Synopsis

One of the greatest services doctors can do their patients is to acquire skill in the management of pain.

• Pain: the phenomenon of pain; clinical evaluation of analgesics; choice of analgesics; treatment of pain syndromes; spasm of smooth and striated muscle; neuralgias; migraine

• Drugs in palliative care: symptom control; pain

• Narcotic or opioid analgesics: agonists, partial agonists, antagonists; morphine and other opioids; classification by analgesic efficacy; opioid dependence; opioids used during and after surgery; opioid antagonists;

• Non-narcotic analgesics (NSAlDs): see Ch. 15

tissue damage, or described in terms of such damage.1 It is mediated by specific nerve fibres to the brain where its conscious appreciation may be modified by various factors.

The word 'unpleasant' comprises the whole range of disagreeable feelings from being merely inconvenienced to misery, anguish, anxiety, depression and desperation, to the ultimate cure of suicide.2,3

• Analgesic drug: a drug that relieves pain due to multiple causes, e.g. paracetamol, morphine. Drugs that relieve pain due to a single cause or specific pain syndrome only, e.g. ergotamine (migraine), carbamazepine (neuralgias), glyceryl trinitrate (angina pectoris), are not classed as analgesics; nor are adrenocortical steroids that suppress pain of inflammation of any cause.

• Analgesics are classed as narcotic (which act in the central nervous system and cause drowsiness, i.e. opioids) and non-narcotic (which act chiefly peripherally, e.g. diclofenac).

• Adjuvant drugs are those used alongside analgesics in the management of pain. They are not themselves analgesics, though they may modify the perception or the concomitants of pain that make it worse (anxiety, fear,

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