疼痛relief medications

也称为止痛药或镇痛药

易于阅读的有关缓解疼痛药物的信息。

可以根据其工作方式将疼痛或止痛药的药物分为不同的类别。以下是常见止痛药的摘要。

疼痛类型relievers

Common pain relievers 描述
Paracetamol 扑热息痛用于治疗轻度至中度疼痛。
  • It acts mainly in your brain and has an effect on many different ways you feel pain.
  • It is a mostly safe and useful medicine if it is taken at the correct dose and can be effective for many different types of pain.
  • For most types of acute or short-term pain, paracetamol is best used when needed, only when you feel pain. However, for some types of chronic or long-term pain, taking paracetamol at regular times (every 6 hours) is likely to be most helpful.
  • 阅读更多有关paracetamol。
非甾体类抗炎
 NSAIDs are used to reduce mild-to-moderate pain and inflammation (swelling).
  • They work by blocking and reducing enzymes and hormones that cause pain and swelling in your body.
  • NSAID可用于短期疼痛，例如受伤或症状大肆刺激。
  • NSAIDs are not suitable if you have stomach problems because they may cause stomach bleeding. They may also not be suitable if you have asthma, heart, liver or kidney problems.
  • Before taking NSAIDs, check with your pharmacist or doctor whether they are suitable for you.
  • NSAIDs are also available as gels or creams that can be massaged onto the painful area.
  • NSAIDs may not be useful for chronic or long-term pain as they treat inflammation and this is not often the cause of chronic pain. If they are used long-term they can have harmful side effects.
  • If long-term NSAIDs are thought to be your best option, you will need to have blood tests and regular check-ups with your doctor.
  • 阅读更多有关NSAIDs。
Opioids Opioids can be used for moderate-to-severe short-term pain such as after an injury or surgery, or for ongoing pain due to cancer.
  • 不建议他们用于其他类型的持续疼痛（例如神经疼痛），因为它们不能极大地改善疼痛水平或帮助您能够做自己想做的事情。
  • In about 20–30% of people, they can cause unpleasant side effects, such as constipation, nausea, dizziness and sleepiness. Ongoing use can lead to dependency and addiction.
  • Codeine, dihydrocodeine and tramadol are weaker opioids for moderate pain, while morphine and oxycodone are used for more severe pain.
类固醇
  • Prednisone
  • Triamcinolone
  • Dexamethasone
 Some steroids are used for pain relief by reducing swelling and inflammation when other pain relievers are not effective alone or are not suitable.
  • They may provide short-term pain relief, but do not improve joint function or stiffness.
  • They are most useful for treating flare-ups of pain.
  • These types of steroids may be given as tablets or an injection directly into a painful joint.
抗抑郁药
 三环抗抑郁药通常用于治疗抑郁症，但低剂量可以缓解某些类型的慢性疼痛，例如神经疼痛。还发现它们可以改善睡眠并帮助放松。
  • To work effectively, tricyclic antidepressants must be taken every day, even when you do not have pain. Taking them only when you need pain relief will not work as well.
  • 你的医生会你低剂量and increase the dose slowly if you need it.
  • 抗抑郁药do not start working immediately — it can take a few days for you to notice the pain relief effects.
  • If tricyclic antidepressants help your pain, you can continue to take them for as long as you need to, but do not take any more than the amount prescribed without talking to your doctor first.
  • If you do not feel any improvement in your pain after 6–8 weeks, speak to your doctor.
  • Many people experience side effects with tricyclic antidepressants, including drowsiness, constipation and dry mouth. If these are troublesome, talk to your doctor.
Gabapentinoids
  • Gabapentin和Pregabalin可以为某些神经疼痛的人提供缓解疼痛。他们不适合所有人。
  • To work effectively, gabapentinoids must be taken every day, even when you do not have pain. Taking them only when you need pain relief will not work.
  • 你的医生会你低剂量and increase the dose slowly, to allow your body to get used to the medicine.
  • It can take a few weeks for you to notice the full pain relief effects of gabapentinoids.
  • If gabapentinoids help your pain, you can continue to take them for as long as you need to.
  • If you do not feel any improvement in your pain after 6–8 weeks, speak to your doctor.
  • Do not stop taking these suddenly without your doctor's advice.

Which pain reliever?

The choice of pain relief medication can depend on many things, such as the type, severity and cause of your pain, other medications you may already be taking, any allergies you may have and other conditions you may have.

Type of pain

急性疼痛

急性疼痛usually occurs because of surgery, injury or infection, such as a dental infection or bone fracture (break). It often comes on quickly, lasts for a short time and goes away as the underlying cause resolves. Treatments usually only need to be given for a short time while the injury is healing.

  • Paracetamol and NSAIDs are commonly used.
  • Opioids are useful and usually only need to be given for a few days. The dose of opioid should be reduced as healing occurs.
  • 阅读更多有关acute pain。
Chronic pain

Chronic pain, also called persistent pain or long-term pain, is pain that lasts longer than 3 months. It is often described as pain that does not go away as expected after an injury or illness.

  • Chronic pain is thought to occur when nerves become over-sensitive and send warning messages to your brain even when there is no injury, or the original injury causing pain has healed. In other words, the fire has been put out, but the fire alarm is still going off.
  • Chronic pain is complex and can be difficult to treat. The aim of treatment is to find ways to support you and reduce the impact of the pain on your life.
  • Medicines generally, and opioids in particular, are often not very effective for chronic pain because they do not greatly improve chronic pain levels or帮助您能够做自己想做的事情。However, medication can be used in some situations alongside other strategies, such as physiotherapy, exercise, diet, relaxation, different ways of thinking and responding to pain (mindfulness and cognitive behaviour therapy), or other non-medicine treatments such as electrical stimulating techniques (TENS machine) and acupuncture.
  • 阅读更多有关chronic painandmedicines for chronic pain。
Nerve pain

神经疼痛是导致神经或神经系统受伤的一种慢性疼痛。神经疼痛的类型包括椎间盘脱垂的坐骨神经痛，脊柱手术后神经损伤，感染后的疼痛，如带状疱疹，患有糖尿病的疼痛，截肢后的疼痛（Phantom Limb Pain或Stump Pain）以及多发性硬化症或中风的疼痛。

  • 用于治疗神经疼痛的药物包括三环抗抑郁药（阿米替林，诺替林林）和加巴喷丁素（Gabapentin，pregabalin）。
  • 如果这些药物帮助你的痛苦,你可以继续e to take them for as long as you need to. If you do not feel any improvement in your pain after 6–8 weeks, speak to your doctor.
  • 阅读更多有关神经疼痛。

Severity of the pain

疼痛通常分组为轻度疼痛，中度疼痛或剧烈疼痛。控制疼痛的逐步或梯子方法是基于疼痛的严重程度。这是一种三步的方法。

  • Step 1: Mild-to-moderate pain
    This type of pain is best treated with paracetamol, ibuprofen and other NSAIDs. Read more aboutparacetamolandNSAIDs。
  • 步骤2：中度至重度疼痛
    更激烈的疼痛是用轻度阿片类止痛药治疗的可待因and曲马多。这些可以与扑热息痛或NSAID一起使用。
  • Step 3: Severe pain
    Severe pain is treated with strong opioids such as morphine and oxycodone. These may be used together with paracetamol or NSAIDs. Read more aboutopioids。

(Image courtesy ofBPAC)

Cause of the pain

根据疼痛的原因和部位，您可能需要使用其他事情来缓解疼痛。

  • R.I.C.E.可以解释肌肉扭伤（休息，冰，压缩和高程）。
  • 消化不良引起的疼痛可能会被抗酸剂缓解。
  • If you have migraine headaches, you may need to take triptan medicines, a special type of painkiller for migraine headaches. They're thought to work by reversing the changes in the brain that may cause migraine headaches.

Read more:Where’s your pain?

Medical conditions

Some types of pain medication can worsen some medical conditions and should be avoided. For example, NSAIDS can make stomach ulcers worse, so if you have a history of stomach ulcers, you should avoid them. NSAIDs must also be used with caution by older adults and people with heart disease, type 2 diabetes or kidney problems.

Medications you are taking

Before taking medication for pain relief, it is important to ask if these may interact with medications that you are already taking for another condition. If you are unsure, check with your doctor or pharmacist.

Allergies

某些过敏可能会阻止您服用某些类型的缓解疼痛药物。例如，NSAID会对某些人引起过敏反应。服药后不久，您可能会出现潮红，发痒的皮疹（荨麻疹），被阻塞和流鼻涕和哮喘（有时是严重）。如果您患有荨麻疹（荨麻疹），鼻息或哮喘，与没有这些条件的人相比，NSAID过敏的风险要高得多。

What can I do to make sure I'm taking my pain relief medication safely and effectively?

向您的医生或药剂师咨询建议或阅读非处方药的包装。这将有助于减少服用这些药物的风险。您也可以比较利益和风险of commonly used painkillers.

References

  1. 管理初级保健急性疼痛的原则BPAC, NZ, 2018
  2. Prescribing gabapentin and pregabalin: upcoming subsidy changesBPAC, NZ, 2018
  3. Managing patient with neuropathic painBPAC, NZ, 2018
  4. 帮助病人应对慢性良性pain: it's not about opioidsBPAC, NZ, 2014
学分：药剂师Sandra Ponen。评论者：奥克兰药剂师安吉拉·兰比（Angela Lambie） Last reviewed: 26 Jun 2018