Choice of analgesics


(see also ranking of opioids, p. 338)

Mild pain

• Non-narcotic (nonopioid) analgesics or NSAIDs, e.g. paracetamol, ibuprofen, diclofenac.13 (Ch. 15) Where these fail after using the full dose range, proceed to drugs for:

Moderate pain

• Narcotic (opioid) analgesics, low-efficacy opioids, e.g. codeine, dihydrocodeine, dextropropoxyphene, pentazocine.

• Combined therapy of NSAIDs plus low-efficacy opioid, either as a fixed-dose formulation, which is convenient for acute pain or separately to find the optimum dose of each, which may be preferable for chronic pain though less convenient.

Where these fail proceed to drugs for:

Severe pain

• High-efficacy opioids, e.g. morphine, diamorphine, pethidine, buprenorphine. An added NSAID is useful if there is an additional tissue injury component, e.g. gout, bone metastasis.

12 Based on Twycross R G 1978 In: Saunders Cicely M (ed) The management of terminal disease. Arnold, London. The work of this author contributes much to this chapter.

13 Paracetamol is sometimes not classed as an NSAID because its anti-inflammatory pattern differs substantially from most, i.e. it is central rather than peripheral, as witness its weak anti-inflammatory efficacy in rheumatoid arthritis.

Where these fail proceed to drugs for: Overwhelming acute pain

• High efficacy opioid plus a sedative /anxiolytic (diazepam) or a phenothiazine tranquilliser, e.g. chlorpromazine, levomepromazine (methotrimeprazine) (which also has analgesic effect).

Note: adjuvant drugs (p. 331) may be useful in all grades of pain.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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