But pain is perfect misery, the worst Of evils, and, excessive, overturns All patience. (John Milton, 1608-1674, Paradise Lost) tissue damage, or described in terms of such 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 • Analgesic drug: a drug that relieves pain due to multiple causes, . paracetamol, morphine. . | SECTION 4 NERVOUS SYSTEM This page intentionally left blank Pain and analgesics But pain is perfect misery the worst Of evils and excessive overturns All patience. John Milton. 1608-1674 Paradise Lost 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 NSAIDs see Ch. 15 tissue damage or described in terms of such 2 3 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 3 Analgesic drug a drug that relieves pain due to multiple causes . paracetamol morphine. Drugs that relieve pain due to a single cause or specific pain syndrome only . 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 . opioids and non-narcotic which act chiefly peripherally . 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 Pain Pain is an unpleasant sensory and emotional experience associated with actual or potential 1
