NCM-212-Pain Reliever & Anti-Inflammatory
Drugs
Prepared by: Kristine Kaye J. Camin
PAIN RELIEVER AND
ANTI-INFLAMMATORY DRUGS
Pain is a normal feature of the human
experience.
Caring for someone with a life-
threatening illness requires a careful
and thorough evaluation, or
"assessment," of their pain and other
symptoms.
It is important when assessing pain to
understand exactly what pain is. There
are several different categories of pain.
Pain can be acute (of recent onset) or
Chronic. It can be localized, or it can be
diffuse.
o Localized pain- Somatic pain is
often localized to a particular
area. It is constant and
stimulated by movement. Pain in
the pelvis, headaches, and cuts
to the skin all fall under somatic
pain.
o Diffused pain- means
"widespread" and refers to pain
that is more or less all over, or at
least in many areas.
There are several ways in which pain is
generated as well, with these
mechanisms leading to different
experiences of pain.
The important thing to remember is
that pain is always what the person
experiencing says it is, occurring when
and where they describe it.
To give us an overview of
understanding its complexity,
pathways, and physiology,
DRUGS USED TO MANAGE PAIN
WHAT IS PAIN?
Pain is a general term that describes
uncomfortable sensations in the body.
It stems from the activation of the
nervous system.
• Pain can range from annoying to
debilitating, and it can feel like a sharp
stabbing or a dull ache. Pain can also
be described as throbbing, stinging,
sore, and pinching
.• Acute pain can be mild and last just a
moment, or it might be severe and last
for weeks or months.
NCM-212-Pain Reliever & Anti-Inflammatory
Drugs
Prepared by: Kristine Kaye J. Camin

• Chronic pain is pain that is ongoing cord or brainstem (cranial

and usually lasts longer than six months sensory input), and is ultimately
interpreted in the cortex of the
brain.
THE FOUR MAJOR TYPES OF PAIN:

• Nociceptive Pain: Typically the

result of tissue injury. Common
types of nociceptive pain are
arthritis pain, mechanical back
pain, or postsurgical pain.
• Inflammatory Pain: An abnormal
inflammation caused by an
inappropriate response by the
body’s immune system.
CHARACTERISTICS OF PAIN:
Conditions in this category
include gout and rheumatoid
• Provocation and Palliation: What
arthritis.
were you doing at the onset?
• Neuropathic Pain: Pain caused
What provokes it, what alleviates
by nerve irritation. This includes
it?
conditions such as neuropathy,
• Quality/Quantity: What does the
radicular pain, and trigeminal
pain feel like and how often? Is it
neuralgia.
sharp, dull, stabbing, crushing,
• Functional Pain: Pain without
throbbing, nauseating?
obvious origin but can cause
• Region/Radiation: Where is the
pain. Examples of such
pain located? To be specific,
conditions are fibromyalgia and
point to the location of the pain
irritable bowel syndrome.
or draw it on the diagram. Does
it radiate anywhere? If so, where
PAIN PERCEPTION PATHWAY
and to what side? Is it equal if
both sides are involved? The
• Pain perception is essential to
more specific you can be the
human well-being and survival.
better.
• The sensation of pain originates
• Severity Scale: How much does it
through complex signaling
hurt on a scalefrom1-10?
pathways which begins in the
periphery, ascends in the spinal
NCM-212-Pain Reliever & Anti-Inflammatory
Drugs
Prepared by: Kristine Kaye J. Camin

• Timing: Does the severity or

character of the pain change
based on time of day, activity,
weather, time of year or
position?

PAIN ASSESSMENT

• An overall appraisal of the

factors that may influence
patients experience and

NONOPIOID ANALGESICS
(SALICYLATES)

• Non-opioid analgesics
encompass the non-steroidal
anti-inflammatory drugs
(NSAIDs) and paracetamol
(acetaminophen). The NSAIDs
include acetylsalicylic acid (ASA,
aspirin), dipyrone (metamizole),
expression of pain(McCaffery
and numerous other drugs in
and Pasero 1999) a
diverse classes.
comprehensive process of
• • The NSAIDs have potent anti-
describing pain and its effect on
inflammatory, analgesic and
function; an awareness of the
antipyretic activity, and are
barriers that may affect nurses
among the most widely used
assessment and management of
drugs worldwide.
pain.
• In palliative medicine, they
COMPARATIVE PAIN SCALE
represent the first step of the
CHART (PAIN ASSESSMENT
World Health Organization’s
TOOL)
analgesic ladder used for mild
pain and they are an important
supplement to opioids and
adjuvant drugs at higher steps of
the ladder.
NCM-212-Pain Reliever & Anti-Inflammatory
Drugs
Prepared by: Kristine Kaye J. Camin
• The disadvantages of non-opioid
analgesics include a ceiling
effect for pain relief and the risk
of side effects.
• NSAIDs are also associated with
an increased risk of adverse
gastrointestinal, renal, and
cardiovascular effects, and
hepatotoxicity can result from
overdosing with paracetamol.
DIFFERENCE BETWEEN
SALICYLATES &NON-
SALICYLATES
Salicylates
• useful in pain management
because of analgesic,
antipyretics and anti-
inflammatory effects.
Mechanism of action:
• lower body temperature by
dilating peripheral blood vessels
• -inhibit the production of
prostaglandins
• -makes pain receptors less likely
to send pain messages
• -Aspirin prolongs bleeding time
by inhibiting aggregation of
platelets
Non-Salicylates
• use as aspirin substitute for PT
allergic to aspirin or who
experience gastric upset. drug of
choice in treating children with
fever and flu-like symptoms.
Mechanism of action:
• doesn't possess anti-
inflammatory action, doesn't
inhibit platelet aggregation,
therefore is the analgesic of
choice when bleeding
tendencies are an issue
SALICYLATES ADVERSE
REACTIONS:
• - GI System; gastric upset,
heartburn, nausea, vomiting,
anorexia, GI bleeding
• loss of blood through GI tract
• allergy may manifest in hives,
rash, angioedema,
bronchospasm, anaphylactic
shock
NON-SALICYLATES ADVERSE
REACTIONS:
• skin eruptions, urticaria
• hemolytic anemia
• pancytopenia
• hypoglycemia
• jaundice
SALICYLATE USED FOR:
• Relieving mild to moderate
pain
• Reducing elevated body
temperature
NCM-212-Pain Reliever & Anti-Inflammatory
Drugs
Prepared by: Kristine Kaye J. Camin
• Treating inflammatory
conditions, such as rheumatoid
arthritis, osteoarthritis, and
rheumatic fever
• Decreasing the risk of
myocardial infarction in those
with unstable angina or previous
myocardial infarction
(aspirin only)
• Reducing the risk of transient
ischemic attacks or
strokes in men who have had
transient ischemia of the
brain due to fibrin platelet
emboli (aspirin only). This use
has been found to be effective in
men (and women older
than 65 years of age only).
• Helping maintain pregnancy in
special at-risk
populations (low-dose aspirin
therapy). For example, it
may be used to prevent or treat
inadequate
uterine–placental blood flow.
NON-SALICYLATE USED FOR:
• Treating mild to moderate pain
• Reducing elevated body
temperature (fever)
• Managing pain and discomfort
associated with arthritic
disorders
SALICYLATE DRUGS EXAMPLE:
• Aspirin (Acetylsalicylic
acid)
• Diflunisal
• Magnesium salicylate
• Salsalate
• Acetaminophen
NON-STEROIDAL ANTI-
INFLAMMATORY DRUGS
(NSAIDS)
• Non-steroidal anti-
inflammatory drugs(NSAIDs) are
medicines that are widely used
to relieve pain, reduce
inflammation, and bring down a
high temperature.
• They're often used to relieve
symptoms of headaches, painful
periods, sprains and strains,
colds and flu, arthritis, and other
causes of long-term pain.
• NSAIDS are a group of
chemically dissimilar agents that
differ n their antipyretic,
analgesic, and anti-inflammatory
activities.
• Act primarily by inhibiting the
COX enzymes that catalyze the
first step in prostanoid
biosynthesis
-This leads to decreased PG
synthesis with both beneficial
and unwanted effects
CLASSIFICATION OF NSAIDS:
• Acetates: diclofenac,
indomethacin, sulindac.
NCM-212-Pain Reliever & Anti-Inflammatory
Drugs
Prepared by: Kristine Kaye J. Camin
• Fenamates: mefenamic acid.
• Oxicams: piroxicam.
• Propionates: ibuprofen,
ketoprofen, naproxen.
• Pyrazolones: phenylbutazone.
• Salicylates: aspirin, diflunisal.
NSAIDs should usually be
avoided by people with the
following conditions:
• Peptic ulcer or stomach
bleeding.
• Uncontrolled hypertension.
• Kidney disease.
• People that suffer with
inflammatory bowel disease
(Crohn's disease or ulcerative
colitis)
• Past transient ischemic attack
(excluding aspirin)
• Past stroke (excluding aspirin)
OPIOID ANALGESICS
• Analgesics are a class of
medications designed
specifically to relieve pain.
• They include acetaminophen
(Tylenol), which is available over
the counter (OTC) or by
prescription when combined
with another drug, and opioids
(narcotics), which are only
available by prescription.
• The opioid analgesics can be
used for either short-term or
long-term relief of severe pain. In
contrast, the anti-inflammatory
compounds are used for short-
term pain relief and for modest
pain, such as that of headache,
muscle strain, bruising, or
arthritis.
TYPES OF ANALGESIA
• Paracetamol
• NSAIDS
• Opioids (Weak & Strong)
• Neurophatic Agents
PARACETAMOL
• Paracetamol, also known as
acetaminophen, is a medication
used to treat pain and fever. It is
typically used for mild to
moderate pain relief.
• Good for mild to moderate
pain. Use iv route in severe acute
pain.
• Contraindicated in severe
hepatic impairment, dose reduce
in mild impairment (e.g. 500mg
QDS).
• Generally safe (except in
overdose) and can be used in
pregnancy
NCM-212-Pain Reliever & Anti-Inflammatory
Drugs
Prepared by: Kristine Kaye J. Camin
• Prescribe: Paracetamol 1g four
times a day orally
• Regular is better than PRN as
paracetamol acts in conjunction
with other analgesia (e.g.
opiates) to increase efficacy
HOW DOES PARACETAMOL
WORK?
• Paracetamol seems to work by
blocking chemical
messengers in the brain that tell
us we have pain.
• Paracetamol also reduces fever
by affecting the chemical
messengers in an area of the
brain that regulates body
temperature.
OPIOID ANTAGONISTS
• An opioid antagonist, or opioid
receptor antagonist, is a receptor
antagonist that acts on one or
more of the opioid receptors.
• The two most commonly used
centrally acting opioid receptor
antagonists are naloxone and
naltrexone. Naloxone comes in
intravenous, intramuscular and
intranasal formulations, and is
FDA-approved for the use in an
opioid overdose, and the
reversal of respiratory
depression associated with
opioid use.
THE TWO MOST COMMON
OPIOID ANTAGONIST
MEDICATIONS INCLUDE:
• Naloxone: You can find
naloxone in Suboxone®, a
medication used to treat opioid
addiction as a measure to
discourage misuse. Naloxone is
also used as a rescue medicine
for opioid overdose and is
commonly known by the brand
name Narcan.
• Naltrexone: Some people in
opioid addiction treatment take
naltrexone to block the effects of
opioids. As a result, they don’t
feel the effects of opioids if they
relapse.
• These medicines help many
people with opioid addiction
manage their symptoms or
recover from an overdose.
Medical professionals and non-
medical professionals can use
naloxone to save the life of
someone experiencing an opioid
overdose.
ANESTHETIC DRUGS
• Anesthetic, also spelled
anaesthetic, any agent that
produces a local or general loss
of sensation, including pain.
• Anesthetics achieve this effect
by acting on the brain or
peripheral nervous system to
NCM-212-Pain Reliever & Anti-Inflammatory
Drugs
Prepared by: Kristine Kaye J. Camin

suppress responses to sensory • Indications: The primary

stimulation. The unresponsive
state thus induced is known as
anesthesia.
• General anesthesia involves
loss of consciousness, usually for
the purpose of relieving the pain
of surgery.
• Regional anesthesia is used to
numb only the portion of the
body that will undergo the
surgery. Usually an injection of
local anesthetic is given in the
area of nerves that provide
feeling to that part of the body.
• Local anesthesia involves loss
of sensation in one area of the
body by the blockage of
conduction in nerves.
indication for PCA is the patient
who requires parenteral
analgesia (e.g. severe pain
and/or oral/transdermal/rectal
route not useable)
• Has incident pain or other pain
patterns that are not predictable.
• The patient-controlled
analgesia
(PCA) pump is a computerized
machine that gives you a drug
for
pain when you press a button.
• In most cases, PCA pumps
supply
opioid pain-controlling drugs
such
as morphine, fentanyl, and
hydromorphone.
• The pump is attached to a thin,
flexible tube (intravenous or I.V.

PATIENT-CONTROLLED
ANALGESIA (PCA)
• Patient-controlled analgesia
(PCA) is any method of allowing
a person in pain to administer
their own pain relief.
• The infusion is programmable
by the prescriber. If it is
programmed and functioning as
intended, the machine is unlikely
to deliver an overdose of
medication.