Types of analgesics

For drugs having analgesic properties and is used in the treatment of pain syndromes of different localization, are a means for the relief of pain associated with a change in pain threshold, the damage (or dysfunction) of the structures of the central and peripheral nervous system - is tramadol, drugs are a class of antidepressants, a group of anticonvulsants . drugs without providing analgesia are also used regularly, but enhancing the analgesic effects of other drugs buy tramadol online. They include muscle relaxants and antispasmodic drugs.

Strong painkillers classification is based on the principle of the separation of drugs in the opioid, non-opioid and combined, including non-opioid and opioid drugs. Other preparations are so-called adjuvant and symptomatic means to achieve the desired effect with minimal side effects, and in less time. The maximum prevalence of non-opioid drugs are obtained, all of which are non-narcotic, they contribute to the free flow of most drugs without prescription in the pharmacy network.

The peculiarity of our country, in contrast to Europe and America, is a less common use of drugs of paracetamol and unreasonably high purpose antispasmodics. Opioid drugs, most of which relates to drugs, are much less common, which is associated with considerable difficulties appointment procedures and accounting traffic in narcotic drugs. However, despite the fact that in our country accounting narcotic drugs complicates their appointment, in the countries of Europe and America-purpose procedure easier, at the same time records and expert evaluation of the social and psychological characteristics of the patient lie on the shoulders of prescribing medication the doctor, including monitoring the level of the drug in plasma, a record of medications used counting vials and so on. A particular subclass of preparations of opioids are potent agents that do not have narcotic properties due to their low narcogene potential (low ability to induce psychological dependence), the account of which is easier, which allows them to be used more widely.

Acute and chronic pain

Pain is just a signal, informing us of the presence of current or potential tissue damage. Depending on the type and kind of pain, pain timing mechanism of the so-called multiple changes of nociceptive transmission that changes the pharmacological media types designated for specific treatment of pain.

If you highlight some of the approaches to the understanding of pain as such, it is necessary to highlight the concept of acute and chronic pain, and the mechanisms of their formation. Acute pain is physiological: it is a signal of danger, informing about local damage. If tissue damage is not too large, then the development of pain is temporary. The mechanism of its formation is simple: develop the activation of peripheral pain receptors (nociceptors or) in damage, is transmitted along the nerves to the posterior horn of the spinal cord, switch to the upward path of the spinal cord and activate the structure of the central nervous system. Reflex response to pain afferent (ascending impulses) is a muscular response (research relationship that evaluates the nociceptive flexor reflex). As a result, people inadvertently removes the damages area from the danger zone, where the damage is applied.

Chronic pain - pain that flows longer period of normal healing, often non-obvious damage. It chronic pain is now a significant social, economic and naturally medical problem.

In this key role played by a specific pathophysiological mechanisms of the type of pain. This occurrence or activation of so-called inflammatory cascade passing through the enzyme cyclooxygenase (COX), which has two isoforms (COX-1 and COX-2), the effect which is associated with both the analgesic effect of NSAIDs which inhibit COX, and with the development of side reactions from the gastrointestinal tract (risk of exacerbations of peptic ulcer or gastritis, mainly related to isoform 1), as well as the possibility of increasing the risk of thrombosis, mostly related to isoform 2.

Changes occur in chronic pain and CNS level: super-strong and long excitation of peripheral nociceptors leads to sensitization of the central notsiogennyh structures that then even a weak signal react pronounced and persistent excitation. Central sensitization mediated inflammatory mediators: for pains - such as tumor necrosis factor α (FNOα), interleukin (IL) 1 and 6, and PGE2. There is a change in the properties of neuronal membranes; in this process, great importance is attached glutamate receptors (NMDA - N-methyl-D-aspartate receptors) and so-called slow calcium channels.

Local inflammation, peripheral and central sensitization are normal adaptive mechanisms necessary for the recovery of damages. At the same time, these changes or modifications are run during the development of chronic pain.

Action painkillersn

The mechanical and ischemic pain develops within nociceptive pain also requires treatment of local pain source to destination and symptomatic treatment may NSAIDs.

Neuropathic pain - in addition to drug therapy causes of pain (eg, use of adequate doses of antiviral drugs for post-herpetic neuralgia), you need a local effect on the source of the pain, if any (for example, the study of the level of compression in the tunnel neuropathy, radiculopathy, the use of local treatments: therapeutic blockades, perineural blockade, epidural and foraminal blockades, muscular blockade during compression of the nerve to the muscle-tendon tunnel), as well as the prescriptions of anticonvulsants and antidepressants groups operating, in addition to the nociceptive structures (perceiving and transmitting the pain) for antinociceptive structures (suppress pain).

Therapy dysfunctional pain may also include the appointment of anticonvulsants and antidepressants, but, in addition, must always be carried out with the participation of specialists in related disciplines, who are responsible for the area of ​​pain (otolaryngologist, dentist, orthodontist when facial pain, for example), and the psychiatrist, whose participation is necessary to assess affective responses to chronic pain.