Non-opioid analgesics in contemporary treatment of pain

Abstract

Pain is a symptom of most diseases that can significantly impair the patient's quality of life. In many diseases it is impossible to eliminate the cause of pain therefore the real goal of treatment is the removal of pain as a symptom, by application of analgesics. Contemporary pharmacotherapy employs conventional (opioid and non-opioid analgesics - NSAIDs and paracetamol) and adjuvant analgesics (antiepileptics, antidepressants and others). Analgesic effect of non-opioid analgesics is mainly the consequence of prostaglandin synthesis inhibition. They are effective for pain of mild/moderate intensity. In acute pain there is no difference in efficiency between NSAIDs and paracetamol, so the choice of the drug is individual. In chronic pain, when inflammation is present, NSAIDs are more effective than paracetamol. Long-term use of high doses of NSAIDs is often accompanied by side effects. In order to reduce their frequency, a careful assessment of risk for each patient should be made, a drug with a low risk of certain side effects should be chosen, the dose and duration of treatment should be limited and the possibility of topical application should be considered. The need for long-term use of NSAIDs should be reviewed periodically.

Bol je simptom većine oboljenja koji može značajno narušiti kvalitet života pacijenta. Kod mnogih oboljenja nemoguće je otkloniti uzrok bola, stoga je realni cilj lečenja uklanjanje bola kao simptoma, primenom analgetika. Savremena farmakoterapija raspolaže klasičnim (opioidni i ne-opiodini analgetici: NSAIL i paracetamol) i adjuvantnim analgeticima (antiepileptici, antidepresivi i drugi). Analgetičko dejstvo ne-opioidnih analgetika uglavnom je posledica inhibicije sinteze prostaglandina. Efikasni su kod bola blagog/umerenog intenziteta. Kod akutnog bola nema razlike u efikasnosti između NSAIL i paracetamola pa je izbor leka individualan. NSAIL su efikasniji kod hroničnih bolnih stanja u kojima je prisutna inflamacija, ali njihovu dugotrajnu primenu često prate neželjena dejstva. Kako bi se smanjila učestalost neželjenih efekata NSAIL, treba izvršiti pažljivu procenu rizika za svakog pacijenta, odabrati lek sa niskim rizikom za određeno neželjeno dejstvo, ograničiti dozu i trajanje tretmana i razmotriti mogućnost topikalne primene. Potrebu za dugotrajnom primenom NSAIL treba povremeno preispitivati.