Most people are not aware of the adverse effects of painkillers and their categories. Dr Rakesh Gupta, senior consultant, internal medicine, Indraprastha Apollo Hospitals, New Delhi, explains the broad classification and which class of medicines should be avoided for certain patients. “Painkillers, also known as analgesics, are broadly categorised into several classes, each with its own mechanism of action and potential side effects. Understanding these categories is crucial as certain classes can pose significant risks for specific patient populations,” he says.
Broad classification of painkillers
NSAIDs (Nonsteroidal Anti-Inflammatory Drugs): This category includes medications like ibuprofen, naproxen, and aspirin. NSAIDs work by reducing inflammation and relieving pain but can cause gastrointestinal issues such as stomach ulcers, bleeding, and can adversely affect kidney function. Patients with kidney disease should avoid NSAIDs due to their potential to worsen kidney function.
Opioids: These medications, including oxycodone, codeine, and morphine, are potent pain relievers but carry a high risk of dependence, addiction, respiratory depression, and constipation. Long-term use or misuse of opioids can lead to severe health consequences.
Acetaminophen (Paracetamol): Acetaminophen is commonly used for pain relief and fever reduction. While it is generally safer for the stomach than NSAIDs, high doses can cause liver damage. It’s important to adhere to recommended dosages to avoid potential liver complications.
Steroidal anti-inflammatory drugs: These medications, such as cortisone, are potent anti-inflammatory agents used for specific conditions. They are generally reserved for severe inflammation and often administered in different forms, including oral, injectable, or topical.
Adjuvants and alternatives: Some medications like antidepressants, anticonvulsants, or muscle relaxants can also be used in combination with traditional painkillers or as alternatives in specific chronic pain conditions.
Medicines to avoid for certain patients
For patients with kidney disease or impaired kidney function, NSAIDs should be avoided due to their potential to worsen renal function and cause kidney damage. The prolonged use of NSAIDs can lead to reduced blood flow to the kidneys, resulting in acute kidney injury or worsening chronic kidney disease.
What are the safest painkillers one can take and are available OTC?
The safest over-the-counter painkillers that have relatively lower risks and are commonly available include:
Acetaminophen (Paracetamol): It is considered safer for most people when taken at recommended doses. However, exceeding the recommended dosage can lead to liver damage, making it crucial to adhere to the prescribed limits.
Low-Dose NSAIDs: When used sparingly and for short durations, NSAIDs like ibuprofen or naproxen can provide effective pain relief. However, these should be used cautiously and avoided by individuals with kidney disease or those at risk of gastrointestinal complications.
Topical Analgesics: Creams, gels, or patches containing ingredients like lidocaine or capsaicin can offer localised pain relief with minimal systemic side effects.
It is important to consult a healthcare professional before taking any pain medication, especially if one has pre-existing medical conditions or is on other medications.
Understanding the potential risks and benefits of different painkillers helps in making informed choices regarding their usage for effective pain management while minimising adverse effects.
