications include antispasmodics and NSAIDs, which are sold at different prices. The most powerful over-the-counter painkillers:

1. Meloflex. Solution for intramuscular injections. Does not affect the progression of the disease. Designed to reduce inflammation, reduce pain.
2. Ketorol. Used to suppress pain syndrome any localization.
3. Papaverine. A good pain reliever for headaches. It has a pronounced antispasmodic effect, so it quickly relieves pain syndromes during menstruation, cystitis, and pancreatitis.

Modern painkillers

In recent years, new generation drugs have been widely used in medicine. These include a group of selective NSAID medications. Their advantage is the fact that they have a selective effect and do not harm healthy organs. Names of modern painkillers:

1. . It is successfully used to treat back pain, relieves inflammation and hyperemia.
2. Flamax. It has antipyretic, anti-inflammatory, antiaggregation effects. Indicated for pain syndromes of various origins.
3. . Prescribed for back pain, postoperative, musculoskeletal and other pain syndromes.

Anti-inflammatory

The group of non-steroidal drugs in the ranking of painkillers is considered the most harmless. The drugs have a powerful anti-inflammatory and antipyretic effect. The name “non-steroidal” emphasizes that, unlike glucocorticoids, they do not contain synthetic steroid hormones. List of known painkillers and anti-inflammatory drugs:

1. Methindol. NSAID, which is more effective for pain syndromes of the spine, joints, after injuries or operations.
2. Nalgesin. Quickly reduces the level of inflammatory hormones in the blood. Prescribed when different types pain syndrome: myalgia, viral diseases, radiculitis and others.
3. . NSAIDs. Indicated for ulcerative colitis, exacerbation of Crohn's disease.

For joint pain

IN complex treatment For joint pain, painkillers are used. Pain in diseases of the musculoskeletal system is often unbearable, so it is impossible to do without medications. The most effective painkillers for joint pain belong to the pharmacological group NSAIDs:

1. Koksib. Available in capsules. The medicine works best in the treatment of osteoarthritis and arthritis.
2. Arcoxia. Prescribed for the symptomatic treatment of osteoarthritis, ankylosing spondylitis, gouty arthritis. The drug is effective after dental surgery.
3. Brufen. Indicated for damage to tendons and ligaments, inflammation of joints of various origins, feverish conditions, lumbago, after sports injuries and accidents.

For back pain

WITH painful sensations every person faces in the back. Modern pharmaceutical industry does not stand still, and every year produces the most effective medications that help fight pain. Popular painkillers for back pain:

1. Revmador. A strong pain reliever from the group of non-narcotic analgesics. Used when degenerative diseases of the spine and joints are accompanied by pain.
2. Finalgel. Classification – NSAIDs. Created for local application during inflammatory diseases joints and back, sprains, injuries (closed) of the musculoskeletal system.
3. Fentatine. Narcotic drug used for treatment unbearable pain. Available in the form of crystalline powder. Intended for subcutaneous injections.

For oncology

For cancer conditions, medications are prescribed that can relieve pain caused by tumor growth or cancer treatment. Begin therapy with non-narcotic analgesics, then move on to weak or (if necessary) strong opionates. The main painkillers for oncology:

• anti-inflammatory: Aspirin, ;
• steroids: Dexamethasone, Prednisolone;
• Type 2 inhibitors: Celecoxib, Rofecoxib;
• opiates: Morphine, Hydromorphone.

Use of painkillers

You should not take pills for every pain syndrome. You can often do without medication, for example, when you have a headache after sleep or mild abdominal cramps during menstruation. The use of painkillers is justified when the cause cannot be eliminated, because they have temporary effect. Uncontrolled use of medications leads to either health problems or addiction. If a doctor has prescribed painkillers, then they must be taken according to the regimen he prescribed.

Price

Medicines that relieve pain are now easy to find in any pharmacy. It’s another matter if you need expensive and not very popular drugs. Then you can order them from the catalog and buy them in the online store. In this case, the drugs may be even cheaper. Approximate price for painkillers:

Name	Quantity	Manufacturer	Price in rubles
Analgin tablet. 500 mg
Ketorol solution 3% 1 ml.
Voltaren tablet 50 mg		Slovenia
Arcoxia tab. 90 ml

How to choose painkillers

You shouldn't always believe advertising and buy expensive medicines. Often, a time-tested drug is much more effective. Before purchasing a medicine, you must read its leaflet. If the medication is intended to relieve joint pain, it will not help with migraines. The question of which painkiller is better is not correct, since each type of medicine relieves a specific problem. In addition, any type of analgesics should not be taken for a long time or frequently. This leads to stomach ulcers and intestinal problems.

Anesthesiology and resuscitation: lecture notes Marina Aleksandrovna Kolesnikova

2. Analgesic drugs

Analgesic ( acetylsalicylic acid, paracetamol, morphine) is a drug that reduces pain of various origins. Medicines that reduce pain provoked only by a specific causative factor, or eliminate a specific pain syndrome, for example, antacids, ergotamine (migraine), carbamazepine (neuralgia), nitroglycerin (angina), are not classical analgesics. Corticosteroids suppress the inflammatory response and the resulting pain, but despite their widespread use for these purposes, they also do not represent classical analgesics.

Analgesics are classified into narcotic, acting on the structures of the central nervous system and causing drowsiness, such as opioids, and non-narcotic, acting mainly on peripheral structures, for example, paracetamol, acetylsalicylic acid.

Additional agents that enhance the effect of analgesics

Drugs in this group are not analgesics in themselves, but for pain they are used in combination with analgesics, as they can change the attitude towards pain, its perception and level out anxiety, fear, depression (tricyclic antidepressants can even cause a decrease in the patient’s need for morphine in terminal state). Such drugs can be psychotropic drugs, as well as those affecting the mechanisms of pain, for example, eliminating spasm of smooth and striated muscles.

Narcotic analgesics – herbal and synthetic products, selectively reducing the perception of pain, increasing pain tolerance as a result of reducing the emotional coloring of pain and its vegetative accompaniment, cause euphoria and drug dependence. Narcotic analgesics reduce the conduction and perception of pain only within the boundaries of the central nervous system, suppressing mainly the nonspecific pathway. Drugs in this group excite opiate receptors and create an effect similar to the effects of peptides of the antinoreceptive system. Therefore, the main mechanisms of pain relief are the following: a disorder in the conduction of the pain impulse from the axon of the first neuron, the body of which is located in the spinal ganglion, to the second neuron, located in the gelatinous substance of the dorsal horns of the spinal cord. Suppression of summation of subthreshold impulses in the thalamus. Decreased participation in the pain reaction of the medulla oblongata, hypothalamus, limbic system (non-emphasized attitude towards pain).

Classification of narcotic analgesics and their antagonists

The classification is as follows.

1. Piperedine-phenanthrene derivatives:

1) morphine;

2) codeine (methylmorphine, 5–7 times weaker than morphine as an analgesic);

3) ethylmorphine (dionine, equal in strength to morphine).

2. Phenylpiperedine derivatives:

1) promedol (3-4 times weaker than morphine);

2) fentanyl (100–400 times stronger than morphine).

3. Diphenylmethane derivatives:

1) piritramide (dipidolor) – equal to morphine;

2) tramadol (tramal) – somewhat inferior to morphine.

4. Agonists-antagonists:

1) opiate receptor agonists and opiate receptor antagonists – buprenorphine (norphine) (25–30 times stronger than morphine);

2) agonists of opiate receptors and antagonists of opiate receptors - pentazocine (Lexir) (2-3 times weaker than morphine) and butorphanol (moradol) (equal to morphine).

Agonists-antagonists cause euphoria and drug dependence much less frequently and weaker than full agonists.

Nalorphine - alone (for example, in case of barbiturate poisoning) and in case of mild morphine poisoning, has an analgesic effect, causes miosis, bradycardia, and aggravates the depression of the respiratory center. In case of severe poisoning with morphine and other agonists, it displaces them from the opiate receptors of the respiratory center and restores breathing. Causes dysphoria, irritability, depression, and impaired focus.

Full opiate receptor antagonists

Naloxone – independent action does not have, is effective as an antidote for poisoning with narcotic analgesics.

Narcotic analgesics should only be used for acute pain for a short time.

Most often used for injuries, burns, myocardial infarction, peritonitis (after the diagnosis has been clarified and the issue of surgery has been decided). Narcotic analgesics are included in lytic mixtures to potentiate anesthesia. Drugs of this group are used for postoperative pain in combination with M-anticholinergics and myotropic antispasmodics. They are prescribed to stop hepatic (pentazocine) and renal (promedol) colic. Chronic pain is a contraindication for prescribing drugs, with the exception of advanced forms of a malignant tumor (dipidolor, tramadol, agonists-antagonists).

Narcotic analgesics are combined with psychotropic drugs to provide special types of pain relief.

Neuroleptanalgesia is pain relief with a combination of fentanyl (strong, lasts 30–40 minutes) and droperidol (mild antipsychotic). Droperidol has a mild sedative effect, relieves emotional reactions and reduces the tone of skeletal muscles. Also important effects of droperidol are antiemetic and antishock. Doses of droperidol - 1: 50. Combined drug - thalamonal. Neuroleptanalgesia is used in low-traumatic operations, in the field of neurosurgery and in cardiology for myocardial infarction, etc. Atalgesia or tranquiloanalgesia - fentanyl in combination with a strong tranquilizer such as sibazone, phenazepam. The main disadvantage is the severe respiratory depression caused by fentanyl and the preservation of consciousness.

From the book Anesthesiology and Resuscitation: Lecture Notes author Marina Aleksandrovna Kolesnikova

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Previous surgery, migraine attack, malignant tumor or fracture - unbearable pain can occur due to various reasons. In such a situation, there will not be enough analgin and folk remedies to make the pain syndrome disappear; it is necessary to select the strongest painkillers.

From severe pain pills will help

Advantages of the tablet form

The advantage of analgesics in tablets over others dosage forms– this is the ease of their use.

Another plus is the absence of local reactions: redness, burning, itching or rash.

Tablets are cheaper - the cost of the tablet form of drugs is slightly higher, this is compensated by the absence of the need to purchase syringes, injection solution and pay for the services of a nurse.

When are painkillers prescribed?

Painkillers are prescribed to people experiencing severe pain. The doctor first conducts an examination, and the test results help determine what is causing the pain.

Analgesics can be prescribed without examination or testing in case of any surgical intervention, be it an appendectomy, reduction of a dislocation, or simple tooth extraction.

Pain requiring analgesics may occur due to the following reasons:

• in the period after surgery;
• for muscle pain, back pain;
• – both in the arms and legs;
• for fractures, bruises and severe sprains;
• for oncology;
• for neuralgia;
• (dysmenorrhea).

At painful menstruation antispasmodics and ibuprofen derivatives are prescribed, and in the later stages of cancer only opioid painkillers help.

Analgesics are used to combat muscle pain

Classification of painkillers

All existing species analgesics are divided into 2 large groups: These are narcotic and non-narcotic. The first direction, which includes 7 different types, has become more widespread.

Pyrazolones and their combinations

“Simple analgesics” include drugs based on pyrazolones, which include the well-known Analgin. The second name of the group is justified - pyrazolones are really simple and very common on the market, but they do not always help get rid of pain.

Analgin is the most famous analgesic

Combined analgesics

Combined painkillers combine the properties of several groups of analgesics. The basis of the drugs is paracetamol, combined with other active ingredients. The properties of a combined analgesic are determined by the groups that it combines: analgesic, anti-inflammatory or antispasmodic action.

The basis of combined analgesics is paracetamol

Antimigraine drugs

NSAIDs are used in the treatment of osteochondrosis

COX-2 inhibitors

Drugs in this group include NSAIDs, but with an important distinctive feature: they do not harm the gastrointestinal tract and, on the contrary, even protect the gastric mucosa. Inhibitors are prescribed to people with peptic ulcers, gastric erosion, and other diseases in which the use of conventional non-steroidal anti-inflammatory drugs is impossible for medical reasons.

Inhibitors are prescribed for stomach ulcers

Antispasmodics

The antispasmodic group of painkillers helps relieve pain by dilating blood vessels and relaxing smooth muscles. Medicines help with spasmodic pain of any nature: during menstruation, migraine or.

Antispasmodics help relieve pain during menstruation

Narcotic analgesics

Opioid or narcotic analgesics are potent drugs, the use of which is justified only in cases of acute and unbearable pain. Medicines suppress the transmission of the pain impulse, and the human brain stops perceiving the pain syndrome, filling with euphoria and comfort. Since narcotic analgesics are addictive, they are sold exclusively by prescription and are prescribed only if painkillers from other groups are ineffective.

List of effective pain relief pills

The principle of operation of most drugs within the same group is similar, but they can have completely different effect on the body.

In the presented list of painkillers you can find both expensive and very cheap drugs. Most of these products can be purchased without a prescription at your local pharmacy.

For inflammatory pain

Eliminates headaches and toothache, severe pain in muscles, bones and joints. They are also effective in pain after injuries and surgery. Pain syndromes of this nature are best treated with non-steroidal anti-inflammatory drugs, as well as analgesics of the combined group.

A drug from the NSAID group, created on the basis of ibuprofen. Nurofen is the most popular drug of all non-steroidal anti-inflammatory drugs, the mechanism of action of which is to block the synthesis of prostaglandins - pain mediators that support the inflammatory response in the body. Nurofen helps with any pain of an inflammatory nature, as well as with migraines, dysmenorrhea and neuralgia.

Nurofen copes with inflammatory pain

Contraindications: age under 6 years, 3rd trimester of pregnancy, severe heart failure, gastrointestinal bleeding, renal failure, ulcer and erosion of the stomach.

Price: 90-130 rubles.

Blue tablets from the NSAID group, used for diseases of the musculoskeletal system, neuralgia and myalgia, dental and tonsillitis, otitis and fever. Like others non-steroidal drugs, Nalgesin relieves pain by blocking the synthesis of prostaglandins.

Nalgesin - effective remedy in pain

Contraindications: gastric erosion or ulcer, inflammation in the intestines, renal or liver failure, gastrointestinal bleeding, increased sensitivity to the drug, pregnancy and breastfeeding, age under 12 years.

Price: 180-275 rubles.

A combined drug based on paracetamol and ibuprofen, it is used for headaches and toothaches, adnexitis, bursitis, injuries and arthritis, and fever. When taking Ibuklin, pain and fever disappear due to inhibition of cycloxygenase and a decrease in the amount of prostaglandins.

Ibuklin is a combination drug

Contraindications: hypersensitivity to components, stomach ulcers, gastric bleeding, age under 12 years, pregnancy and lactation.

Price: 100-140 rubles.

A new drug from the NSAID group, approved for long-term use. Like previous remedies, it relieves fever, pain and inflammation by reducing the amount of prostaglandins in the body. Used for various types inflammatory pain, as well as neuralgia and migraine.

Movalis relieves pain and inflammation

Contraindications: age under 16 years, pregnancy, lactation, gastric ulcer, hepatic and renal colic.

Price: 550-750 rubles.

For spasmodic pain

Spasmodic pain can occur for various reasons: these include migraine, diseases of the gastrointestinal tract, algodismenorrhea and some other conditions. With such pain syndrome, antispasmodics and complex painkillers with antispasmodic action will help.

Inexpensive and effective tablets from the group of antispasmodics, effective Russian analogue No-shpy. The effect of taking them is achieved by expanding the smooth muscles of blood vessels and internal organs. Used for gastroduodenitis, ulcers, cholecystitis, liver and renal colic, dyskinesia biliary tract, colitis and proctitis, intestinal colic and flatulence, dysmenorrhea, as well as during strong contractions during childbirth.

Drotaverine belongs to the group of antispasmodics

Contraindications: hypersensitivity to the active substance, severe heart failure, age under 12 years, arterial hypotension.

Price: 40-80 rubles.

An antispasmodic used for pain during menstruation, migraines, as well as for spasms of the gastrointestinal tract, intestinal and biliary colic. Approved for long-term use and has virtually no contraindications. This remedy relieves pain by releasing ionized calcium into smooth muscle cells, which expands smooth muscle and stops spasms.

Sparex is approved for long-term use

Contraindications: age under 12 years, hypersensitivity.

Price: 300-370 rubles.

A complex analgesic consisting of an NSAID, an antispasmodic and an enhancing substance. The analgesic effect is achieved by inhibiting prostaglandins and reducing the release of calcium into smooth muscle cells. Eliminates spasmodic pain in as soon as possible, used for diseases of the gastrointestinal tract, algodismenorrhea, and pyelonephritis.

Spazmalgon is a complex drug

Contraindications: renal and liver failure, prostate adenoma, glaucoma and tachyarrhythmia, anemia, leukopenia.

Price: 190-255 rubles.

For oncology

In later stages of development malignant neoplasm the pain can become unbearable. Only the strongest painkillers, which cannot be purchased without a doctor’s prescription, can help get rid of it.

Smooth green tablets belonging to the class of NSAIDs. Ketanov is the most powerful analgesic among non-steroidal anti-inflammatory drugs, the effect of which is achieved due to a sharp decrease in the amount of prostaglandin in the body, and is comparable to narcotic painkillers. The drug is used for postoperative, postpartum and dental pain, arthrosis, oncology and injuries.

Ketanov is a strong analgesic

Contraindications: age under 16 years, stomach and intestinal ulcers, gastrointestinal bleeding, bronchial asthma, kidney disease, concomitant use with other NSAIDs.

Cost: 80-145 rubles.

Promedol

Centrally acting narcotic painkiller. It disrupts the transmission of pain impulses and also changes the perception of pain in the brain. It is actively used not only for oncological diseases, but also after surgery, with peptic ulcer and chronic pancreatitis, myocardial and pulmonary infarction, prostatitis, renal and hepatic colic, neuritis, burns and injuries.

Features of the drug Promedol

Contraindications: age under 2 years, arrhythmia, hyperthyroidism, hypersensitivity to components, alcoholism, seizures, asthma.

Price: 180-220 rubles.

Opioid analgesic type drug. A powerful and fast-acting drug that relieves pain in a matter of minutes. The analgesic effect of Tramal is associated with blocking the conduction of pain impulses and with a distortion of the emotional perception of pain. It is used for injuries, after operations and other painful medical procedures, for pain during myocardial infarction and for oncology.

Tramal is an opioid pain reliever.

Contraindications: age under 16 years, pregnancy, breastfeeding, renal failure, epilepsy.

Cost: 350-420 rubles.

Painkillers during pregnancy

During pregnancy and lactation, it is necessary to carefully select an analgesic so that the negative effect of the drug does not affect the fetus. There are few painkillers approved for use during pregnancy and breastfeeding due to the large list of side effects.

There are 2 safe active ingredients that can be used to relieve pain during this period:

1. Paracetamol and modern drugs created on its basis. The use of three tablets per day is allowed, the maximum duration of use is 3 days.
2. Drotaverine and No-shpa. You can take no more than 1 tablet per day, and no longer than 3 days in a row.

No-shpa can be taken during pregnancy

Pain tablets for children

Children's bodies are very sensitive to side effects medications, so you should be especially careful when choosing analgesics for children. There are no absolutely harmless painkillers, but there are good and effective analgesics that can be taken at a young age.

List of painkillers approved for children:

1. Paracetamol and its derivatives. Preferably in the form of soluble effervescent tablets.
2. Preparations based on ibuprofen: Nurofen, Ibufen, MIG and others. Only if the child does not have chronic diseases Gastrointestinal tract.
3. Antispasmodics and combination drugs based on ibuprofen and drotaverine. No more than a tablet per day.
4. Preparations based on nimesulide, such as Nimesil, Nimulid and Nimegesic, if the child is over twelve years old.

Painkillers help fight the syndrome, but are not able to destroy the root cause. To get rid of pain forever, you need to understand why it occurs and undergo the necessary course of treatment. Painkillers – good helpers in the treatment of pain, but you cannot rely on them alone.