Analgesics

Dr Norhisham
 Learning Objectives
Know the different analgesics
Applying the WHO Ladder for
analgesia
 Scope
Introduction on analgesics
Principles of pharmacotherapy
Types of analgesics
Equianalgesic Dosing
Conclusion
 Introduction
Definition of Analgesics
Drugs that are used for pain relief
Principles in Pain Pharmacotherapy

Complete assessment of pain

Choose analgesic based on
cause/mechanism of pain
Consider non-pharmacological
measures
Monitor for side effects
Titrate dose according to response
and side effects
WHO Pain Ladder
 WHO Pain Ladder
Oral route
Clock
Ladder
Individualised
Attention to detail
 Classification of Analgesics
Non-Opioids
Opioids
Adjuvants/Co-Analgesics
 Non-Opioids
Acetoaminophen
Non-Steroidal Anti-Inflammatory
Drugs (NSAIDs)

Useful for
Pain caused by soft tissue and muscle
infiltration
Bone pain
 Opioids
Opioids for mild-moderate pain
Opioids for moderate-severe pain
 Opioids
Factors to consider
Previous opioid exposure
Severity and nature of pain
Age of patient
Extent of cancer, particularly hepatic
and renal involvement
Concurrent disease
 Adjuvants/Co-Analgesics
Corticosteroids
Tricyclic Antidepressants
Anticonvulsants
NMDA receptor antagonists
Neuroleptics
Bisphosphonates
Adjuvants/Co-Analgesics
Equianalgesic Doses
Equianalgesic Doses

TSD - Typical Starting

 Conclusion
Choice of analgesic depends on the
severity, cause and patient factors
Consider risk and benefit to patient
Apply principles of WHO pain ladder
 References
WHO Cancer Pain Relief. 2nd Ed
Healthcare Guideline - Assessment and Management
of Chronic Pain. Hooten et. al. ICSI 2013
Pain- Current Understanding of Assessment
Management and Treatments. NPC & JCAHO
Monograph 2001
Palliative Medicine handbook. 3rd Ed. Ian Back
Management of Cancer Pain. Portenoy. The Lancet
1999
Opioid Equianalgesic Tables- Are they all equally
dangerous? Shaheen et. al. JPSM 2009