Non opioids pain management Done by Noor Alkhawaja

Non opioids pain management Done by : Noor Alkhawaja

Introduction • Pharmacological treatment of pain : • Opioids • non-opioids • • • adjuvants >> not typically used for pain but may be helpful for its management 1. Antidepressants 2. Anticonvulsants 3. Local anesthetics / antiarrthymics 4. Corticosteroids 5. Botulinum toxin

Paracetamol (acetaminophen) • Mechanism of action : • The exact mechanism is not clear , , it has potent antipyretic & analgesic actions but weak anti inflammatory action so it’s not true NSAID • Appear to inhibit prostaglandins synthesis in CNS , , but in peripheral tissue is poor inhibitor • . Acetaminophen does not affect platelet function or increase bleeding time. It is not considered to be an NSAID.

Pharmacology • Bioavailability >> 63 -89% • Half life >> 1 -4 hrs • Dose >> 3 or 4 grams. • Onset of action >> Pain relief onset by route: By mouth – 37 min Buccal – 15 min Intravenous – 8 min

Therapeutic uses • 1) used for the relief of mild to moderate pain. • 2) fever (drug of choice as antipyretic for children (due to the risk of Reye syndrome with aspirin) • Osteoarthritis ( + NSAID to reduce inflammation). • Low back pain • Headaches • Post operative • Dental pain

Adverse effects • At normal therapeutic doses >> free of significant adverse effects • Patients with hepatic disease >> at higher risk of acetaminophen-induced hepatotoxicity • Paracetamol hepatotoxicity is the most common cause of acute liver failure • N-acetylcysteine is an antidote in cases of overdose

NSAID effect: • Antibiotic. • Analgesic. • Anti-inflammatory.

Diclofenac • known as voultaren. • It is phenyl-acetecic Acid derivated. • It is non selective. • COX inhibitor. • Route of Administration: oral , IM , IV , rectal , topical. • Indicated for management : mild to moderate pain.

• Used to 1) Treat inflammatory disorders especially MSS (Arthritis , RA , OA , AK , Gout). 2) Acute Migraine. 3) Kidney stone , gallstone. 4) Chronic pain associated with cancer. • Common side effect: 1) Vascular and coronary risk as major cardiovascular events increased about third by it. 2) GI adverse event ( bleeding , ulcer ). 3) Acute Kidney failure. Contraindicated in: • Acute peptic ulcer or GI bleeding , severe renal/liver insufficiency , caution in patient with fluid retention or Heart failure , third trimester pregnancy.

Ketorolac • Brand name Toradol. • Is used for short-term management of moderate to severe pain. It is usually not prescribed for longer than five days. • Not for chronic or mild pain. • Effective when administered with paracetamol to control pain in neonates because it does not depress respiration as do opioids. • Used during eye surgery help with pain. Ketorolac is effective in treating ocular itching.

Adverse effects: • MI. • GI bleeding. • Stroke.

Analgesic ladder