Analgesic [Neurosurgery Wiki]

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====== Analgesic ======

An analgesic, or painkiller, is any member of the group of [[drug]]s used to achieve [[analgesia]].

The word analgesic derives from Greek ἀν-, "without", and ἄλγος, "pain".

===== Types =====

Three types of [[pain]] [[medication]]

1. [[Nonopioid analgesic]]

a) [[Nonsteroidal anti-inflammatory drug]]: [[aspirin]], [[ibuprofen]], [[acetaminophen]]

2. [[Opioid]]s

a) agonists

b) partial agonists

c) mixed agonists/antagonists.

3. drugs that are not strictly analgesics, but which act as adjuvants when added to any of the above: tricyclic antidepressants, anticonvulsants, caffeine, hydroxyzine, corticosteroids.

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[[Opiate]]s and [[acetaminophen]] are preferred [[analgesic]] agents, and [[gabapentin]] is a contextual third choice, in neurocritically ill patients. Other agents are rarely prescribed. The discordance in physician self-reports and objective audits suggest that pain management optimization studies are warranted.
((Zeiler FA, AlSubaie F, Zeiler K, Teitelbaum J, Bernard F, Skrobik Y. Analgesia
in Neurocritical Care: An International Survey and Practice Audit. Crit Care Med.
2016 Mar 15. [Epub ahead of print] PubMed PMID: 26983164.)).


Analgesic drugs act in various ways on the peripheral and central nervous systems. They are distinct from anesthetics, which reversibly eliminate sensation, and include [[paracetamol]] (known in the US as acetaminophen or simply APAP), the [[Nonsteroidal anti-inflammatory drug]]s (NSAIDs) such as the salicylates, and opioid drugs such as morphine and oxycodone.

In choosing analgesics, the severity and response to other medication determines the choice of agent; the World Health Organization (WHO) pain ladder specifies mild analgesics as its first step.

Analgesic choice is also determined by the type of pain: For neuropathic pain, traditional analgesics are less effective, and there is often benefit from classes of drugs that are not normally considered analgesics, such as tricyclic antidepressants and anticonvulsants.