“Do you feel pain? Take paracetamol, diclofenic, Ibuprofen, naproxen, piroxicam, mephenamic acid or indomethacin.”  Many people advise other people to take painkiller as they feel pain.

Many people’s experienced to use painkiller to relieve pain without advice from pharmacists or doctors as they feel minor pain.

Even, pharmacists and doctors advised peoples not to take painkiller but people continue to use it irrational.

Some patients who have taken very large amounts of minor painkiller (analgesics) over long periods may develop changes in the kidneys which may lead to renal failure and frequently hypertension.

Paracetamol(acetaminophen)  The deethylated active metabolite of phenacetin,was also introduced in the last century but has come into common use only since 1950.

The central analgesics action of paracetamol is like aspirin,i.e. it raises pain threshold, but has weak peripheral anti-inflammatory component. Analgesic (pain killer) action of paracetamol is additive. Paracetamol is a good and promptly acting antipyretic.

Paracetamol is one of the most commonly used ‘over-the-counter’ analgesic(painkiller) for headache, mild migraine, musculosketal pain, dysmenorrhoea, etc. But is relatively ineffective when inflammation is prominent as in rheumatoid arthritis.

Diclofenic is among the most extensively used painkiller(analgesic); employed in rheumatoid and osteoarthritis, bursitis, ankylosing spondylitis, toothache, dysmenorrhoea, renal colic, post-traumatic and post-operative inflammatory conditions-affords quick relief of pain and wound edema.

Ibuprofen is used as a simple analgesic and antipyretic. It is particularly effective in dysmenorrhea in which the action is clearly due to prostaglandins synthesis inhibition. It is available as an “over-the-counter” drug.

Ibuprofen and its congeners are widely used in rheumatoid arthritis, osteoarthritis and other musculosketal disorders, especially where pain is more prominent than inflammation.

They are indicated in soft tissue injuries, fractures, vasectomy, tooth extraction, postpartum and postoperatively: suppress swelling and inflammation.

Choice of painkiller (analgesic);

Efficacy differences among different painkiller (analgesics) are minor, but they have their own spectrum of adverse effects. They differ quantitatively among themselves in producing different side effects and there are large inter-individual differences. At present painkiller (analgesics) are a bewildering array of strongly promoted drugs. No single drug is superior to all others for every patient. Choice of drug is inescapably empirical.

The cause and nature of pain (mild, moderate, or severe); acute or chronic; ratio of pain: inflammation) along with consideration of risk factors in the given patients (age, concurrent disease and drug therapy, history of allergy) govern selection of the analgesic. Also to be considered are the past experience of the patient, acceptability and individual preference.

Patients differ in their painkiller (analgesics) response to different painkiller. If one painkiller (analgesics) is unsatisfactory in a patient, it does not mean that other painkillers will also be unsatisfactory. Some subjects ‘feel better’ on particular drug, but not on a closely related one. It is in this context that availability of such a wide range of painkiller (analgesics) may be welcomed. Some guidelines are:

  1. Mild-to-moderate pain with little inflammation: paracetamol or low –dose ibuprofen.
  2. Postoperative or similar acute but short-lasting pain: indomethacin, ibuprofen, naproxen, diclofenic, aceclofenic, or meloxicam.
  3. Acute musculoskeletal, osteoarthritic, injury associated pain: paracetamol, ibuprofen, naproxen, ketoprofen or diclofenic.
  4. Exacerbation of rheumatoid arthritis, ankylosing spondlylitis, acute goat, acute rheumatic fever: naproxen, piroxicam, indomethacin, high dose aspirin.
  5. Gastric intolerance to traditional painkiller (analgesic) like, ibuprofen, naproxen, ketoprofen, mephenamic acid,piroxicam, indomethacin or predisposed patients: a selective COX-2 inhibitor or paracetamol. Athritis patients who are dependent on NSAIDS like diclofenic, ibuprofen and have developed peptic ulcer must receive concurrent proton pump inhibitor as gastroprotective .
  6. Patients with history asthma or anaphy-lactoid reaction to aspirin/other NSAIDs (diclofenic, ibuprofen).
  7. Patients with history hypertension or other risk factor for heart attack/stroke: avoid celecoxib, etoricoxib or parecoxib aspirin, ibuprofen, naproxen, ketoprofen, may be used at the lowest dose for shortest period.
  8. Paeditric patients: only paracetamol,aspirin,ibuprofen and naproxen have been adequately evaluated in children- should be preferred in them. Due to risk of Reye’s syndrome,aspirin should be avoided.
  9. Elderly patients: use lower dose of the chosen, NSAIDs like diclofenic, ibuprofen, naproxen, piroxicam, tenoxicam.
  10. Fast acting drug formulation is suitable for fever, headache and other short lasting pain, while longer acting drugs/suatained release formulations are appropriate for chronic arthritic pain.
  11. Pregnancy: paracetamol is safest;low dose aspirin is probably the second best.
  12. Hypetensive,diabetic,ischaemic heart disease,epileptic and other patients receiving long-term regular medication: possibility of drug interaction with NSAIDs like diclofenic, ibuprofen, naproxen, piroxicam, tenoxicam should be considered.







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