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An Imperfect Arsenal

By Rachael Moeller Gorman // Spring 2007

 

DRUG TYPE

PAIN TARGET

HOW IT WORKS

POSSIBLE SIDE EFFECTS

OPIATES:
include morphine, codeine, oxycodone
Nociceptive, inflammatory; some neuropathic, idiopathic pain relief Activates the mu-opioid receptor system Drowsiness, nausea and vomiting, constipation, dependence
Nonsteroidal anti-inflammatory drugs (NSAIDS):aspirin, ibuprofen, naproxen
Inflammatory pain Dampens the body’s inflammatory response by inhibiting COX-2 enzyme (COX-1 is inhibited as well) Ulcers because of COX-1 inhibition, gastric hemorrhage, Reye’s syndrome in children (aspirin)
COX-2 inhibitors:
celecoxib
Inflammatory pain, especially arthritis An NSAID; inhibits only COX-2 enzyme With long-term use, possible increase in risk of heart attacks and stroke
Paracetamol/ acetaminophen
Mild acute pain Activates cannabinoid receptors Liver damage
Anticonvulsants: carbamazepine, pregabalin, gabapentin, lamotrigine Some neuropathic and idiopathic pain Dampens the excitability of the central nervous system Dizziness, drowsiness, vomiting
Tricyclic antidepressants: amitriptyline Some neuropathic and idiopathic pain Inhibits reuptake of certain neurotransmitters Vomiting, drowsiness, anxiety, insomnia, headaches
Serotonin/ Norepinephrine Reuptake Inhibitors (SNRIs): duloxetine Some neuropathic and idiopathic pain Inhibits reuptake of certain neurotransmitters Upset stomach, nausea, dry mouth, constipation
Drug Mixtures: acetaminophen + oxycodone = Percocet; hydrocodone + acetaminophen = Vicodin Moderate acute pain Travels various pathways to attack pain Various, depending on mixture