Besides these two types of analgesics there are also other medications like aspirin and particular non-steroidal anti-inflammatory drugs (NSAIDS) that are commonly included and used as painkillers, but in fact they;re not. They provide some pain relieving effects but their primary purpose is elimination of inflammations, so including them to the class of analgesics is wrong.

Non-narcotics

Of all over-the-counter, non-narcotic painkillers the most popular is definitely acetaminophen. It is found in over 600 drugs, combined with other active elements for example in cold, flu or sinus infection medications. It is also available as a stand-alone drug. So when using it make sure you are not exceeding the dosage by combining it with drugs that contain acetaminophen, because an increased intake of this substance may damage your liver.

Narcotics

There are two main types of narcotic painkillers: opiates and opioids (substances derived from opiates). Opiates are the active chemicals that are contained in opium (the infamous liquid of white color that is extracted from the unripe seeds in poppies).

Opiates were previously widely used in medicine prior to the creation of effective opioids. But apart from analgesics effects the opiates provided, there were numerous side-effects that are very common for narcotics: delirium, hallucinations, loss of orientation, etc. This is why the use of painkillers in early days was quite limited and the effectiveness was traded for a certain price.

Opioids are considered any substance that affect the opioid receptors in the CNS (central nervous system) or gastointestinal tract. Opioids are usually divided into four main groups:

• Endogenous opioid peptides (substances produced within the human body such as endorphins, enkephalins, dynorphins)
• Opium alkaloids (thebaine, morphine, codeine)
• Partially-synthetic opioids (heroin, hydrocodone, hydromorphone, nicomorphine)
• Fully synthetic opioids (demerol, tramadol, methadone, propoxyphene, buprenorphine, butorphanol)

Opioids are applied as highly effective painkillers in cases of chronic or severe pain (for example, tramadol is known as the most effective medication is case of chronic pain). In contrast to opitates, opioids don’t have the negative narcotic side-effects and also don’t exhibit an upper limit in dosage. If increased gradually (especially in cases of chronic pain) the dosage of opioids used can be that high that it would be fatal for a person if taking any other medications with such concentration.

There are numerous discussions on the addictive nature of opioids, with many doctors claiming that they can form a habit over the long term. This is true, and as with any habit there may be withdrawal effects taking place in case the treatment is ceased immediately. However, when using opioids you have to weight all the pros and cons especially when you’re dealing with chronic pain, like in the case of arthritis. Is addiction such a high price for a relief when you’re constantly tortured by pain? It’s up to you to decide.

The research shows that a range of treatments not relying on medication produces good results. This includes massage and rehabilitation therapy designed to keep muscle tone and get the body moving again after injury or disease has reduced mobility. The benefits come both from the physical work done by the therapist, and also from the supportive bond that can develop between the patient and therapist. This can be allied with learning relaxation techniques and rediscovering swimming as an excellent form of exercise for the muscles not relying on joints overcoming gravity. Moving into the fringe world of technology, there is the long-running TENs machine and the newly emerging pulsed magnetic field equipment (which, as yet, does not have FDA approval). Such machines are said to produce significant relief among patients who believe in the power of the machines – not unlike acupuncture which also requires the patient to have confidence in the system. However, the best approach is cognitive behavioral therapy which teaches people how to maximize their mobility within the limitations imposed by the pain.

The point of these therapies is to avoid you becoming too dependent on the pill bottle for pain relief. If at all possible, you should keep drug costs under control and avoid the risk of a habit forming. That said, there are a number of analgesics or painkillers that can help you manage the pain. The strongest are the opiates. These are narcotic and should only be used in short bursts unless you are managing a severe pain following an operation or a terminal condition like cancer. The middle ground is held by opioids like tramadol which have fewer problems of dependence. The strategy is to slowly build up the dosage until you feel the best level of pain relief and the lowest level of side effects – most commonly constipation, nausea, vomiting and drowsiness. The problem with tramadol is that you also slowly build up tolerance, i.e. your body gets used to the drug and it has less effect. If you have been learning how to get a good quality of life with a cognitive behavioral therapist, this is not a problem. You should be phasing out the drug in any event. But if you have not been learning how to cope without medication, you may be tempted to increase the dosage. This is dangerous because you may end up dependent.

Chronic pain can be caused directly by an injury or disease, or it may be a side effect or complication following surgery, caused by drug interactions, etc. Always liking to produce lists, doctors have classified pain into the following categories:

Nociceptive where you feel a sensation in a specific location. This may be somatic and so felt in the joints, bones, muscles and ligaments, or visceral which is felt in the internal organs such as the heart, lungs, liver and kidneys. The latter can be more difficult to localize because the pain simply comes from inside the body.

Non-nociceptive may be neuropathic, i.e. pain generated by the nervous system and not tied to a specific location in the body. When the nervous system is damaged, the messages become more difficult to interpret and the brain is often confused by random effects. The result is unpredictable feelings of tingling, numbness, pins and needles and other unpleasant symptoms. Alternatively, there may be sympathetic pain where the skin and tissue around an injury become unusually sensitive and restrict movement.

No matter which variety of pain you may have, there are a range of analgesics or painkillers available to relieve any suffering. The less powerful drugs are the nonsteroidal anti-inflammatory drugs (NSAIDs) which reduce swelling and inflammation in the joints and elsewhere. The more powerful deal with moderate to severe pain with tramadol being the most commonly prescribed because it is less likely to cause dependence than the opiates. Tramadol works by changing the way in which the neurotransmitters carry messages in the nervous system. Because of this, it is equally effective no matter what the cause of the pain, i.e. localized or arising from the nervous system itself. The messages are not carried to the brain or not clearly interpreted as being pain messages. Thus, you can have a reasonably good quality of life even though the source of the pain remains active in your body.

When the stimulus generates the pain message, it is transmitted to the brain. This depends on the neurotransmitters, yet it is still not certain how everything works together. One thing is clear. Pain is pain, and it does not matter whether it is classified as acute or chronic, i.e. short-term or likely to last a long time. The real difference is that the cause of acute pain is often clear, e.g. you broke a bone, so you know it will heal. But the causes of chronic pain may not be clearly identified. Nevertheless there are a number of approaches to deal with the problem. There are drugs from the pharmaceutical companies. You start with aspirin for the less serious pain and work up to the seriously powerful opiates that will knock you out and kill all but the most severe of pain sensations. The majority of the drugs come in a pill or capsule, but there are also topical creams you can rub on to the affected parts of your body and, in the more extreme cases, there are injectable versions that deliver the drugs close to the point where they will do the most good.

Holding the middle ground is tramadol. This is a opioid, i.e. it has the same general effect as an opiate, but is synthetic rather than produced from a natural substance. This drug is now the first response used by doctors for moderate to severe pain. It’s not completely clear how or why it works except that it affects the levels of neurotransmitters. The brain therefore becomes less aware of the pain. This gives relief and, if the pain is acute, you have greater peace while the cause of the pain is treated and heals. For chronic pain, tramadol is equally effective but there are two issues. The first is you should not take too high a dosage over too long a time. This can be habit-forming. The second problem is psychological. The acute patient knows the pain will stop fairly soon. It is harder to maintain a good quality of life if the pain is chronic.