TYPE OF PAINKILLER

1.Types of painkillers
Opioids (pronounced oh-pee-oyds) were first made from the juice of the opium poppy. But many are now manmade in a laboratory. These are the strongest painkillers and are often the best way of treating cancer pain. You can only get them on prescription from your doctor. Many of these drugs are based on morphine because morphine is the most effective painkiller we have. Used properly, it does not have too many side effects. Very few people are allergic to it or cannot tolerate it. You may worry that you will become addicted to morphine and other morphine based drugs. This is a common fear, but it is highly unlikely. Sometimes you might need very high doses of these drugs to control your pain. It is quite safe to take high doses if you need them. Your nurse and doctor will keep a close watch for side effects. There are different types of opioid painkillers – strong ones and weak ones. Morphine is a strong opioid and codeine a weak one. You are usually started on a weak opioid, and then move on to a stronger one if needed. Non-opioid drugs can be mixed with either weak or strong opioids to give you the best pain relief possible.The different types of opioids are listed below. You may find all this confusing at first. There are not only different types of opioids, but also different preparations of the same drug. For example, there are slow acting and fast acting types of morphine. The opioids most commonly used for cancer pain include
Morphine
Diamorphine
Fentanyl
Buprenorphine(Temgesic or Transtec patches)
Oxycodone
Codeine
MorphineThere are lots of different types of morphine that can be given in different ways, including
An 'immediatae release' liquid or tablet that you take every 2 - 4 hours
A 'slow release' tablet or capsule that you take every 12 hours
A liquid that can be injected into a vein or given through a drip
A liquid that can be given through a small needle under the skin When you start on morphine, you will normally be given the more short acting immediate release type, which you take at least every 4 hours. That way your dose can be adjusted quickly and easily until you are comfortable. Your doctor or nurse will give you instructions on how much morphine to take and when to take it. Their instructions will allow you some flexibility so that you can take enough to control your pain. If the dose you are on is not enough for you, you will probably find that you need to top it up more often than 4 hourly. You keep a note of how much you have and when. Then your doctor can work out how much you need every 24 hours. It is best to have an experienced Macmillan or symptom control nurse to help you through this process. Once you and your nurse know how much morphine you need to get your pain under control, your doctor can give you slow-release tablets containing enough morphine to control your pain for 12 hours. You take these twice a day - morning and night. These are sometimes called ‘sustained release' morphine or 'MST'. The morphine is released slowly from the tablet and controls your pain for long periods. This gives you better pain control and is also more convenient than taking tablets every 4 hours.


Many painkillers are available over-the-counter (OTC; without prescription from a doctor) from pharmacies and shops, allowing patients freedom of choice from a wide range of medications. However, it can often be confusing knowing which painkiller is best for you and most appropriate for your symptoms. The following medications are commonly available OTC for the treatment of pain:
Paracetamol
Aspirin
Ibuprofen
Codeine-containing medications
Generally, which medication to take comes down to individual preference; however, there are some particular patient groups in whom one type of drug may be preferable. For instance, aspirin is not recommended for use in children, or in patients with bleeding disorders; paracetamol is therefore a safer option in these individuals. The most appropriate medication can also depend on the type of pain experienced - aspirin and ibuprofen are ideal for the treatment of pain associated with inflammation (i.e., swelling, such as muscle pain and the pain associated with arthritis). If patients are unsure which medication is right for them, they should always consult their pharmacist or doctor.
Paracetamol
Trade-names include: Beechams, Benylin, Calpol, Disprol, Lemsip, Panadol
Paracetamol is an excellent analgesic (painkiller) and antipyretic (reduces fever), and forms the basis of many common remedies for pain relief and the symptoms of cold and flu (often in a formulation that also contains a decongestant). Available for over 40 years as an OTC medication, paracetamol is a very well-known and popular drug, familiar to most people.
There are many different brands and formulations of paracetamol available, including tablets, capsules, soluble tablets and liquids for children. It is especially popular for use in children, due to its good efficacy and safety profile - paracetamol has a low incidence of gastric irritation compared to some other painkillers. However, with so many reports of paracetamol overdosing in the media, can we really believe it is that safe?
Paracetamol has virtually no side effects when taken at the correct dose. It can be taken by most groups of patients, including the elderly, young, and pregnant women. However, an overdose of paracetamol can result in liver damage. Few symptoms occur in the first few days following a paracetamol overdose, apart from at the most, vomiting and nausea. However, from about 2 days after ingestion, acute hepatic necrosis can occur. If there is a delay in receiving an antidote, this damage may be irreversible and lead to death; however in most cases an antidote will be given in time and the damage to the liver is then reversible (in these cases there is no lasting, permanent damage).
In order to prevent accidental overdoses, paracetamol is no longer sold as bulk packs, and all packs clearly state that the product contains paracetamol. Pharmacists can also advise on whether a product contains paracetamol.
Aspirin
Trade-names include: Anadin, Disprin
Aspirin, one of a class of drugs known as non-steroidal anti-inflammatory drugs (NSAIDs), has been used commercially for over 100 years and has been available as an OTC medication since 1915. In addition to its analgesic (pain-relieving), anti-pyretic (fever-reducing) and anti-inflammatory actions, which make it ideal as a treatment for pain, colds and flu and for arthritis-related pain, new uses are constantly being found for aspirin. This includes the use of aspirin in the prevention of heart attacks and strokes, which is due to its blood-thinning effect. Aspirin is also being investigated in the treatment of some forms of cancer and dementia. It is of no surprise then, that aspirin is often described as being a 'wonder drug'.
However, although aspirin may have a number of benefits, it does also possess some significant side-effects, which include stomach bleeding and other gastrointestinal effects, such as nausea, diarrhoea and vomiting. Caution is advised in elderly patients, who may be more susceptible to its undesirable effects. In addition, aspirin is not recommended for use in children under the age of 16 years, unless it is specifically indicated, due to the slight possibility of developing a rare complication called Reye's syndrome.
While the blood-thinning effect of aspirin may be beneficial in patients susceptible to heart attacks, it can also be an undesirable effect: aspirin is contra-indicated in patients with bleeding disorders. Caution is also advised in patients with asthma, since aspirin has been found to induce asthmatic attacks in patients with the disease.
Ibuprofen
Trade-names include: Advil, Brufen, Nurofen, Proflex
Ibuprofen has been on the market since 1969 as a prescription drug, and has been available OTC since the 1980s: it was the first modern NSAID to be made available in Ireland without prescription. As an anti-inflammatory, it is ideal for treating pain associated with arthritis, as well as other types of pain. Ibuprofen is widely acclaimed as being a safe alternative to aspirin, which is associated with fewer side-effects. Unlike aspirin, it is considered safe for use in children - and in fact, paediatric formulations are available in Ireland that are suitable for babies as young as 3 months. Like aspirin however, ibuprofen is not recommended for use in patients with bleeding disorders, and caution is also advised in patients with asthma. In these groups, paracetamol may be the best alternative painkiller.
Codeine-containing medications
Trade-names include: Codis, Migraleve, Solpadeine
Codeine is an opioid analgesic - and therefore acts in a different way to paracetamol or the NSAIDs. It is only a moderate analgesic however, and as such it is most often used in combination with other agents, such as paracetamol or ibuprofen, in order to increase their effect. Many of these formulations are available OTC.
While codeine increases the analgesic effect of the medication, it is also associated with a number of adverse effects, including gastrointestinal effects - such as constipation, nausea and vomiting, and central nervous system effects - including dizziness, confusion and drowsiness. It is not recommended for use in children.
Taking more than the stated dose of codeine, or taking the medication for a prolonged period of time, may lead to tolerance, psychological and physical dependence. Codeine-containing medications should only therefore be used for short-term pain relief.