Analgesic Medications

What are Analgesics?
Analgesics are medicines that are used to relieve pain. They are also known as painkillers or pain relievers. Technically, the term analgesic refers to a medication that provides relief from pain without putting you to sleep or making you lose consciousness.

Analgesic Pain Relievers
Many different types of medicines have pain-relieving properties, and experts tend to group those medicines that work similarly. Two of the most common groups of pain killers are nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids (narcotics), but there are many more.

Sometimes experts will group analgesics based on their potency, or how strong they are. An example of this is the World Health Organization’s analgesic ladder. This step-wise approach to pain relief recommends non-opioid analgesics such as acetaminophen and NSAIDs for mild-to-moderate pain; weak opioids, such as codeine, dihydrocodeine or tramadol, for moderate-to-severe pain; and stronger opioids, such as oxycodone and morphine, for severe pain.
What are analgesics used for?
Analgesics may be taken to relieve pain that arises from a wide range of conditions, such as:

appendicitis
cancer
congenital conditions such as curvature of the spine
fibromyalgia
gallbladder disease
gastrointestinal disorders
headaches
improper lifting techniques
infection
menstruation
migraines
multiple sclerosis
nerve damage
osteoarthritis
pain syndromes
poor posture
rheumatoid arthritis
sprains
strains
surgery
trauma
toothache
wound cleansing and debridement.

It is important to note that not all analgesics are appropriate for all these conditions.
What are the differences between analgesics?
Analgesics differ in the way they work and, in their potency, (how strong they are). There are also differences in the way they are absorbed, distributed, metabolized, and excreted within the body.

Within the same class of analgesic (for example NSAIDs), there are differences in their likelihood for side effects, potency, and the way they need to be taken (for example, by mouth, applied topically, by injection).

Below, we have listed seven different classes of analgesics:

Analgesic combinations (includes narcotic analgesic combinations)
Antimigraine agents
Cox-2 inhibitors
Miscellaneous analgesics
Narcotic analgesics
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Salicylates.

1. Analgesic combinations, including narcotic analgesic combinations
Description: Contain painkillers in conjunction with other analgesics, or with other substances that enhance the analgesic effect (such as caffeine) or induce sleep or other desired results. Includes narcotic analgesic combinations.

Table: Common analgesic combinations (including narcotic analgesic combinations) available in the U.S.

Generic name
Brand name examples

acetaminophen + aspirin
Excedrin Back & Body

acetaminophen + aspirin + caffeine
Athriten, Excedrin, Goody’s Headache Powders

acetaminophen + butalbital
Bupap, Phrenilin Forte

acetaminophen + butalbital + caffeine
Capacet, Fioricet, Margesic

acetaminophen + caffeine
Excedrin Quick Tab, Excedrin Tension Headache

acetaminophen +caffeine + isometheptene mucate
MigraTen, Prodrin

acetaminophen + caffeine + magnesium salicylate
KneeRelief

acetaminophen + diphenhydramine
Midol PM, Tylenol PM

acetaminophen + phenyltoloxamine
Lagesic, Myophen

aspirin + butalbital + caffeine
Butalbital compound, Fiorinal

codeine + acetaminophen
Tylenol with codeine #3

codeine + acetaminophen + butalbital + caffeine
Fioricet with codeine

codeine + aspirin + butalbital + caffeine
Ascomp with codeine, Fiorinal with codeine

dihydrocodeine + acetaminophen + caffeine
Panlor-DC, Trezix

hydrocodone + acetaminophen
Hycet, Lorcet, Lortab, Norco, Vicodin

hydrocodone + ibuprofen
Ibudone, Reprexain, Vicoprofen, Xylon 10

ibuprofen + diphenhydramine
Advil PM, Motrin PM

naproxen + diphenhydramine
Aleve PM

oxycodone + acetaminophen
Percocet 2.5/325, Primlev, Roxicet, Xartemis XR

tramadol + acetaminophen
Ultracet

2. Antimigraine agents
Description: These medicines are used to relieve the pain that arises from migraine headaches. There are several different classes of drugs that can relieve a migraine such as ergots, triptans, and NSAIDs. Some are available in combination with caffeine (caffeine can enhance the effectiveness of other ingredients and has analgesic properties).

Table: Common antimigraine analgesics available in the U.S.

Generic name
Brand name examples

almotriptan
Axert

dihydroergotamine nasal
Migranal (nasal)

eletriptan
Relpax

ergotamine
Ergomar

ergotamine + caffeine
Cafergot (oral/rectal), Migergot (oral/rectal)

frovatriptan
Frova

naratriptan
Amerge

rizatriptan
Maxalt, Maxalt-MLT

sumatriptan injection
Imitrex, Imitrex Nasal, Onzetra Xsail

sumatriptan + naproxen
Treximet

zolmitriptan
Zomig, Zomig-ZMT

3. Cox-2 inhibitors
Description: Cox-2 inhibitors are a type of nonsteroidal anti-inflammatory drug (NSAID) that specifically blocks COX-2 enzymes. COX-2 enzymes are responsible for releasing prostaglandins after infection or injury. NSAIDs that favor COX-2 enzymes have a higher risk of cardiovascular effects but less gastrointestinal effects.

Table: List of Cox-2 inhibitors available in the U.S.

Generic name
Brand name examples

celecoxib
Celebrex

rofecoxib
Withdrawn because of safety concerns

valdecoxib
Discontinued

4. Miscellaneous analgesics
Description: Miscellaneous analgesics are ones that are unique in the way that they work. An example is acetaminophen, which is still thought to work on cyclo-oxygenase (COX) enzymes, but differently to NSAIDs.

Table: List of miscellaneous analgesics available in the U.S.

Generic name
Brand name examples

acetaminophen
Actamin, Mapap, Tylenol

ziconotide
Prialt

5. Narcotic analgesics
Description: Work by binding to opioid receptors, which form part of the opioid system that controls pain, pleasurable, and addictive behaviors. The main opioid receptor that narcotic analgesics bind to is the mu receptor.

Table: List of common narcotic analgesics available in the U.S.

Generic name
Brand name examples

alfentanil
Generic only

buprenorphine
Belbuca, Probuphine (implant), Subutex

butorphanol (injection)
Generic only

codeine
Generic only

fentanyl
Actiq (lozenge/lollipop), Duragesic (transdermal patch), Fentora (buccal tablet), Sublimaze (injection), Subsys (sublingual spray)

hydrocodone
Hysingla ER, Zohydro ER

hydromorphone
Dilaudid, Exalgo, Palladone

levorphanol
Levo-Dromoran

meperidine
Demerol, Meperitab

methadone
Dolophine, Methadose

morphine
Arymo ER, Duramorph (injection), Kadian, MS Contin

nalbuphine
Nubain

oxycodone
Oxaydo, Oxycontin, Oxyfast, Roxicodone, Xtampza ER

oxymorphone
Opana, Numorphan (injection)

propoxyphene
Discontinued

tramadol
Conzip, Ultram

tapentadol
Nucynta

6. Nonsteroidal anti-inflammatory drugs (NSAIDs)
Description: Block cyclo-oxygenase enzymes which are responsible for the production of prostaglandins.  NSAIDs that favor COX-1 enzymes are more likely to cause gastrointestinal side effects; those that favor COX-2 enzymes have a higher risk of cardiovascular effects but less gastrointestinal effects.

Table: List of common nonsteroidal anti-inflammatory drugs (NSAIDs)

Generic name
Brand name examples

More COX-1 selective*

flurbiprofen
Ansaid

ketorolac (nasal)
Sprix

ketoprofen
Orudis, Oruvail

tolmetin
Tolectin DS

aspirin
Bayer, Aspiritabs

Relatively nonselective

ibuprofen
Advil, Motrin, Genpril, Midol IB, Proprinal

naproxen
Aleve, Flanax Pain Reliever, Midol Extended Release, Naprosyn

Less than 50-fold COX-2 selective*

indomethacin
Indocin, Tivorbex

sulindac
Clinoril

piroxicam
Feldene

mefenamic acid
Ponstel

meloxicam
Mobic, Vivlodex

diclofenac
Cataflam, Voltaren, Zipsor, Zorvolex

celecoxib
Celebrex

etodolac
Lodine

More than 50-fold COX-2 selective

etoricoxib
Not approved in the U.S.

lumiracoxib
Not approved in the U.S

rofecoxib
Withdrawn because of safety concerns

7. Salicylates
Description: These are substances that are found naturally in some plants (such as white willow bark and wintergreen leaves) or derived from salicylic acid. Not all have pain relieving effects, some are used as food preservatives and antiseptics. Those that do relieve pain work in a similar way to NSAIDs.

Table: List of common salicylates with analgesic effects

Generic name
Brand name examples

aspirin
Aspiritab, Bayer

diflunisal
Dolobid

magnesium salicylate
Doan’s Pills

salsalate
Disalcid, Salsitab

Are analgesics safe?
Most analgesics are considered safe when taken for short periods of time and exactly as directed on the packaging or by a doctor. Some analgesics, such as ibuprofen and acetaminophen, are considered safer than others.

Narcotic analgesics and narcotic analgesic combinations have been associated with some serious risks such as respiratory depression (unusually slow and shallow breathing), opioid-use disorder, and potentially fatal overdose. They are potentially addictive and should only be used for certain conditions and under strict monitoring.

NSAIDs have also associated with some serious side effects, such as an increase in the risk of fatal heart attack and stroke. Some NSAIDs, such as diclofenac and celecoxib, are more likely to increase this risk than others and NSAIDs should never be used just before or after heart bypass surgery (coronary artery bypass graft, or CABG). Other NSAIDs, such as ketorolac, aspirin and indomethacin, are associated with a higher risk of gastrointestinal side effects. Most NSAIDs are not suitable for children or adolescents under the age of 18 years. Ibuprofen is the only NSAID approved for children aged three months and older.
What are the side effects of analgesics?
All medicines have side effects but how vulnerable a person is to them depends on several different factors such as age, genetics, kidney function, and gender (see managing common drug side effects)

Narcotic analgesics have many side effects, although people with cancer or terminal illness taking narcotics for long periods may become tolerant to some of these side effects.

Drowsiness, sleepiness, or dizziness is common with most narcotic analgesics. This can affect driving or a person’s ability to operate machinery and perform other hazardous tasks. Alcohol may potentiate these effects. See narcotic analgesics for other commonly reported side effects.

NSAIDs may also cause side effects, especially when used at higher than recommended dosages for long periods of time. Gastrointestinal side effects that may occur include bloating, diarrhea, constipation, irritation of the lining of the stomach, nausea or vomiting. NSAIDs may also affect kidney function and reduce how quickly blood flows through the kidneys. They may cause retention of sodium and water, which can lead to edema and high potassium levels. Occasionally, they may cause more serious damage to the kidneys. See NSAIDs for other commonly reported side effects.

Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Types of Analgesics

Please refer to the drug classes listed below for further information.

analgesic combinations
antimigraine agents
CGRP inhibitors
cox-2 inhibitors
miscellaneous analgesics
narcotic analgesic combinations
narcotic analgesics
Nonsteroidal anti-inflammatory drugs
salicylates

Ref.
https://www.drugs.com/drug-class/analgesics.html